On February 7, the Nebraska legislature passed the first reading on a bill to increase Medicaid dental reimbursement rates by a whopping 25%. In the only state with one state legislative body, that legislative body passed the bill 35-0. Recognizes … Read More
UPDATE: YouTube video added of hearing 22-1046 Malouf v. State ex rel. Ellis Supreme Court Hearing, January 31, 2024 It might just be possible that more than a dozen years after the great WFAA expose on “Crooked Teeth,” a Medicaid … Read More
This week, Pro Publica and the Texas Tribune released the results of an investigation into the Texas Office of Attorney General Civil Medicaid Fraud unit and its recent tremendous loss of staff coinciding with the firing of its long-time head, … Read More
The movement to set a dental loss ratio (DLR) for the dental insurance industry is fast becoming a national issue and is now on the agenda of a number of state dental associations as well as the ADA thanks to … Read More
Inspector General Raymond Winter who came to post last October released his first quarterly report at the end of December. It is also the report for the first quarter of fiscal year 2024. No cases involving dentists highlighted OIG settled … Read More
This week, Attorney General Ken Paxton issued a press release touting his agency’s recovery of some $203 million in 2023 from Medicaid fraud, waste, and abuse. The figures come from the 2023 Joint Interagency Coordination Report, which “summarizes the collective … Read More
The Office of the Inspector General just published a short interview with Inspector General Raymond C. Winter, who was appointed to the position last year. The interview is about his 2024 priorities. IG Winter had previously been a deputy attorney … Read More
Arizona, through its Arizona Health Care Cost Containment System (AHCCCS). the state’s Medicaid agency, has instituted a value-based healthcare initiative with its Differential Adjusted Payment (DAP) program, which has been running for several years. Value-based healthcare initiative Value-based healthcare focuses … Read More
TDMR has written extensively on how the provisions of the Texas Medicaid Prevention Act may be used by apparently unscrupulous relators to seemingly blackmail honest dentists into hefty monetary settlements to avoid costly and lengthy litigation. Problems with TMFPA The … Read More
The Texas Supreme Court agreed this past week to hear arguments as to why the $16.5 million summary judgment against Dr. Richard Malouf should not be upheld. Oral arguments will be heard on January 31 next year. A dozen years … Read More
Inc. Magazine just published an article by Adam Levin, Chairman and Founder of CyberScout, with his take on the alarming increase in fraudulent claims within Medicare and Medicaid due to the proliferation of medical identity fraud. This figure now exceeds … Read More
Back in March, TDMR published an article on the number of active THSteps Enrolled Dental Providers obtained from an open records request filed with Texas Health and Human Services. Records since 1996 Texas HHS has been compiling these figures since … Read More
Looking for a fee increase for Medicaid services? Here is another opportunity to make your voice heard. We received this email notification for Texas HHS this week. The Texas Health and Human Services Commission is working on its Legislative Appropriations … Read More
Over the years, we have published the concerns of many dentists who informed us of the various and sometimes substantial shortcomings in the performance of the various DMOs contracted by Texas HHS for dental Medicaid. There have been wrongly placed … Read More
Governor Greg Abbott announced yesterday that he has appointed Raymond C. Winter (“Ray”), former head of the Civil Medicaid Fraud division of the Office of the Attorney General, as the Inspector General for Texas HHS. He will replace Sylvia Hernandez-Kauffman, … Read More
Two weeks ago, TDMR reached out to Texas HHS to find out if a new dental director had been hired for the Medicaid CHIP program to take the place of Dr. Margaret Laccabue. And, yes, that has occurred. We were … Read More
OIG announced on their website yesterday that they were updating their self-reporting protocol for Medicaid providers. Here is what is said with a PDF copy of the protocol below. The OIG has updated the protocol providers use to voluntarily disclose … Read More
NOTE: DentaQuest had contacted us and the fees used for comparison initially were their commercial fees, not the Medicaid fee schedule available to providers and not publicly available online. We did not receive the correct fees from DentaQuest. However, we … Read More
Last month, TDMR was told that Inspector General Sylvia Hernandez Kauffman was going to be leaving OIG sometime in September. Today, we received confirmation from an OIG spokesperson that Ms. Hernandez Kauffman will be leaving the position on October 2. … Read More
The Office of Inspector General has another proposed rule on the Texas HHS “Comment on Proposed and Draft Rules” webpage entitled – “Recoupment of Overpayments Identified by Retrospective Payment Review.” This one is another addition to the Texas Administrative Code … Read More
