Thursday, February 02, 2012

New Medicaid Dental Rules in Texas is Potential Windfall for Wall Street–Anyone Surprised? Not me!

I made an entry here a few weeks ago about Kool Smiles telling their patients they have to choose a doctor, not their clinic under the new rules. I wondered how that would work, since the dentist’s don’t stay too long at the dental mills. Chances of seeing the same dentist twice (unless it’s the next day) slim to none. 

Here’s a comment on that from a Texas dentist I thought deserved being front and center.

Medicaid orthodontics has suddenly come to a halt the past few weeks. Almost no cases are being approved. Audits of legitimate practitioners continue. There are rumors that the bureaucrats are considering clawbacks in order to save face even though the State approved the cases.

I still have not heard of any audits of corporate practices but I am not normally in contact with those entities.  However, it would be hard and embarrassing to seek clawbacks from corporations that have spent the money and never should have received the money.
The new Medicaid structure could be a windfall for corporations. Well leave it up to American ingenuity to profit from the total incompetency of bureaucrats.

Under the new program, the patient is to choose from one of three dental managed-care(neglect) companies. I believe a dentist is only allowed to sign up with one managed-care company. A patient could potentially sign up with a managed-care company other than the one utilized by their current dentist.  It appears that the corporations are thinking of ways to make up for the lost orthodontics and utilize the new changes.

The corporations have the advantage on this one. Three different dentists equal all three managed-care companies. I have been told by legitimate practitioners that some of these corporations are now offering $25-$50 cash to patients to switch to the corporate entities.

Six kids could equal $300 cash to a Mother. While it is unethical and potentially a criminal offense for a doctor to fee-split, corporations are not licensed practitioners. This new approach is probably much more cost effective than billboards and signs and produces instant results. It is also harder to track and flies under the radar. What agency has authority over them?

Legitimate practitioners will lose patients and may eventually give up Medicaid.  Corporations will get control of more Medicaid patients and maybe more creative billing techniques. Access and quality of care will probably diminish dramatically. 

Isn't it great knowing that you have the Texas Dental Board, Texas OIG and Texas Department of Insurance protecting the citizens of Texas.

Dr. D

Anyone out there been offered bucks to switch dental providers, email me

Don’t forget to comment, you can do so anonymously, just plug in any ole made up email address in the field.