March 6, 2014 -- Why should anyone care about a dental Medicaid ruling from an administrative law court in Travis County in Texas? One reason is that this case involves several millions of taxpayer dollars. Other similar cases brought before this court of alleged dental Medicaid fraud and abuses have and will involve taxpayer money, in excess of $100 million.
The vast majority of dental Medicaid fraud cases are generally resolved in settlement agreements. Alleged violators usually pay some amount of restitution to the government in exchange for no admission of wrongdoing. Often, the alleged violators return to "business as usual." We, the public and dental profession, receive little or no data on case specifics. Records of investigations are sealed upon settlement.
Public record disclosure of this particular case exposed some of the dark underbelly of the dental Medicaid industry, along with some of its nefarious inner workings.
The scammers running the Texas Dentists for Medicaid Fraud Reform (TDMR) website have boasted time and time again, over rulings made against Texas taxpayers and for Antoine Dental. Heck, they have a whole section of their website devoted to their “wins”. They have also had their cronies on this website, commenting about how they are winning their cause; which appears to be “Let us continue to defraud taxpayers.” Frankly, I think their name should be “Friends of Dental Medicaid Fraud”. I’m not sure what they consider a “win”. Apparently, it’s not what you and I call a “win”. Their headlines over there are outright false! So imagine the bullshit contained within! I especially love their comment section, entitled “Speak Your Mind”, amazingly what is on my mind doesn’t seem to make it, maybe yours will. Click here.
Today, what’s missing from their website is the headline of this blog post;or something close to it.
It appears the Applet Court and Judge Rick Gilpin disagreed 100% with all other rulings in the Antoine defraud Texas taxpayers case. He issued a “Final Order” on Friday (February 28,2014) that walked through this case and all the hearings and ruling step by step and ruled completely opposite of all other rulings—Antoine Dental to remain on 100% pay hold.
You don’t want to miss reading the Final Order. He all but called them all, Antoine owner, Dr. Nazari—including the Administrative Law Judges—criminals and at the best—imbeciles. You read it and decide.
On Dental Claims, State’s Bark Worse Than Its Bite
by Becca Aaronson
October 15, 2013
Texans discovered nearly two years ago that the state was spending more on orthodontic claims in its Medicaid program than the other 49 states combined, but recovery of millions in purportedly misspent Medicaid money has moved slowly.
After a couple judicial setbacks, the Health and Human Services Commission’s Office of Inspector General has stepped up its game by bringing in the big guns at the attorney general's office and private counsel. The OIG also hired a chief dental director, Dr. Linda Altenhoff, and is making sure that multiple dental experts review cases before they’re brought to a judge. The outcome of those efforts will be apparent when an administrative judge rules on a case testing the state's evidence for withholding payments to Antoine Dental Center in Houston, which was argued in May.
Meanwhile, the accused Medicaid providers have made it clear they aren’t returning any money — or allowing the state to sully their reputations — without a fight. They’ve formed a coalition, Texas Dentists for Medicaid Reform, and filed a lawsuit against the state challenging the OIG’s hardball tactics of withholding Medicaid payments for months on end during fraud investigations with limited evidence that fraud occurred.
[We can’t forget about Texas Dentists for Medicaid Fraud. See links at end of this blog post.]
After WFAA-TV in Dallas reported in December 2011 that Texas spent more on braces and Medicaid orthodontic claims between 2008 and 2010 than the other 49 states combined, the U.S. House Committee on Oversight and Government Reform released a report that found the Texas Medicaid and Healthcare Partnership, the company contracted by the state to process Medicaid claims, had only one dentist on staff and essentially rubber-stamped dental and orthodontia claims without reviewing whether those services were medically necessary.
Texas Dentists for Medicaid Reform has all the trappings of a public interest group: The State Capitol is featured prominently on its website; the Texas star is in its logo; the word "reform" is in its title.
But TDMR, as it calls itself, acts like a private interest group.
Last month, the organization held a dinner at the Omni Southpark Hotel in Austin. TDMR's website invited the public, but the event was not public after all.
An e-mail informed News 8 we would not be allowed to attend.
Board member Dr. Juan Villareal would not disclose who the organization's donors are. "Donors can be anonymous, and a lot of them don't want their names mentioned," he told WFAA, adding that TDMR does not have members, only donors.
"We basically take donations from people who are interested in our cause," Villareal said.
So what is the cause? "Due process" is a phrase overheard in the hallway outside the dinner venue. TDMR offered News 8 an interview with a lawyer — presumably on its payroll — to explain the term "due process."
A look at the name tags outside the dinner show many of of the invited guests have had their Medicaid payments suspended under a doctrine called Credible Allegations of Fraud (CAF). Under CAF, physicians and dentists can have their Medicare or Medicaid payments withheld if the government believes they've committed fraud.
Dr. Villareal had $1.2 million in Medicaid dental payments to his clinic, Harlingen Family Dentistry, suspended under CAF. He appealed his case and won in an administrative hearing, but says he still hasn't received his money.
TDMR's board consists of Villareal, his partner, and another dentist who was charged with Medicaid fraud.
TDMR's website traces to an office labeled "SLS Worldwide Transportation" at a strip mall in Austin. The same address is also home to a website for Dr. Richard Malouf, a Dallas dentist who's being criminally investigated for fraud by the state of Texas.
And the SLS Limousine office is home to the website of Harlingen Family Dentistry, Villareal's dental office.
"TDMR is not so much about the money, as it is about denying due process" Villareal said. "That's the main concern."
"Due process" may summarize Medicaid reform for TDMR's donors.
But Dr. Morna Staffel said that doesn't speak for a Medicaid system she and many other dentists wrestle with every day.
"I don't think there is a group that's speaking out for the legitimate and the ethical dentists... either general dentists or pediatric dentists," she said.
Dr. Staffel's office regularly has to re-do work done by some of the dental chains supporting TDMR.
"Yesterday, in fact, I had to do dental treatment on three different children who'd been treated at another dental clinic during a 12-month period," Dr. Staffel told News 8. "Eighty percent of the restorations that had been placed either were improperly placed, or done incorrectly, or failing."
That work will need to be redone, she says, but getting Medicaid to pay for it is a slog.
"It's very time-consuming. It requires a great deal of my office staff time." Dr. Staffel said. "In the end, if we don't do the treatment, the child gets hurt."
She said her office often ends up doing the work for free.
Dr. Staffel wants parents — even those on Medicaid — to know they have a choice in dentists. And if they feel their children are not getting treated properly, they can go elsewhere.
So who really is Texas Dentists for Medicaid Reform? Thirty-nine dental chains have had their Medicaid payments withheld under Credible Allegations of Fraud.
As for many other Texas dentists, reform means something else.
Texas Dentists for Medicaid Reform (TDMR) testified before the Texas Senate Finance Committee recently. The group was "singing the blues", saying all the reports of any such fraud taking place in Texas are lies. .
Despite recent reports of $1billion dollars in Medicaid monies being recovered by the Texas Attorney General’s office in the last 10 years, the group’s attorney, Greg Ewing, all but called it hogwash at the hearing.
Their press release contained the mother of all Freudian Slips and guess who was lucky enough to find it?
The original link to their website contained in the press release read “Texas Dentists for Medicaid Fraud.” In that entire press release there were two truthful statements: the speaker was in fact Greg Ewing and their mission is Medicaid Fraud
Within three days after this blog pointed it out, the PRWeb press release had been changed. Now there is only one honest statement, Greg Ewing’s name, and that might be in question at this point. Do they read this blog, you bet!
This group has the fingerprints of savvy political operatives all over it. You know what I mean; call it one thing even though it’s something else.
Their name gives the illusion they are for “reform”. I suspect in reality they are for “fraud”, as their “fraudian” slip (above) indicated. Their actions indicate the only reform they support is for the Texas OIG or AG to disband any investigations in to Medicaid fraud. See their January 2013 testimony in front of the Texas Senate Finance Committee.
Anyone want to take bets on whether their web presence will appear they are middle of the road, trying to fix what’s broken, etc.? Truth is, they don’t want what’s broken fixed at all!
WFAA’s Byron Harris must be fed-up with his reports and statistics being questioned by folks hoping to keep the Medicaid dental spending unchecked in Texas.
Here is Byron’s latest:
Bracing Ourselves: How Texas spent $705 million on Medicaid braces
by BYRON HARRIS Bio | Email WFAA Posted on February 4, 2013 at 6:35 PM Updated yesterday at 2:32 PM
Until last year, the Texas Medicaid Dental Orthodontic program was spending money like a Christmas shopper on Black Friday. Between 2008 and 2011, Texas spent $705 million on Medicaid orthodontics, which experts say many children don't even need. That's because the state was paying the bills without adding them up, or even seeing if the money was well spent.
It was what Doug Wilson, the Inspector General of Texas Health and Human Services, calls a "pay and chase" environment. Texas now is earnestly in the "chase" mode. It has between 300 and 400 open investigations. Wilson took over the Office of Inspector General in 2011, and after a series of WFAA stories exposing questionable Medicaid payments, the state is beefing up its investigation of Medicaid fraud.
"Texas is a huge state. There are a lot of kids out there," Wilson told News 8 in a lengthy interview last month. "Some of the things we're seeing are just errors and other things that we're seeing are more intentional. And we're taking appropriate actions and making referrals as necessary."
The state now is holding payments back from 91 Medicaid providers for Credible Allegations of Fraud. Dozens are dentists and orthodontists.
The first signs of trouble were in 2008. That's when an audit by the OIG revealed problems.
"The volume of prior authorizations (for spending on braces) was extremely high," Wilson says.
The OIG warned the state that applications for braces (orthodontics) were not being inspected carefully enough, and that the state should consider beefing up its staff.
"We thought things were going to get better," Wilson says. "As we now know, they didn't necessarily get better. The volume of orthodontia in our state was extremely high. We warned them, and I think they tried to act but they didn't go far enough."
In 2011, News 8 began asking for Medicaid records under the Freedom of Information Act (FOIA) and the Texas Public Information Act (TPIA) to see how much Texas was paying to put braces on kids under Medicaid, and how it compared to the rest of the nation.
Data obtained by News 8 from TDHHS showed that Texas spent $184 million on orthodontics for Medicaid kids in 2010. News 8 had to pay for this data because the state did not compile them on its own. TDHHS has now adjusted the total upward to $200 million.
To get a national picture, News 8 obtained total spending figures from the federal Medicaid Statistical Information System (MSIS). These numbers, which took weeks to obtain, had never been compiled until News 8 asked for them. The most recent totals available were, and still are, from 2009. The entire nation spent $355,550,331 in 2009.
Texas alone spent about 70 percent of the rest of the nation combined.
Last week some whacked “organization” had their “President” testify before the Texas Senate Finance Committee singing the blues over dentists being investigated for Medicaid fraud in the state.
Well, it’s not really an “organization” per se, it’s more like 3 highly questionable dentists and a general counsel for a controversial law firm.
Greg Ewing, president of Texas Dentists for Medicaid Reform Fraud (you will understand this later) group said dentists were unfairly having funds withheld by the state because of a “2 years of disinformation” – did he mean by the media? If so, that means the media has mucho power! He further stated “evidence of fraud does not exist”. Ewing actually insinuated to even investigate the possibility for Medicaid fraud would be a waste of taxpayers money, saying “the State will lose money because the level of investigation will end up costing taxpayers millions more".
Was he really telling the Senate Finance Committee, “look guys, they have already stolen it, let ‘em keep it and while you’re at it, tell HHS and OIG to leave them alone?”
Ewing also sat there with a straight face and told the Finance Committee that the Texas Medical Association did an independent review of Carousel Dentistry operations and found the clinics “highly efficient”. Why Carousel was even mentioned in beyond me. More on Carousel later.
Who is Texas Dentists for Medicaid Reform?
The president of TDMR is Greg Ewing, an attorney for Asbahi Law Group. Asbahi Law Group is more or less a lobbyist started in 2009 by Mazen Asbahi, a former community organizer, but best known for his appointment by the Barack Obama campaign to head up outreach efforts in the Arab American and American Muslim community. Asabahi later resigned after it was revealed he served on the board of the Allied Assets Advisors Fund with Jamal Said which supposedly raised money for Hamas. Currently it’s reported Mazen Asbahi newest lobby efforts are to get guns to Syrian Rebels.
Wonder why this Mazen Asbahi guy is so interested in Texas Medicaid fraud?
The only other people mentioned on their website are 3 members who are dentists., Dr. Tara Rios, Dr. Juan Villareal, DDS and Dr. Vivian Teegardin, DDS, both of Harlingen Family Dentistry in Harlingen, Texas.
Dr. Tara Rios, DDS Brownsville Family Dentistry 1601 E. Alton Gloor Boulevard Suite 108 Brownsville, TX 78526 Phone: (956) 542-1956 Fax: (956)542-3672 office@drtarariosdds.com 2010 –D2930 Crowns = 82
In the bios of the “members” of TDMR, they fail to use Dr. Rios’s complete name – Dr. Tara Rios Ybarra. In 2010 then Texas State Representative (D-South Padre Island) was taken into federal custody for Medicaid fraud which also involved Texas dentist Gary Morgan Schwaz and six others. Schwaz, owner of Valley Oral and Maxillofacial Surgery was accused of paying dentists to received referrals for Medicaid recipients.
Appears it’s not the first time Rios-Ybarra has been used as a patsy. While a Texas Representative it appears she sponsored bills that were actually put forth by “special interests”.
Comment: “Well, we can all see that she was basically elected to her district because she is Hispanic and nothing more. I guess this is what happens when you are corrupt. She had no business being elected to any office in the united states. She would be great in Mexico though. Worthless piece of trash!”
Dr. Tara Rios, DDS