While DentaQuest limits its Medicaid network in Texas and threatens to boot over 100 providers from its network in urban areas, yesterday, its Canadian parent company, Sun Life Financial Inc., crowed about its share price reaching an all-time high, boosted … Read More
TDMR has received a missive from a concerned dentist, which we are publishing. It sums up the frustration and intense concern about DentaQuest’s recent actions in limiting its network, including a threat to remove over 100 urban providers. This prodigious … Read More
Our story on foreign-owned DentaQuest’s limitations on dental care access for Medicaid children in Texas has sparked outrage among dental providers, leading to an outpouring of angry comments. Many practitioners shared their frustrations and experiences, highlighting how the restrictive policies … Read More
In a stunning move last week, DMO DentaQuest sent out a letter (copy below) to its Medicaid provider network that as of October 15, it would “be limiting the number of additional” general and pediatric dentists into its network in … Read More
Remember we wrote that Texas should beware of DentaQuest and its corporate behavior, which cost the company $11 million in fines in Louisiana for Medicaid contract violations, which was recently cited in a report by the Louisiana Legislative Auditor’s office. … Read More
In July, the Louisiana Legislative Auditor’s office published a scathing audit review of DentaQuest’s performance as one of the two dental maintenance organizations with Louisiana Medicaid. It fined the company for its poor performance. FYI, Louisiana calls them dental benefit … Read More
A few weeks ago, it was announced that Benecare Dental Plans has taken over the contract as a third-party payer for the Medicaid program in Massachusetts under MassHealth. DentaQuest lost the contract, which it had held for at least a … Read More
In a surprising move, the Arkansas Department of Human Services (DHS) announced this week that it is ending its Medicaid managed care dental program and transitioning back to a fee-for-service model starting November 1, 2024. This move from contracting with … Read More
According to a press release and an article on the American Alliance for Dental Insurance Quality website, this past February, the Massachusetts Dental Society (MDS) and nine other dental organizations sent identical letters to the MassHealth Dental Program, requesting that … Read More
This past week, TDMR came across the State Of Texas Medicaid Managed Care Dental Rate Setting reports on the Texas HHS Provider Finance web portal. These are the third-party actuarial reports compiled for Texas HHS to recommend the per-member, per-month … Read More
BY KAREN BROOKS HARPER, Texas Tribune APRIL 26, 2024 “State’s premature release of bid proposal info touches off new battle over $116 billion in Medicaid contracts” was first published by The Texas Tribune, a nonprofit, nonpartisan media organization that informs … 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
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
In our last article “ADA Says Dentists Need to Accept Value Based Care as “Inevitable,” we referenced an online discussion on the Dentistry in General YouTube channel held on June 13. This passionate discussion revolved around the JADA editorial advocating … Read More
A firestorm erupted last month with an editorial published in the Journal of the American Dental Association titled “Value-based care in dentistry – Is the future here?” by Marko Vujicic, the chief economist and a vice president of the ADA’s … Read More
On June 27, we reported that the Legislature would not be increasing the Medicaid fee schedule for dentists despite the overwhelming need and the record abundance of funds in the state coffers this legislative session. The reason cited was that … Read More
Considering that one of the largest DMOs in the country was hacked by the Russian ransomware group LockBit and their entire network data stolen, there has been surprisingly little media coverage about this massive data theft. The consequences of identity … Read More
The number of privacy law firms “investigating” MCNA for its massive data breach is growing exponentially. Here are just a few of the announcements made since our last article. Silver Golub & Teitell LLP Investigates MCNA Dental Data Breach Class … Read More
MCNA has been making the news the last few days because it placed a notice on its website May 26 as well as sent letters to several state Attorney Generals that it was hacked back in February and that the … Read More
Recently, an OIG audit of a managed care organization (MCO) found issues when determining the fair market value of outsourced services and behavioral health claims. The audit reviewed multiple financial statistical reports (FSR) for UnitedHealthcare Community Plan of Texas, L.L.C. including Medical … Read More
TDMR received an email from a provider that a new problem had developed in credentialing a dentist that adds even more time to the process. No TPI in welcome letter Apparently, TMHP is no longer including the TPI (Texas Provider … Read More
This seems like a silly question because surely the agency that pays billions of dollars to DMOs and MCOs and keeps the Medicaid show on the road in Texas should know something—and perhaps should know everything– about the credentialing of their Medicaid dentists in Texas. You wouldn’t be … Read More
The recent business headlines about Sun Life, the Canadian insurer that purchased DentaQuest earlier this year, and its Q2 financial results are quite bipolar – either dismal or glowing. Good Q2 or not for DentaQuest purchaser Several publications spotlight the … Read More
PRESS RELEASE BY Sun Life Financial Inc. Jun 01, 2022, 08:27 ET BOSTON and WELLESLEY, Mass., TORONTO, June 1, 2022 /PRNewswire/ – Sun Life Financial Inc. (TSX: SLF) (NYSE: SLF), through its U.S. business, announced today the completion of its acquisition of DentaQuest, the second-largest dental benefits provider … Read More
Everyone remembers the Frew case back in 2004 when the Supreme Court forced Texas to provide basic healthcare services including dental care for Medicaid-eligible children. Reason for fee increase in 2007 For those that don’t remember, let’s recap. Linda Frew, … Read More
The list of complaints about DentaQuest from Medicaid providers keeps growing. It seems that new Canadian ownership hasn’t changed any business practices so far, but we hear they like their money too. While some problems have been reported about MCNA … Read More
The Department of Health and Human Services Office of Inspector General recently released its 2021 Medicaid Fraud Control Units (MFCU) Fiscal Year 2021 Annual Report. Investigates criminal fraud Medicaid Fraud Control Units have the job of investigating criminal fraud by … 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 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
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
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
We received an email from a dentist a few weeks ago who was having trouble with a particular DMO. In the process of trying to assist them, we reached out to Texas HHS in an attempt to find a state-level … Read More
Our 2021 survey of Texas dental maintenance organizations is complete and the results have been compiled. Survey says: long-term providers MCNA and DentaQuest have improved their performance in the minds of Medicaid dentists from previous years while newcomer United Healthcare … Read More
SURVEY IS CLOSED As we come out of the pandemic and into a hopefully normal July 4 weekend, TDMR is issuing our annual survey to find out how dental maintenance organizations have been performing for Medicaid dentists over the last … Read More
Texas HHS-OIG has just published its report for 2020 on Medicaid fraud uncovered and reported by MCOs in Texas. The report shows that DentaQuest and MCNA found only $234,098 and $127,264 in Medicaid fraud, respectively for 2020. According to the … Read More
Bill filing has started for the upcoming legislative session at the Texas Capitol. One of the early filings is HB 648, a bill introduced by House Rep. Richard Peña Raymond of Laredo to modify the mandate of the HHSC Office … Read More
Remember back in 2012 when the media and the state were outraged by dentists giving out gift cards or other small inducements to have Medicaid children get under care? In case you don’t, here are links to some media articles … Read More
We are pleased to make public the results of our Texas Medicaid Dental Maintenance Organization Annual Survey 2020. This year 90 dentists took the opportunity to give us their views on the performance of MCNA and DentaQuest. Last year we … Read More
Texas HHS-OIG published on their website June 24 an audit they completed on DentaQuest back on January 9. The audit found that DentaQuest had $1.53 million in “unallowable, unsupported, and overstated expenses on its Administrative Expenses FSR [Financial Statistical Report]” … Read More
