Some stories never die. Here we are a decade later still talking about "Crooked Teeth" and the outcome of all those stories that ran on WFAA alleging hundreds of millions of dollars of Medicaid fraud committed by Texas orthodontists and dentists.
Huge story keeps going
Remember the legislative hearings. Remember the introduction of MCNA, DentaQuest and Delta Dental without contract tender. Remember the timely retirements of HHSC executive commissioner Thomas Suehs and Medicaid director Billy Millwee. Remember the mad dog allegations of former Inspector General Doug Wilson and his henchman Jack Stick. Remember the state losing every payment hold case that went before an administrative court. Remember the state alleging $16 million in Medicaid fraud by Dr. Rachel Trueblood and settling the case for $39,000. Remember Jack Stick quitting and Doug Wilson getting fired. Remember the state finally firing and suing ACS/Xerox/Conduent for hiring high school dropouts and janitors to rubber stamp Medicaid orthodontic prior authorization requests. Remember the state settling that $1 billion case for less than a fifth of that to save litigation costs.
Oh, yes, remember the federal audits that put responsibility for the massive Texas spending on Medicaid orthodontia at the feet of state bureaucrats.
We remember those things.
Not much in qui tam awards
Well, the lead whistleblower was Dr. Christine Ellis, a professor of orthodontics at the University of Texas Southwestern Medical School in Dallas who has her own orthodontic practice in Dallas, Ellis Orthodontics. She even testified before a congressional committee in Washington in April 2012 to inform them of the "alleged Medicaid fraud in orthodontic billings by Texas dentists and corporate dental chains," according to a press release on her law firm's website. She also claimed to be one of the whistleblowers uncovering the wrongdoing of Xerox et al.. Odd, that she doesn't mention any of this in her bio on her practice's website. Something to be proud of, no?
Considering the allegations of hundreds of millions of dollars in orthodontic Medicaid fraud that ruined the lives and finances of many of her peers, she must have been rewarded handsomely for her investigative perspicacity.
Not quite.
An open records request to the Texas Office of the Attorney General reveals that Dr. Ellis has received only $574,689.14 in qui tam awards to date with another $25,000 set to be paid out in the near future. As far as Xerox is concerned, no relator has received anything.
Lafountain did almost as well
My goodness, a low-profile, uncredible guy with little dental education like Joshua Lafountain has done almost as well.
Deflection of responsibility from the state
The reason we haven't let this story die is that it is a scam. It has been a scam from the beginning to deflect responsibility from the Texas government for the extraordinary amount of Medicaid orthodontic spending from 2007 to 2011 to Medicaid dentists who weren't supposed to fight back.
If all had gone according to plan, this story would have been buried back in 2012 along with a lot more bankrupt dentists and qui tam awards piled high.
Even the relatively recent summary judgment against Dr. Richard Malouf had nothing to do with falsifying HLD scoring sheets or providing braces to unqualified cases. All the state proved was that his billing number was used incorrectly to bill for cases not done by him. The service was provided by a qualified professional to an eligible patient.
It is important to keep this story alive while there is a story to tell. There is a lot to be said for telling your side of the story and being very public about it when you have been wronged.
This situation has had repercussions on the whole profession of dentistry in Texas and its public perception.
The author’s tone of this article suggests he/she doesn’t believe Ellis caught Richard Malouf with his pants down.
I personally saw the fallout from putting braces on every Medicaid kid with a crooked tooth in front. There’s no way the scores to qualify the kids were not faked.
If I could tell you the number of kids I saw who had to have others like me remove their wires and brackets because the clinics they had been going to were suddenly not open and they couldn’t find the dentists who had been adjusting the wires every month.
The state dental director at the time this all began to unravel, John Roberts, DDS, came to Baylor College of Dentistry where I worked at the time, to beg the orthodontic faculty to help finish cases for all the kids abandoned by the Malouf chain of clinics.
So don’t do revisionist history and say this wasn’t happening or wasn’t any fraud going on because there was!!
Dr. Bolin, after a decade of investigation and litigation, all we are saying is that there has been no criminal or civil judgment proving someone faked HLD scores including Dr. Malouf. In fact, it is the opposite. Dr. Ellis’ attorneys ran the Antoine Dental Center SOAH hearing trial way back in 2013 and failed to prove it. Just one of several such rulings. If this weren’t the case, your allegations would have merit but they just don’t align with the facts. It is unlikely you were ever a Medicaid provider, having been an associate professor. From their point of view, the state ran a “bait and switch” operation. It encouraged providers to take in orthodontic patients and even gave prior authorization for their treatment. The state’s contractor reviewed every request submitted to it and approved it. That approval was supposed to mean something, that the case met the criteria for medical necessity. Ah, but when the heat got too high over the amount being spent by the program (not the cost per patient – a full orthodontic treatment was only $2500), the state, instead of just changing approval criteria or the process, chose to call the dentists fraudsters, ruining reputations and bankrupting many, even though bureaucrats had known for years that the prior authorization process of their contractor consisted of high school dropouts adding up a column of numbers. We have provided documentation on that one on this website. Understandably, Dr. Ellis refuses to take Medicaid patients in her practice.
Orthodontic Theft:
This is a travesty to the entire Dental Profession. I blame the State of Texas for not taking the time to investigate and stop this fraudulent activity. To give all of this money to the so-called “Doctors” just shows how sloppy Xerox and the oversight of our profession is a sham. As a professional, we should abide by our Code of Ethics every day and those that choose to violate them for the almighty $$$ should be, in my opinion, return all the money they scammed and throw them in jail.
Dr. Cohen, the state knew about Xerox’s rubber-stamping of orthodontic prior authorizations for years. But does that make all those prior authorization requests fraudulent? Our point is that no one has proved either widespread falsification of HLD scoring or false billing and there is such a thing as innocent until proven guilty. After a decade, if there had been a landslide of criminal charges/convictions and lost licenses no one could disagree with you, least of all us. The truth of the matter is that a lot of poor children with bad teeth got a lot of good dental work done paid for by the state. Texas spent more than California and New York and a bunch of other states combined. That is the horrible crime. Here is some suggested reading: https://www.tdmr.org/dentists-told-2009-assume-medicaid-ortho-pas-reviewed-board-certified-orthodontist/, https://www.tdmr.org/court-document-shows-altenhoff-and-hhsc-knew-xerox-dental-clerks/, https://www.tdmr.org/no-penalty-or-fine-for-xerox/, https://www.tdmr.org/medicaid-dentists-demanded-who-was-reviewing-orthodontic-pas/
Yes, just because you can “get away with” putting wires on teeth, knowing full well that the case is not a debilitating malocclusion, doesn’t mean you should do it!
Yes the state of Texas, Jerry Felkner as the Doctor who signed off on all those Xerox claims (he says he told Brian Milwee about it but nothing was done), and others who knew should be held accountable.
If Felkner had resigned in disgust, Milwee would have just replaced him with another yes man.
Plenty of blame to go around. No honor among theives.
Dr. Bolin, the definition of ectopic eruption and how it was scored in the Medicaid Providers Manual prior to 2012 allowed many children to qualify for treatment. Administrative court judges in payment hold hearings found this to be the case. There are copies of several rulings on our website – Harlingen Family Dentistry, Antoine Dental Center. The fraud is that HHSC changed the definition in 2012 and OIG attempted to make it retroactive to blame Medicaid dentists for the spending. Do you realize Xerox’s defense in the massive lawsuit filed against them by the state over the prior authorization mess was that HHSC knew everything Xerox was doing and either tacitly approved or refused to pay Xerox the funds necessary to fix it?
I am a dentist licensed in 7 states and a dental reviewer for a well known insurance company and Medicare CCO. It is my responsibility to approve or deny Prior authorizations based upon each case meeting the states criteria for dental / ortho. If I approve cases that do not meet this criteria then I am held responsible. I take my position very seriously, because FWA happens from every possible direction. State directors and workers are not infallible, far from it, and obviously in this case their reviewers were not adequately trained or professionally certified to even approve Prior Authorizations. Why is it that we all know how difficult it is to obtain a license to practice, properly obtain State X-ray certs, pay large tax bills and follow the crazy number of state rules day in and day out to practice, yet as individuals we automatically assume that the State somehow has it together with regard to matters such as this? Have we all not been to a DMV? Where is their accountability? Why are their standards far less than we are expected to have as individual providers or even as insurance companies?
Dr. Ash, your comments are well taken. This is why managed care was brought into Medicaid dentistry in Texas in 2012. The amount of dental fraud they have reported since has been negligible.