Several legal media outlets reported yesterday that former Texas Medicaid claims administrator Xerox has brought an appeal before the Texas Supreme Court because the company says the state is “wrongfully blocking the company from designating the dentists who treated patients in the alleged fraud scheme as responsible third parties.”
The lawsuit is still going on
This action, of course, stems from the $1 billion lawsuit filed against the company by the state in May of 2014 when it was summarily terminated from Texas Medicaid for its ridiculous orthodontic prior authorization process which used untrained office staff, working from home on piece-work to rubber stamp the requests ie. alleged Medicaid fraud. This had gone on for years between 2007 and 2012 without the state apparently noticing. The state alleges the company lied to them. However, other documents suggest the state knew earlier.
Motion to include dentists previously denied
The original motion to include the dentists as parties now before the Supreme Court was brought before a Travis County judge who denied it in April 2015. The Third Court of Appeals declined to overrule the decision in February 2016.
Should the company prevail, just about every Medicaid dentist could be affected
Should the appeal succeed, according to legal sources, every dentist and orthodontist in Texas who ever submitted a Medicaid prior authorization request to TMHP during the time period in question could be brought in the state’s suit against the company.
The company’s brief to the court also accused the state of using a “web of lawsuits” to divide and conquer” and having brought “coercive fraud suits” so it could take “inconsistent positions” in different trials.
The state is also still suing a number of dentists, many of which are still sealed in whistleblower filings.
The State knew about this issue and even when they found out about it the state did not put procedures in to stop the charges to Medicaid. There is plenty of blame to the State, the company and the dentist. Who really benefited from this mistake. A lot of children who got better teeth. This is a difficult law suit and will probably end up being settled without fault but what are the Feds going to do about wanting the money back they paid out in Medicaid. Interesting!
The feds have already said that Texas owes them $133 million.
1 Billon dollars is a holy cow . lets barBQ the holly cow then. Xerox is going to fire and burn every single dentist as piece of charcoal if they have to.
Fraud is not a dentist issue. Third parties are the cause. they want any piece of any cake that gives easy money. lets milk the cow.