The Houston Chronicle broke a bombshell story today (paywall, unfortunately). This ortho story still has legs. OAG assisted company they were suing to defraud insurer The Chronicle reported that the Office of the Attorney General had secretly made last-minute modifications … Read More
TDMR has done a review of the Texas Medicaid dental maintenance organization contract available publicly on the Texas HHS website and found a requirement that all medical necessity determinations be based on “valid and reliable clinical evidence or a consensus … Read More
We found an article recently published on the OIG website that we thought should be republished here. Providers encouraged to self-report errors More providers are participating in the OIG self-audit process so they can determine if they need to self-disclose … Read More
The 2021 annual report published by Texas HHS-OIG on fraud and abuse recoveries by MCOs and DMOs again shows a minimal amount of Medicaid fraud being found and recovered considering the state’s whooping multi-billion dollar healthcare budget. For 2020/2021, the … Read More
It has been reported in two Florida business publications this week that children of the late MCNA founder Dr. Jeffrey Feingold have sold the company’s headquarters in Ft. Lauderdale to a Florida capital firm. According to The Real Deal, a … Read More
TDMR published a letter from a dentist a month ago who expressed their outrage about DMO self-made rules that restrict and inhibit treatment of young Medicaid-eligible children to their detriment. Now that the holiday season is well out of the … Read More
It is remarkable that in a state that cherishes free enterprise, it is okay for dental maintenance organizations to offer money and other inducements to encourage parents with Medicaid-eligible children to use their company yet it is a crime for … Read More
After our article last month on rate and coverage drops in Webb county for Medicaid waiver patients when DentaQuest took over the program, it didn’t take too long for us to be contacted about similar concerns within CHIP and children’s … Read More
We just received a press release from the Office of the Attorney General. Paxton Stops Vaccine Mandate for Healthcare Workers AUSTIN -Texas Attorney General Ken Paxton secured a preliminary injunction for the State of Texas, stopping the Biden Administration from imposing vaccine mandates on the employees of Medicaid and Medicare providers and suppliers. “This … Read More
Almost three hundred seniors and patients with disabilities were stranded mid-treatment plan in Laredo thanks to a change in dental insurance providers in July of this year. Since 2017, Dr. Amin Abdul of the Asclepius Dental Center of Laredo has … Read More
Texas Medicaid dental providers should know that DentaQuest was purchased by Canadian group benefits giant Sun Life Financial Inc, the country’s largest. The sale took place back in early October. The price? $2.475 billion US. Bloomberg reported: The acquisition gives … Read More
On Friday, TDMR received an email notification from the Office of the Governor that its Regulatory Compliance Division is now reviewing and accepting public comments on the Texas State Board of Dental Examiners rule change to establish the standards of … Read More
This is a trial balloon. We’ve written numerous articles about the need for changes to the Texas Medicaid Fraud Prevention Act. The Act needs to be a deterrent for real fraudsters, not a state-supported protection racket to be used against … Read More
Dr. Jeffery Feingold passed away on October 7 after a battle with cancer at the age of 75. His passing has received little press attention. Surprisingly, no major media have reported on it considering Dr. Feingold’s important contribution to healthcare … Read More
Last week TDMR obtained a copy of the latest HHS Ombudsman report on complaints about managed care to the agency from Medicaid clients. The report contains a significant section on Dental Managed care. Medicaid dentists may not get a copy … Read More
Our last story on reputationally challenged qui tam relator Joshua Lafountain and the highly questionable settlements forced from a large number of Medicaid dental entities, supported by the Office of the Attorney General, brought about an outraged comment from an … Read More
Back in 2020, we started reporting on the various whistleblower claims brought by Joshua Lafountain, a former dental office manager in Dallas with no formal dental training, against 71 various Medicaid dentists and dental entities. Although he had never worked … Read More
After our last article about possible termination from a DMO’s network for filing a complaint with HHS before all company complaint procedures have been exhausted, we picked up online copies of the Medicaid Provider manuals for DentaQuest, MCNA and UnitedHealthcare … Read More
Dr. Janice Reardon, Chief Dental Officer of the Office of Inspector General, has been honored with the Lifetime Membership Award by the Texas Dental Association. The award recognizes her 30 years of continuous membership in the TDA. A graduate of … Read More
After we published our article last week about the HHS complaint line and its email address, we received a few emails from dentists. Several were excited about the possibility of complaining to HHS about their DMO troubles, but one had … Read More
