Statement to committee by TSBDE Executive Director,Glenn Parker
Total number of dentists accepting Medicaid
4687 in August 2007 7399 in August 2012
Increase of 57%
Total number of Orthodontists accepting Medicaid
142 in August 2007 368 in August 2012 226% increase in providers
Civil Orthodontia "Whistleblower" Lawsuits
20 cases involving 400+ potential dentist defendants 8 convictions so far 2 plea agreements so far 4 indicted currently 9 awaiting the Grand Jury
Credible Allegations of Fraud (CAF) Payment Holds
- 89 for non-orthodontic services
- 26 Orthodontic services
Criminal Medicaid Fraud Cases
153 total criminal cases (dentists, support staff,private equity investors) 45 are orthodontia related
30 % orthodontic are fraud cases 27 orthodontic provider investigation completed $229,000,000 of probable fraud 93% is the average of cases where patients did not qualify for braces. Ranging from 39% to 100% of records checked so far. $154,000,000 in general dentistry of probable fraud 55% is the average of overutilization - billing fraud; overtreatment. Ranging from 25% by some providers to 99% by other providers.
Office of Inspector General & TMHP
August 2008 audit of TMHP revealed problems 2011 was follow-up on 2008 audit 12 investigation in 2011 108 so far in 2012Time needed to complete an investigation 4 years in 2011 8 weeks by end of 2012
How do the new DMO's (MCNA & DentaQuest) in Texas negotiate to enroll providers? Individual dentists - if the own their own clinic Management, i.e. NCDR, LLC and CSHM - in the case of group practices.TSBDE cases turned over to district attorneys
200 in 10 years - of individuals practicing dentistry without a license 3rd degree felony 5 convicted and jail time if acted upon, most have plea agreements and board is not notified
Curbing illegal corporate practice of dentistry and patient shopping DentaQuest - Cease and Desist Letters Texas State Board Dental Examiners (TSBDE) - Forward to AG's office for investigation Could but have not sent Cease and Desist Letters. Look if someone is working for a non-dentist owner and take action against that dentist Non-dentist may not influence or attempt to influnce a dentist in treatment, doing so is practicing dentistry without a license. i.e. Doug Brown - Kool Smiles i.e. David Wilson - Small Smiles i.e. Stephen Thorne - Pacific Dental i.e. Michael Dell – Affordable Dental Have had cases where dentist being investigating said he or she was influenced by a Office Manager or other employee of a DSO. 5 dentists reported such in last 2 years Took action against the dentist
# of Dental Practices or Dental Management Organizations Unknown by TSBDE Acronyms for illegal operating dental management companies
DSO – Dental Service Organization
DMSO – Dental Management Service Organizations
NDOE – Non Dentist own entities
Indicator of fraud Billboards offering Free Braces OIG re: Jail Time:
There will be, and there are, and it’s a parade of horrors. We don’t see the end of the parade but we are going to make sure that every body that participated in the parade gets to be evaluated to see if we can criminally prosecute them. We’re going to make sure that if there’s an ability to recover under the Texas Medicaid Fraud Prevention Act we will pursue that.
We are coordinating with the Office of Inspector General through our task force, if we find that the quickest way to get resolution and recover the money from them is to go through the Office of the Inspector General processes, through SOA, we will do that. So we are trying to attempt to anything and everything to facilitate the quickest resolution and get the state of Texas money that has been stolen from it, back.
It’s the “quickest resolution” that gives me pause.
