Showing posts with label Texas Dental Board April 11 2012. Show all posts
Showing posts with label Texas Dental Board April 11 2012. Show all posts

Thursday, May 09, 2013

State Representative Lois W. Kolkhorst (R - Brenham) passed Texas House Bill 3201

Dental Medicaid Fraud in Texas Prompts New Legislation for Dental Board Reform and Patient Rights

May 3, 2013

AUSTIN, TEXAS (May 3, 2013) — State Representative Lois W. Kolkhorst (R - Brenham), Chair of the Public Health Committee in the Texas House of Representatives, authored and passed House Bill 3201, a sweeping dental practice reform bill for Texas, calling for parental rights for pediatric dental patient care, additional disclosure information for dental license renewal, and new disciplinary actions by the Texas Dental Board.

“As a mother of two children, I was shocked to learn that in 2010, there were estimated to be over 15,000 Texas children who were given inappropriate dental care, including braces on baby teeth,” said Kolkhorst. “Most of these were Medicaid cases that involved dentists and dental clinics who would not allow parents to observe the dental care given to their children.” Under the bill’s reforms, Texas parents and legal guardians would be given the right to observe most dental services being provided to their children.

Kolkhorst also said her legislation is aimed at cracking down on the millions of dollars in dental and orthodontic Medicaid fraud recently uncovered by both WFAA-TV investigative news reports (in North Texas) and the Texas Attorney General’s office.

Thursday, October 11, 2012

Texas Task Force Hunting Down Medicaid Dental Fraudsters

Texas finally appears serious about the state’s extraordinary Medicaid dental fraud. Hopefully indictments will soon be coming. I hear at least one bunch of merry bandits, are locking doors on some of their clinics and owners are scurrying like the nasty rats they are.

tribune

 

 

 

Joint Task Force Tackles Medicaid Dental Fraud

by Becca Aaronson October 10, 2012

Through a new joint task force, the Texas attorney general’s office and the office of the Inspector General at the Health and Human Services Commission have teamed up to strengthen investigations of fraud and abuse in the state’s Medicaid dental program for children. And because the task force allows the agencies to coordinate limited resources, state officials say, the state can advance investigations and recover misused taxpayer funds more quickly. 

“The Medicaid and orthodontic fraud task force was convened to ensure the state had a comprehensive and coordinated response to a dramatic uptick in fraud by Medicaid providers,” said Daniel Hodge, the first assistant for Attorney General Greg Abbott. “The highest levels of all affected agencies and divisions are actively involved in advancing the investigation as efficiently and effectively as possible."

John Scott, the deputy attorney general for enforcement litigation, chairs the task force, which also includes officials from the Medicaid Fraud Control Unit and Civil Medicaid Fraud Unit at the AG's office, and officials from the inspector general and other departments of the HHSC.

In 2010, Texas spent as much on orthodontic services as every other state combined, according to a report released in April by the U.S. House Committee on Oversight and Government Reform. "The state has admitted that widespread fraud was occurring and that the organization the state hired to assess prior authorization forms was essentially rubber stamping forms for approval," the report states. An orthodontist consulted by the inspector general's office at HHSC estimated that 95 percent of approved claims should have been denied, according to the report.

State officials said the task force, which was created this year, allows the agencies to take advantage of what each group brings to the table. For example, the inspector general’s office has software to monitor whether a provider’s claims data looks suspicious and can put payment holds on providers it suspects are committing fraud. And the AG has teams of lawyers from the two Medicaid fraud units who follow through on investigations, subpoena records and press charges. 

The state is also getting an assist from whistleblowers like Dr. Morna Staffel, a pediatric dentist in Fort Worth, who said she has stacks of evidence — in the form of patient records — of children being overtreated and, in effect, abused by dental clinics seeking to profit off the state’s dental program for low-income children.

On Monday, for example, she had to remove six teeth in a child’s mouth that had abscessed less than six months after Medicaid paid for the child to be treated at a nearby dental clinic. “When I see this type of situation, I’m pulling patient records, I’m keeping patient records, I’m calling the [Office of the Inspector General],” said Staffel.

Evidence turned over to the state by whistleblowers is filed under seal. And state officials cannot disclose how many investigations they are currently pursuing. But one provider, All Smiles, which was the focus of a WFAA-TV report in October that brought the allegations of fraud into the national spotlight, appears to be in their crosshairs.

State authorities familiar with the task force’s investigations said the group is committed to recovering all taxpayer funds lost to dental fraud, from both dental providers and the Texas Medicaid and Healthcare Partnership, which was responsible for evaluating the medical necessity of dental claims and approving payment.

The state audited TMHP’s process for evaluating dental claims in 2008 and recommended that the contractor increase the number of licensed dental professionals reviewing orthodontia claims, according to a State Office of Administrative Hearings report related to a recent allegation of Medicaid dental fraud. “TMHP responded to the audit’s recommendation by saying that an increase in the use of dental professionals would require a change in TMHP’s contract, which did not occur,” the report states. 

TMHP recently renewed its state contract, and state officials familiar with the investigations said they plan to work with the company on negotiations to recover state funds lost to medically unnecessary claims.

In an email to The Texas Tribune, Ken Ericson, a spokesman for TMHP, said, “Several providers are under state attorney general investigation — and we are cooperating with that investigation.”

Most of the rise in Medicaid dental claims was probably legitimate, said Stephanie Goodman, spokeswoman for HHSC, because the state had increased reimbursement rates by 50 percent to expand access to care. “Those other factors kind of masked the fact that there was also probably an increase of bad actors in the program,” she said.

Texas became a target for dental fraud after 2007, when the Legislature allotted an additional $1.8 million for Medicaid children’s dental services, as part of a legal settlement to increase access to care.

State authorities familiar with the task force's investigations confirmed it has found that some dental clinics have illegally solicited Medicaid patients by standing outside large retailers and grocery stores and handing out gift cards in exchange for signing up for a free dental exam. And the inspector general recently issued a statement that said, “Offering inducements to Medicaid clients is a violation of state and federal law and is subject to a penalty of up to $10,000 per violation.”

As the Tribune reported in July, the crackdown on orthodontic fraud has left many patients with untended braces, and a difficult transition to Medicaid managed care has exacerbated problems with access to care. The state is currently severing ties with Delta Dental, one of three Medicaid managed care plans, in part because state officials said the company failed to establish a computer system for providers to submit claims in a timely manner. In December, 1.1 million individuals enrolled with Delta Dental will be transferred to the other two managed care dental plans.

Staffel said the transition to managed care has limited the number of orthodontists willing to take referrals for Medicaid patients, and many patients have been left "hanging in limbo," after the state shut down their orthodontic clinic by withholding Medicaid payments while the state investigates allegations of fraud.

HHSC has informed orthodontic providers that the dental board can suspend or revoke their license for abandoning Medicaid patients. 

"We’ve worked really closely with the dental board on that issue," said Goodman, adding many orthodontists have also stepped up to help address the problem with access to care. "Even providers that didn’t normally take Medicaid patients have agreed to take a few."


 

  • Dr. Staffel worked for Dr. Eugene Kouri at Eugene Kouri, DDS MSD, Inc. 2921 Lackland Road #201, Fort Worth, TX 76116

 

  • Gene M. Kouri, DDS, MSD - Dr. Kouri received his MSD in Pediatric Dentistry and his doctorate in Dental Surgery from Baylor University. He began his private practice in 1961 with a brief interruption for service as a captain with the United States Army Dental Corps. Dr. Kouri’s professional associations include the Texas Society of Dentistry for Children, American Academy of Pediatric Dentistry and the Southwestern Society of Pediatric Dentists. – http://genekouriddsmdfortworthtx.com/texas-pediatric-dentists

Dr. Eugene Kouri came in at number 8 in 2010 Texas’s Top Stainless Steel Crown  state records, topping off at 6,108. In 2011 his office billed the state over $2M, nearly $700M for stainless steel crowns alone!

2010 Top Ten Dentists to bill Texas for stainless steel crowns:

  1. Linda T. Burke -  Harlingen, TX
  2. Trueblood Dental Associates - Austin, TX
  3. Buckner Market Place Dental - Dallas, TX
  4. Smile Center – San Antonio, TX
  5. Robert Morgan DDS MSD – Irving, TX
  6. Kool Smiles Laredo, TX
  7. Valley View Smiles/ All Smiles Dental – Dallas, TX
  8. Eugene Kouri, Fort Worth, TX
  9. Bill Pope, McAllen, TX
  10. Robert Morgan DDS, Richardson, TX

 

Friday, July 27, 2012

Texas Stakeholders meeting today at 1PM Central time: Orthodontics on the menu.

Click reserve my seat, fill out the form and they will send you a link to the meeting.

http://www.hhsc.state.tx.us/news/meetings/past/2012/072712-Dental-Stakeholders-Meeting.shtml

Medicaid Dental System an Ongoing Challenge

Texas Tribune July 27, 2012

While Texas works to fix a system that allowed dental clinics to charge the state millions of dollars in questionable Medicaid bills, dental providers say impoverished Texas children do not have adequate access to care and that the state’s rocky transition to Medicaid managed care is compounding the problem. 

Concerns over the system will be addressed Friday, when the state’s Health and Human Services Commission holds a "dental stakeholders" meeting in Austin. John Roberts, an official with HHSC, said the dental directors of managed care health plans, members of state government and other state officials will address 14 questions previously submitted by dental providers across the state. One topic on the agenda: "Discussion on orthodontic continuation of care for abandoned patients."

Shannon Ash of Lewisville says her three teenagers haven’t been able to get their braces checked by an orthodontist for two months and are using wax to hold off the pain from wires cutting into their cheeks. After the dental clinic that had gotten state approval to put braces on her children shut down, the children’s new orthodontist told Ash that the Medicaid managed care dental plan assigned to her children by the state didn’t think her children’s braces were medically necessary. Therefore, it wouldn’t reimburse the orthodontist for treatments.

“I don’t have money to take care of the issue, or else I would have had it done myself,” Ash said. “If I had known this [would happen], I would have just let my kids’ teeth be crooked.”

After news broke last fall that Texas was paying millions to dental clinics for fraudulent or unnecessary Medicaid activities, such as putting cosmetic braces on low-income children, the state cracked down. The Health and Human Services Department's Office of Inspector General has put 23 orthodontic clinics on payment holds since October while it investigates fraud allegations. And managed care organizations that began administering Medicaid dental plans in March are placing stricter requirements on dental providers to prevent fraud.

Wednesday, May 30, 2012

Orthodontics Offices Closing in Texas

Looks like the spin has started in Texas. I’m hearing many Orthodontic clinics will  close up shop on July 1, 2012.

In the piece below, Dr. Michael Newman's says, "...about 5 percent of them would meet the requirements now."

Fact is, about 5% qualified EVER! Only thing that is changing is maybe, just maybe, stricter enforcement of standards already in place.

Surely Dr. Newman really meant to say, "about 5% is all we can bill for and not get nailed for Medicaid Fraud, now"

TIMES RECORD NEWS - Wichita Falls, Texas

Orthodontist office braces for closure
Practice was only one in area taking Medicaid

Wichita Falls, TX May 26, 2012 -The only orthodontic office accepting Medicaid payments in Wichita Falls has stopped seeing patients and has locked its doors.

Red River Orthodontics set up shop on Euerka Circle in mid-2010. A sign in the door of the vacated Wichita Falls practice directs patients to an office in Fort Worth.

Representatives of Red River Orthodontics declined to comment, and referred questions to an attorney who could not be reached Friday.

The business was registered in the Wichita County Clerk's office under the title John Gremmels, Grill Repair, PA. The address given was in the 3300 block of Monterra Crest Drive in Fort Worth.

Last year Texas paid out $184 million in Medicare for orthodontics. That's more than every other state combined.

Dr. Bill Hendrickson, of Hendrickson Heetland Orthodontics, said he suspects Red River Orthodontics bolted for the door when they realized the Medicaid money was drying up.

"Their words were, 'It's a good investment,'" said Hendrickson, who visited the office personally. "They said, 'This is a very lucrative business.'"

Hendrickson now is in talks with state officials. He said he's trying to take on the patients who were displaced when Red River Orthodontics jumped ship.

Technically, at least one dental office that offers orthodontic services still accepts Medicaid, but is actually kept from doing so because of more stringent, state-mandated requirements.

In 2005 about 80 percent of dentist Dr. Michael Newman's patients were on Medicare. Newman, who operates Texas Orthodontics in Wichita Falls with his wife Denise, practices orthodontics as well as other dental procedures. Until October 2011 he was able to treat most of the patients who needed Medicaid to pay for his services.

But stricter enforcement of Medicaid standards mean that most of them, even patients who have already been fitted with braces, won't receive his care.

"I would say about 5 percent of them would meet the requirements now," Newman said.

In fact, only one of his potential patients received the go-ahead from the state for treatment. Newman wasn't allowed to treat that patient because he isn't a specialist.

A few factors have contributed to this, he said.

One is that some orthodontists have been accused of taking advantage of Medicaid funds. One case, detailing taxpayer money given to All Smiles Dental Centers in Dallas, has drawn significant media attention.

Another factor is the splitting of the third-party entity that paid Medicaid funds to orthodontists, the Texas Medical and Healthcare Partnership. About a year ago, he said, the company was divided into three new agencies, DentaQuest, Delta Dental, and Managed Care of North America. Newman said it hasn't been the same since.

He said the companies have drawn up constricting new rules that makes it virtually impossible to get a patient approved for payment.

"They started cutting back so that we couldn't get the cases approved," he said.

One rule that's being more strictly enforced is that an orthodontist must prove that a procedure is "medically necessarily" to maintain a patient's health. Newman said this is laughable.

"There is no patient I have ever seen who is going to die because of their teeth," said Newman, an officer of the American Orthodontic Society.

Friday, April 13, 2012

Just a wild guess, but I’m thinking the ADA and the DGPA are none too happy about the hearings on Corporate Dentistry in Texas

Yes, the ADA is a different group and as we know the ADA rules, since they have the gold. But honestly, they might as well be the one and the same.  If you dig deep enough everyone with the DGPA is with the ADA, right?

Just two short days before the Texas Hearings on April 11, 2012, the ADA issued this:

 

 

ADA explores growth of large group practices

By Karen Fox, ADA News staff
April 09, 2012

The ADA is taking steps to increase dialogue with large group practices and gather information regarding this rapidly expanding career option.

Image: Growth of corporate dentistry

This sector of the dental workforce has experienced significant growth in a relatively short period of time. According to the ADA Health Policy Resources Center, in just two years the number of large dental group practices has risen 25 percent.

For now, it’s still a small piece of the overall dental delivery system pie. In a 2008 sampling frame, the Health Policy Resources Center concluded that solo dentist practices account for 92 percent of all dental practices, and very large group practices with 20 or more dentists make up only 3 percent.

However, in analyzing its data on individual dentists, the HPRC has concluded that the rate of solo practitioners is falling. In 2010, 69 percent of dentists were solo practitioners compared to 76 percent in 2006.

Wednesday, April 11, 2012

Texas Dental Board Meeting

Just a reminder today is the day of the big Texas Dental Board Meeting, the one where the Dental Board Executive Director didn’t want to attend, so she resigned.

I look forward to a report on the action.

Sherri Meeks resigns.

Update on April 11, 2012 – the condensed version:

  1. Legislature wanted to talk “Corporate Dentistry”
  2. Dental Board claims not to have a clue nor the authority to have a clue.
  3. Riled up a well versed audience member or two
  4. Fire in the Hole!

I’m sure the reporters that were there will have more detail on this tomorrow, hopefully but it might take a day or two for them to get up to speed.