MCNA Secret Recoupments Story Touched Raw Nerves with Medicaid Dentists

Our story on MCNA secretly recouping payments from a dentist who had an MCNA pre-approved treatment plan for a young Medicaid-eligible cancer patient touched a raw nerve with a number of dentists from around the state.  The story received a number of comments which we are re-publishing here so that they receive the attention they deserve and are not lost as a side note to the last story.

This outpouring is a stark contrast to our experience of the past few years when dentists were too anxious to comment on stories regarding state payment holds.  Starting in December 2012, it took over a year for someone to leave a comment on one of our articles.

But now that a private contractor is apparently going beyond state law regarding payment holds and ignoring due process (the exact activities that caused the Sunset Advisory Commission to reform the Heatlh and Human Services Commission Office of Inspector General and put into place due process legislation SB 207), they are speaking out.

SB 207 does the following:

Streamlines the credible allegation of fraud (CAF) payment hold appeal process.

• Limits OIG’s ability to place payment holds in cases not involving fraud.
• Shortens timeframes and limits the scope of appeal hearings to more quickly mitigate state financial risks.
• Removes requirements for providers to pay for half of their CAF hold and overpayment hearing costs, consistent with other state hearing procedures.
• Clarifies that “fraud” does not include unintentional technical, clerical, or administrative errors.

We are fairly certain for every comment below, there are 10, 20 or more other dentists in the same boat.

Here are those comments:

hedieh says:

I am not sure what difference we can make unless all the DDS in all states form an organization that can lobby on our behalf. We do so much free work for our Medicaid patients and CHIPs and even their parents because we know that is what our duty is to take care of the community. We have now implemented so much more documentation such as intraoral photos of everything and long narratives, pre and post treatment X-rays, and the pt suffers by being in the chair for so much longer than needed, parents are getting frustrated because they don’t understand why every procedure now takes over an hour or more just. MCNA needs to outline exactly what they want us to do so that there can spend less money on creating GOTCHA issues for all of us who work long and hard hours in an already stressful environment.

Diane says:

This is not at all surprising. I had a meeting this morning with a Houston news network about this very issue. I represent an organization that advocates for quality access to care specifically with providers who participate in the Dental Medicaid program in Texas. Many providers in Houston share this same experience. MCNA has bullied recoupments without explanation along with placing payment holds on an entire practice without notification based on minimal and erroneous findings. Law abiding providers continue to see and treat patients without any information or communication from MCNA. MCNA has also gone so far as to drop a provider from EFT payments without any kind of notification. There have been numerous emails and phone calls to HHSC to meet with us. Yet very little has been done by HHSC to address these outcomes. This is giving DSO’s more power than the OIG based on their tactics. Unfortunately, providers have to cut back on operations and staff while payments holds are sorted through MCNA without the courtesy of a timeframe. Is a credible third party vendor doing their audit sweeps? My lingering question is…. Does MCNA have the financial stability to handle and manage federal dollars? Will the Texas Senate subpoena MCNA to answer for this? Are other providers in different states having these same issues? Is this a financial trend with MCNA to gain interest on the monies that are collected or withheld?

Sally says:

Can I get your contact information so I may speak to you about our own issues with MCNA. I’m actually waiting for them to give me an in-person meeting at their headquarter. Like you have mentioned, there is no help from anyone within our state to turn to in these kind of situations… Thank you so much and I look forward to hearing from you. It has been a painstaking ordeal, especially with MCNA acting like bullies and not giving providers any due process.

(We have since spoken to Sally and her husband was placed on payment hold and excluded from MCNA apparently without any due process.)

Christopher says:

I seriously doubt that MCNA will be subpoenaed or will be treating Texas dentists any better when they have Rick Perry lobbied for them to bury all the dirty dealings that they are doing.

Hebey says:

I am in on any organization to advocate for providers. Let’s put our money towards our priorities.

John says:

If the states does not plan to do anything with MCNA. We the Medicaid dentists can still do something about it. We can advise our Medicaid patient families not to choose MCNA as their Medicaid insurance company, they have the other option such as DentaQuest. I think the more patients abandon MCNA, the more attention from the states will get and rethink about this company.