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
Last Friday, Texas Health and Human Services sent an email notification that OIG was proposing a new rule (bottom of page) concerning “recoupment of overpayments identified by inspection” and wants public feedback by August 11. Public feedback Public feedback? Well, … Read More
We’re not exactly sure what happened, but Raymond C. Winter, who headed up the Civil Medicaid Fraud division of the Office of the Attorney General of Texas for the last 15 years, is no longer there. According to his LinkedIn … Read More
UPDATE: Taxpayers to pay settlement which the Legislature must approve. Attorney General Ken Paxton and four of his former top deputies who said he improperly fired them after they accused him of crimes have reached a tentative agreement to end … Read More
TDMR has learned that a number of Medicaid dentists around the state have been receiving informal letters from the Office of Inspector General about their billings. Avoid formal process Apparently, OIG is looking to resolve billing situations informally rather than … Read More
The following article was supplied by Texas HHS-OIG. Keeping accurate and complete patient records is part of providing quality patient care. Good record keeping can also help protect a practice against allegations of wrongdoing. The patient record is a legal … 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
Medicaid fraud or fraud of any type is serious business, and something TDMR decries. Those low enough to use their position as healthcare professionals to bilk federal and state governments for personal gain that cheats the taxpayer and young underprivileged … Read More
Almost a decade ago, on May 13, 2011, Byron Harris, famed WFAA investigative reporter, started a large freight train roaring down the track with his first story of a series, “Texas taxpayers pay big for straight teeth.” False narrative destroyed … Read More
The Supreme Court of Texas today rejected an attempt by Xerox/Conduent to point the finger at Texas dentists when it goes to court in an attempt to defend itself from at least $2 billion in damages and penalties stemming from its failed Medicaid orthodontic prior authorization … Read More
TDMR has been asked to inform its readers that a new association of dentists is in the process of being formed. The new association is to be called the United States Dental Association. Among the founding members of the new organization … Read More
In January of last year, Dr. Juan Villarreal’s long-awaited book “Truth Decay: How Government Corruption Caused a Political Scandal Victimizing Texas Dentists and How It Could Happen to You!” was released on Amazon.com. “Truth Decay” details Dr. Villarreal’s personal struggles … Read More
A dozen years ago, Texas health care administrators hired a company to help determine when taxpayers should cover the cost of dental care for the state’s poorer residents, particularly children. The company, later acquired by the giant corporation Xerox, deployed … Read More
The following is an interview done with Dr. Juan D. Villarreal, author of “Truth Decay: How Government Corruption Caused a Political Scandal Victimizing Texas Dentists and How It Could Happen to You!,” published by TDMR. The book has now been available … Read More
TDMR has learned from a staffer in the office of Sen. Juan “Chuy” Hinojosa that they have been informed by Health and Human Services that managed care organizations, including MCNA, do not have any right under any Texas or federal … Read More
TDMR received the following email from a Texas dentist. He has given permission for us to publish it and we are doing so anonymously to hopefully prevent any further retribution against himself and his practice. I am writing this email … Read More
After more than a year of delays, Texas is officially kicking Planned Parenthood out of the state’s Medicaid program. In a move that could affect thousands of low-income women, state health officials on Tuesday delivered a final legal notice to … Read More
In testimony before the Senate Committee on Health and Human Services in September, Inspector General Stuart Bowen shocked committee chairman Sen. Charles Schwertner with the revelation that the 22 MCOs (managed care organizations) operating in Texas had only found and … Read More
In response to TDMR’s latest story on payment holds placed on Medicaid dentists by MCNA, TDMR received an emotional missive from a Medicaid dentist about his negative experience with MCNA. He gave permission to publish his comments. The legislative session … Read More
Feeding on outrage sparked by the release of controversial undercover videos of Planned Parenthood officials, Gov. Greg Abbott vowed one year ago to cut off $3.1 million in Medicaid funding that the organization’s Texas affiliates receive to provide family planning … Read More
TDMR has learned that a number of dental providers have reported being placed on payment hold by MCNA for “willful misrepresentation or abuse of claims.” Payment holds placed for mistakes and missing paperwork In these reports, dentists claim that MCNA’s … Read More
The policy revision to the Medicaid orthodontic benefit process contemplated by representatives of the Texas Medicaid and Healthcare Partnership and the Health and Human Services Commission in 2009 was sweeping. Per the final draft of the confidential policy revision attached … Read More
A new document has come to light out of the lawsuit the state filed in 2014 against Xerox, its former Medicaid claims administrator, that shows Medicaid dentists were concerned as early as 2007 about Xerox’s prior authorization process and demanded … Read More
The prosecution and defense in the case of Dr. Howard S. Schneider, 78, each hired medical experts to diagnose Schneider, who has pleaded not guilty to those charges and one count of scheme to defraud. Schneider’s trial was set to … Read More
For three months, Courissa Hall essentially lived in a Houston rehabilitation hospital providing care for her 4-year-old daughter, who suffered brain damage during a routine appointment at a local dental clinic that specialized in treating Medicaid patients. She’s still processing … Read More
The investigative digging of the Texas media into the operations of state government has once again revealed to the public, otherwise blissfully ignorant, the tremendous apparent hypocrisy of several state officials who view their positions as the divine right of … Read More
The Texas Supreme Court this week issued a ruling allowing a whistleblower suit filed by Michael McMillen, a former Health and Human Services Commission Office of Inspector General attorney, to continue. McMillen contends he was fired in early 2012 for reporting … Read More
The Texas Supreme Court has given another shot to a former government lawyer who alleged he got fired after blowing the whistle that the state was illegally seeking reimbursement from some Medicaid recipients. F. Michael McMillen saw his employment lawsuit … Read More
There have been many changes for Medicaid dental providers over the last few years. The change from fee-for-service to managed care. The upheaval caused by the former Health and Human Services Commission Office of Inspector General and rampant allegations … Read More
Almost six months ago, undercover videos surfaced purporting to show officials with Planned Parenthood in Texas discussing illegal acts. Texas Republicans pounced, opening up multiple battlefronts against the embattled women’s health organization. With allegations flying that Planned Parenthood was illegally … Read More
We want to close out 2015 with a round-up of the year’s most important stories relating to TDMR issues. It has been an exceptional year for changes at the Health and Human Services Commission. The implosion that occurred at HHSC … Read More
Planned Parenthood’s Texas affiliates on Monday filed a federal lawsuit to keep state health officials from booting them from the state’s Medicaid program. Following Texas’ announcement in October that it would stop funding any care for poor women at Planned Parenthood clinics — a response … Read More
November 17, 2015 — The Supreme Court of Texas has dismissed a petition that would have prevented practitioners from receiving Medicare funds when that provider is being investigated for fraud. In the November 13 dismissal, the state Supreme Court upheld … Read More
This past Friday, the Texas Supreme Court dismissed a petition from the Texas Office of Attorney General to review a 3rd Court of Appeal decision preventing the Health and Human Services Commission Office of Inspector General from placing payment holds … Read More
The federal government has warned Texas that it cannot block Medicaid participants from “qualified providers of their choice” or because of the provider’s “scope of practice.” In doing so, the U.S. Department of Health and Human Services has essentially put … Read More
Texas officials are giving up on recovering most of the hundreds of millions of dollars spent on questionable Medicaid dental and orthodontic procedures. After years of an ongoing scandal over fraudulent billing and courtroom losses, the commission that oversees Medicaid … Read More
Stuart Bowen, the inspector general of the Texas Health and Human Services Commission, told The Dallas Morning News that a whistleblower alleging Medicaid fraud at Texas Planned Parenthood clinics spurred the agency’s investigation. The Daily Signal previously reported that inspectors from the … Read More
The editorial board of the Austin American Statesman has called the decision by Texas “lawmakers and state officials” to investigate Planned Parenthood for Medicaid fraud part of a “witch hunt” that won’t stop until the health care provider “is completely dismantled … Read More
The Governor of the State of Texas said he hopes Planned Parenthood files legal action against their move to cut off Medicaid funding to the abortion biz so he can put their officials under oath. Newly-elected Governor Greg Abbot told … Read More
