Xerox, a company that worked on the Texas Medicaid program, may still have files that contain information about many current and former Medicaid clients. The company is being sued by the state and has refused to return the files. One … Read More
Fraud in Medicaid constitutes a scam amounting to more than a billion dollars and a newly installed computer system is assisting to ferret out the criminals. As per Kaiser, about $28 billion is paid by Texas to provide care for … Read More
On August 14th, the Senate Committee on Health and Human Services heard testimony regarding Medicaid fraud, waste and abuse. The full presentation given by Chris Traylor, Chief Deputy Commissioner, Douglas Wilson, Inspector General, Kay Ghahremani, Texas Medicaid/CHIP Director, and Joseph … Read More
The allegations state health regulators leveled against Rachel Trueblood two years ago were dramatic: The Austin dentist had billed the government for millions of dollars in unnecessary procedures and office time, they said. Regulators froze $100,000 of outstanding Medicaid payments … Read More
A quick search of the Travis Country Criminal Court docket shows that Jack Stick’s DWI was not dispensed with yesterday. Stick, the new Chief Counsel for the Texas Health and Human Rights Commission, has a new hearing set for October 2nd. His … Read More
To understand waste, fraud and abuse of taxpayer dollars in the Medicaid system, let’s begin with a couple of basics on what the role of Medicaid is in health care and how it works. Medicaid Basics Medicaid is a program … Read More
August 26, 2014 — Texas health officials have accepted a $39,211 settlement from an Austin dental practice that had been charged with improperly billing more than $16 million in orthodontic Medicaid claims. Glenn Wood, MD, who owns Carousel Pediatrics, disputed … Read More
Texas Medicaid officials, already in a legal battle with Xerox Corp. over the company’s alleged failure to prevent widespread dental fraud, filed another lawsuit Tuesday accusing Xerox of improperly taking large quantities of medical records and not protecting patients’ confidentiality. … Read More
Texas Health and Human Services Commission Inspector General Doug Wilson told Sen. Judith Zaffirini and other members of the Senate Committee on Health and Human Services at their August 14th hearing on Medicaid fraud, waste and abuse that his agency … Read More
Gov. Rick Perry today made the following statement regarding the decision by the Travis County Grand Jury: “As governor, I took an oath to faithfully uphold the constitution of Texas, a pledge that I have kept every day as I’ve … Read More
AUSTIN — Texas state government ultimately is to blame for hundreds of millions of dollars of Medicaid spending wasted on braces and orthodontic work that were not medically necessary, according to federal auditors. The audit report, released last week, concludes … Read More
A federal audit has found a Texas state agency to blame in an ongoing fight with Xerox Corp. over who is responsible for hundreds of millions of Medicaid dollars potentially misspent on unnecessary dental and orthodontic procedures. The Austin American … Read More
Three Medicaid dentists who are involved in HHSC-OIG cases will be testifying tomorrow before the Texas Senate Committee on Health and Human Services. Dr. Chad Evans of Smile Magic from Dallas, Dr. Vivian Teegardin of Harlingen Family Dentistry and Dr. … Read More
Texas is “ultimately responsible” for millions of misspent Medicaid dollars, according to a new federal audit, because a state agency failed to properly oversee the contractor that reviewed the medical necessity of Medicaid claims. For nearly five years, the Texas … Read More
August 11, 2014 — In the latest development in the ongoing Texas Medicaid scandal, a federal report has laid the responsibility for hundreds of millions of dollars spent on dental and orthodontic procedures that may have been medically unnecessary squarely … Read More
A federal auditor has laid responsibility for hundreds of millions of dollars spent on dental and orthodontic procedures that may have been medically unnecessary squarely on the state agency that oversaw the program. The Texas Health and Human Services Commission … Read More
Last Wednesday, the Department of Health and Human Services, Office of Inspector General released the results of its long anticipated audit of Texas Medicaid orthodontic spending. The feds conducted the audit because Texas Medicaid payments for orthodontic services rose from … Read More
At the end of July, Xerox, Texas Medicaid’s disgraced former claims administrator, filed for a protective order with the Travis County District Court. The stated reason for the order is because the Office of the Attorney General has apparently demanded … Read More
Letters to both Rep. Richard Peña Raymond and Rep. Lois Kolkhorst, chairmen of the House Human Services and Public Health Committees respectively, have been sent from TDMR President Greg Ewing requesting a public hearing on SB1803 and HHSC’s compliance to … Read More
As part of the lawsuit against Xerox, the former lead contractor for the Texas Medicaid and Healthcare Partnership, the Texas Office of the Attorney General alleges that Xerox, from the beginning of its contract with Texas, wrote misleading documents that … Read More
In the lawsuit against Xerox filed by the Texas Attorney General, there is one more startling revelation. The State is alleging that Xerox as early as 2004, when the company took over the contract as the state’s Medicaid claims administrator, the … Read More
Back in January 2009, a Medicaid Orthodontic Stakeholder meeting was held in Austin at the offices of the Texas Dental Association. Dr. Linda Altenhoff presided at the meeting. Dr. Altenhoff is currently the Dental Director for the Texas Health and … Read More
GAO identified a gap in state and federal efforts to ensure Medicaid managed care program integrity. Federal laws require the states and the Centers for Medicare & Medicaid Services (CMS) to ensure the integrity of the Medicaid program, including payments … Read More
Work continues to move the Medicaid claims administration contract from Xerox to Accenture. HHSC is reviewing Accenture’s readiness to take over the contract, which also includes processing claims for the Children with Special Health Care Needs program and vendor drug … Read More
Apparently TMHP/Xerox “dental specialists” were only trained to add up HLD scores on Medicaid orthodontic pre-approval requests and determine whether the total was 26 points or more, per allegations contained in the lawsuit filed against Xerox by the Attorney General … Read More
Michael McMillen, former Deputy Chief Counsel, Texas Health and Human Services Commission Office of Inspector General, is suing the HHSC for wrongful dismissal after reporting alleged violations of law within the agency. The nature of the alleged violations are not known. The … Read More
On May 7th, Dr. Kyle Janek, the Executive Commissioner of the Texas Health and Human Services Commission, issued his final order in the case of Antoine Dental Center of Houston. Upheld reversal of favorable SOAH ruling on Antoine Dental As expected, … Read More
As was reported in the Austin American Statesman back on May 25th, the Texas Health and Human Services Commission is seeking tens of thousands of dollars in advance from dentists who wish to go before the State Office of Administrative … Read More
Xerox Corp at the end of May was awarded a $500 million contract to revamp New York’s Medicaid system despite Texas suing the company and discontinuing their contract as chief Medicaid claims administrator in the state. The Rochester Democrat and … Read More
Wednesday, TDMR received a notice that HHSC had put online a report from Deloitte Consulting LLP entitled, “State of Texas Medicaid Payment Reform – Market Assessment and Recommendation Analysis.” The report is dated March 31st, 2014 and is 51 pages … Read More
Yesterday, HHS-OIG issued an audit entitled “Acute-Care Hospitals In Texas Did Not Always Reconcile Invoice Records With Credit Balances And Refund To The State Agency The Associated Medicaid Overpayments.” The federal auditors, in looking over eight acute care hospitals in Texas, … Read More
Of the eight acute-care hospitals in our sample, one hospital always reconciled patient accounts and refunded associated Medicaid overpayments to the Texas Health and Human Services Commission (State agency). However, the seven remaining hospitals in our sample did not always … Read More
Deloitte Report for Texas As market pressures continue to mount, states are not only looking to derive more value from their managed care programs but also seeking to use these programs to address CMS’ Triple Aim: better health, better quality, … Read More
Of the eight acute-care hospitals in our sample, one hospital always reconciled patient accounts and refunded associated Medicaid overpayments to the State agency. However, the seven remaining hospitals in our sample did not always reconcile patient account credit balances and … Read More
HHSC yesterday sent out a notice that a new draft HHSC strategic plan has been issued to cover 2015 to 2019. They have invited public comment. Naturally, the report is 348 pages long and their first public hearing on the report … Read More
May 27, 2014 — In the latest flurry of lawsuits in the Texas Medicaid scandal, eight dentists have filed suits claiming the state and attorney general (AG) “protected” Xerox because they feared a federal clawback for hundreds of millions of … Read More
With the Attorney General of Texas filing suit against Xerox and the Health and Human Services Commission publicly washing its hands of the Fortune 500 company as lead contractor in the Texas Medicaid and Healthcare Partnership, Xerox now joins dental … Read More
May 20, 2014 — In the wake of a Texas lawsuit that claims Xerox wrongly approved Medicaid claims for orthodontic services that were not medically necessary, some of the dentists being pursued for orthodontic overpayments are now suing Texas for … Read More
The Texas Tech University System Board of Regents officially named state Sen. Robert Duncan, R-Lubbock, the sole finalist to be the system’s next chancellor in a press release issued Monday afternoon. Duncan is expected to start in his new position … Read More
Last week, Attorney General Greg Abbott filed a lawsuit against Xerox and its subsidiary, ACS Healthcare, alleging that the company had not properly vetted dentists’ pre-authorization requests to perform Medicaid orthdontic work on poor children, saddling taxpayers with hundreds of … Read More
