Showing posts with label Texas Orthodontics. Show all posts
Showing posts with label Texas Orthodontics. Show all posts

Thursday, February 21, 2019

Xerox Pays $236 Million to Settle State of Texas Dental Fraud Case Legal Team: Whistleblowers Dr. Christine Ellis, Madelayne Castillo, Yarubi Morales and others Are Vindicated

Xerox Pays $236 Million to Settle State of Texas Dental Fraud Case
Legal Team: Whistleblowers Dr. Christine Ellis, Madelayne Castillo, Yarubi Morales
and others Are Vindicated


AUSTIN, Feb. 20, 2019 – The $236 million settlement of the State of Texas’ Medicaid fraud
claims against Xerox Corp. business units vindicated whistleblowers Dr. Christine Ellis,
Madelayne Castillo, Yarubi Morales and other whistleblowers, their legal teams said today. The
settlement is the largest recovery ever in a healthcare fraud recovery suit in Texas for Medicaid
related claims.

The State’s lawsuit alleged that Xerox violated the Texas Medicaid Fraud Prevention Act and
“rubber-stamped” prior authorization requests by unqualified clerical employees, allowing “vast
numbers” of orthodontic procedures for children whose condition did not meet Medicaid criteria
for treatment. The company, formerly known as Affiliated Computer Services, Inc., before Xerox
acquired it, also was accused of making false statements or representations in Medicaid filings
with the state.

Dr. Ellis, an orthodontist in Dallas, testified before a congressional committee in Washington in April 2012 about alleged Medicaid fraud in orthodontic billings by Texas dentists.

Ms. Castillo was an employee of the now-defunct All Smiles dental chain and West Texas Dental. Ms. Morales was a former employee of the now defunct All Smiles dental chain and Rodeo Dental.

Dr. Ellis, Ms. Castillo, Ms. Morales and several other whistleblowers all filed suits approximately
two years before the State filed its suit. The State has acknowledged that the facts underlying its
suit are the same as those underlying the whistleblowers’ previous filings.

Xerox became the state’s Medicaid administrator in 2003. Between 2004 and 2012, Texas
expended approximately $1.1 billion on orthodontics under the Texas Medicaid program.
According to the State’s lawsuit, Xerox, and ACS, Inc. before it, repeatedly represented to Texas
Medicaid officials that their prior authorization system ensured proper predeterminations of
qualifications.

Ms. Castillo, Ms. Morales and several other whistleblowers who filed cases against ACS/Xerox
are represented by Rusty Tucker of the Law Offices of James R. Tucker, P.C. of Dallas and MikeTibbals of Dallas. Ketan U. Kharod, of Guerrero & Whittle, PLLC, of Austin, Charles S. Siegel
and Caitlyn Silhan, of Waters and Kraus, of Dallas, Daniel L. Hargrove, of the Hargrove Law Firm
of San Antonio, and James R. Moriarty, of the Law Office of James R. Moriarty of Houston
represent Dr. Ellis.

Charles Siegel of Waters and Kraus said, “Because of Dr. Ellis and other whistleblowers who
brought lawsuits against ACS/ Xerox, the State of Texas ultimately showed how Xerox and ACS,
Inc. deeply compromised the integrity of the Texas Medicaid program. They faced vicious legal
attacks in their courageous efforts to set the record straight.”


Rusty Tucker of the Law Offices of James R. Tucker, P.C. said, “Our legal team hopes this
settlement sends a strong message that companies that prey upon Texas families and defraud the
state will face the judgment of the courts. Companies who commit unlawful acts in violation of
the Texas Medicaid Fraud Prevention Act will be held accountable. Dr. Ellis, Ms. Castillo, Ms.
Morales and other whistleblowers who came forward should be recognized for helping expose this
massive fraud.”

The case is “The State of Texas v. Xerox Corporation, et al.,” Cause No. D-1-GV-14-000581 in
the 53rd Judicial District of Travis County, Texas.

CONTACTS:
Rusty Tucker, Law Offices of James R. Tucker, P.C. (214) 505-0097
Charles Siegel, Waters and Kraus (214) 357-6244
James Moriarty, Law Offices of James R Moriarty (713) 857-1212

Thursday, June 27, 2013

Texas cracking down on unnecessary dental treatment

FrotnlineTexas Law Cracks Down on Unnecessary Dental Treatments

June 27, 2013, 11:55 am ET by David Heath Center for Public Integrity

A new Texas law will give regulators more power to crack down on dentists performing unnecessary treatments, especially on children.

A spokesman for the bill’s author — Republican State Rep. Lois W. Kolkhorst of Brenham, Texas — said the law came about largely because of a joint investigation by the Center for Public Integrity and PBS Frontline. The investigation revealed a pattern of questionable practices by Kool Smiles, a chain focused on Medicaid-provided dental care for children. The spokesman also credited independent reporting by Dallas station WFAA-TV on Medicaid fraud.

The joint investigation by the Center and FRONTLINE, titled Dollars and Dentists, quoted former employees who alleged that dentists at Kool Smiles were encouraged by company production standards to put more expensive stainless-steel crowns, rather than fillings, on cavities in baby teeth. Kool Smiles denies those allegations.

“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,” Kolkhorst said in a statement.

Kolkhorst said only one dentist has had his license revoked for Medicaid fraud or patient complaints in the past two years. “That’s just not acceptable,” she added.

The law beefs up the ability of the state dental board to investigate complaints. It also gives parents the right to be in the room with their children while they are at the dentist.

In addition, dentists working for corporate dental chains are required to report information about the chains to the dental board. Currently, the state maintains no information about dental chains.

Gov. Rick Perry signed the bill last week. It takes effect on Jan. 1.

Watch Dollars for Dentists

Wednesday, February 13, 2013

Texas orthodontist, Dr. Michael Goodwin to fork over $1.5 million beside fine and facing prison.

I bet Dr. Richard Malouf’s ears perked up yesterday when he heard good ole Dr. Goodwin had to fork over $1.5 million, beside a fine of $250,000 and facing up to 10 years in prison. But come to think of it, Malouf has already agreed to pay up over $1M to settle fraud charges. Hmm…

amarilloFebruary 12, 2013

Amarillo orthodontist must forfeit $1.5M

By Jim McBride

jim.mcbride@amarillo.com

An Amarillo orthodontist must forfeit $1.56 million he fraudulently gleaned from the Texas Medicaid program by billing for dental work he never performed, an Amarillo judge has ruled.

In a preliminary order issued Monday, U.S. District Judge Mary Lou Robinson said the government presented “credible evidence” Michael David Goodwin, owner of Goodwin Orthodontics, 3629 Wolflin Ave., reaped $1.56 million in ill-
gotten gains between 2008 and 2011.

Goodwin, 63, pleaded guilty in December to one count of health care fraud. He faces up to 10 years in federal prison and a fine of up to $250,000 when he is sentenced. Under the plea, Goodwin agreed not to challenge the forfeiture.

Prosecutors allege Goodwin frequently billed for work he never performed and scheduled up to 100 patients daily. Employees and patients likened the scheme to “herding cattle,” court documents show.

A phone message Tuesday at Goodwin Orthodontics said the office was temporarily closed.

Friday, February 08, 2013

Texas Medicaid orthodontics spending off the charts; Facts are facts folks.

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:

 

WFAABracing 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.

Texas Medicaid Dental and Ortho Jan 2013

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 Ortho

 

Texas alone spent about 70 percent of the rest of the nation combined.

Saturday, December 22, 2012

A special Christmas blessing goes out to the orthodontists who have volunteered to see these victimized children!

For the past several years, hundreds of Texas Orthodontic clinics have put braces on children who didn't need them, all to bilk the Medicaid system - stealing your tax dollars. Now that the Feds and State of Texas are hunting down the dirty dogs. What did the owners do? Well they locked their doors and ran; being the cowards they are. Now, ten’s of thousands of children have been abandoned, braces still on and treatment unfinished. Now, volunteers are stepping in.

 


 

Roderick Williams, 11, got his braces more than two years ago. When we met him, all that remained were brackets. His wires were broken. His orthodontist was out of business.

His mom, Denecia Williams, was at a loss.

"Now what do I do?" she said. "And it's been a hassle ever since."

Like hundreds of other Texas kids,  Roderick was stuck without anyone else to remove what was still left in his mouth. Now there is.

 

Thursday, October 18, 2012

Texas expands Medicaid dental fraud estimates to $154 million

 

;

by BYRON HARRIS Bio | Email WFAA-TV Posted on October 17, 2012 at 10:03 PM Updated today at 12:01 PM Story

NEWS 8 INVESTIGATES

WFAATexas Medicaid dental expenditures quadrupled in recent years, from $400 million in 2006 to $1.43 billion in 2011. The Office of Inspector General is now tracking more than $383 million of potential fraud and overpayment, it told a Texas House of Representatives committee.

In a House hearing on Monday, News 8's investigations of Medicaid dental fraud were praised by state representatives. "I have to tip my hat to WFAA in Dallas for doing what they've done," said Rep. Lois Kolkhorst (R-Brenham), chairwoman of the Public Health Committee.

The state has suspended payments to 26 orthodontic organizations under a policy called Credible Allegation of Fraud (CAF). The state can hold money back from Medicaid providers if it suspects it was billed fraudulently. Texas estimates that $229 million in Medicaid payments to put braces on kids' teeth may have been improper.

Audits show as many as nine out of 10 payments may have been fraudulent. For general dentistry, more than $154 million may have been overpaid. Expert analysis shows half the bills checked were erroneous. Eighty-nine dental providers have had payments withheld under CAF.

The OIG told a the public health committee of the Texas House that more manpower, more interest in fraud, and improved software are helping catch more fraud going forward. E-mail 

E-mail bharris@wfaa.com

Tuesday, August 28, 2012

22 year old sues dentist for rotten teeth after braces for 11 years

August 28, 2012

By Erin Tennant, ninemsn

A 22-year-old patient is suing his orthodontist for making him wear braces for 11 years.

Devin Bost from the US state of Oregon said he wore braces from the age of 7 to 18, causing him tooth decay and gum disease, according to this lawsuit.

He filed his lawsuit in a county circuit court last Friday, seeking $150,000 for pain and suffering and a further $35,000 to pay for corrective surgery.

Some of Mr Bost's teeth will need to be removed and replaced with implants, his lawyer said, but it may not be possible in some parts of his mouth because the teeth have rotted through to the jaw.

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.

Thursday, July 19, 2012

Dr. John G. "Jack" Vondrak’s Sun Orthodontix abandon possible 4,000 patients.

 

EL PASO, Texas – KVIA TV Part 2

sunorthodonixParents of former patients, an attorney and Health and Human Services are claiming a chain of orthodontics clinics are committing patient abandonment.


After Texas Medicaid cut off reimbursement to Sun Orthodonix, amid a fraud investigation by the Texas Office of Inspector General, the chain of clinics in turn cut off treatment to its Medicaid patients still in the midst of orthodontic treatment.

The move has left hundreds of teens and adolescents with braces on their teeth but no doctors treating them.

One El Paso orthodontist estimates up to 4,000 El Paso kids could be affected from the response from Sun Orthodontix and other local clinics which may be doing the same to their Medicaid patients.

Not having a doctor is a hard fact to swallow for two Northeast El Paso teens well into their orthodontic treatment they had be undertaking with Sun Orthodontix.

The pair has fought through the discomfort of braces, the pain of tooth extractions and even the stretching of their mouths by orthodontic devices.
"He ran a fever he was in pain, he didn't eat," the boys' mother Emma Diaz said about her 14-year-old, Issac. "And now it's like we go through all of that and what now?"

Diaz says her sons showed up to their routine orthodontics appointment at Sun's Northeast El Paso location in June, where they were handed letters giving the boys two options: have the braces removed by Sun, or leave the braces on and find another orthodontist.

"It would be considered patient abandonment," Health and Human Services Commission spokeswoman Stephanie Goodman said. "And it's true for dentists, orthodontists, doctors, it's fairly standard across the medical profession."


A patient contract obtained by ABC-7 from when a teenager first got her braces at a Sun Orthodontix clinic in El Paso reads:
"Good news! Once the braces have been placed, your treatment is fully covered. Even if you happen to lose your insurance, by keeping your monthly appointments, you are guaranteeing that your insurance will continue to pay for services rendered."

But even though the patient kept her appointments, as soon as Medicaid cut its payments to Sun Orthodontix, a subsidiary of National Orthodontix Mgmt, treatment was cut as well.

Sun Orthodontix's attorney, Frank Sheeder, would not address this "guarantee," but he did say the clinics are following the process for terminating and transferring care.

Sheeder says the state pre-approved the treatments, then without warning, put a hold on Medicaid reimbursement five months ago.

In an email, Sheeder writes:
"An orthodontic practice can't reasonably be expected to continue to provide services for free for such a long time."

In the letters to patients, Sun states that it has been forced to lay off more than a hundred employees and four orthodontists.

Still, Goodman says lack of payment should not translate into lack of treatment.
She says doctors have a professional obligation to finish what they started or they could face consequences.

"In those cases where we have an orthodontist, who is accepting Medicaid, put braces on a child or did any treatment, in most cases braces, and now says that because the payment's not there, 'I'm not going to continue the treatment'? We will be referring those to the dental board, who we're working very closely with," Goodman said. "And they've assured us they will move on those cases."

That assurance is not of much comfort to 16-year-old Andy Diaz.
He has had four teeth extracted as per his course of treatment prescribed by his orthodontist at Sun Orthodontix.

He has been left with the braces on his teeth and big gaps where his teeth used to lie.

"If they can at least just close the bottom ones, I'd be happy," Andy Diaz said. "You can't leave a kid with gapped teeth."

They already have, but for how much longer is the real question.

ABC-7's Matt Dougherty spoke with the owner and founder of Sun Orthodontix, Dr. John G. "Jack" Vondrak, when he was in El Paso recently.
Vondrak refused to comment on the record.

From Sun Orthodontix Website:

Dr. John Vondrak is the founder of Sun Orthodontix. His experience as a practicing orthodontist, that spans over three decades, and his commitment to provide families of all income levels with affordable, quality care have been instrumental to Sun's growth and success. Dr. Vondrak continues to treat patients and oversee the training of new orthodontists in Sun's specialized method of treatment.

Dr. Vondrak earned his orthodontic degree from Howard University School of Dentistry in Washington D.C. and completed his internship in oral surgery at Louisiana State University Medical Center in New Orleans. Dr. Vondrak received his Doctor of Dental Surgery from the University of Nebraska in Lincoln and served in the U.S. Air Force as a dental officer before entering private practice.

Dr. Vondrak is a past president of the New Mexico Orthodontic Society and a member of the American Association of Orthodontists (AAO), the Southwestern Society of Orthodontists (SSO), the American Dental Association (ADA), and local and regional dental societies in both New Mexico and Texas.

Dr. Vondrak's wife, Barbara, is herself an accomplished dental professional, who plays an active role at Sun. She holds a Masters Degree in Dental Hygiene Education, has worked as an Accreditation Consultant for the ADA, and has served as chairwoman of the American Dental Hygienist Association's Dental Education Committee.

The Vondraks have two daughters and a son, all of whom live in Texas. Their daughters, Cameron and Clarian, are following in their father's footsteps and are currently enrolled in dental programs. Their son, Greg, is the Project Coordinator for Sun, and their son-in-law, Craig, is the Director of Operations. The Vondraks are the proud grandparents of seven beautiful grandchildren.

Monday, July 09, 2012

The state of Texas is not done with Dr. Richard Malouf–Orthodontics Fraud King of Texas - and his All Smiles Dental Centers

 

wk



 

FOR IMMEDIATE RELEASE
Contact: Brandy Dietz
bdietz@waterskraus.com
800.226.9880

Waters & Kraus Client Takes on Dental Medicaid Fraud in Texas

Texas AG Joins Whistleblower Lawsuit Against Dallas Dentist and Dental Clinics
DALLAS — July 9, 2012 — Dallas-based law firm Waters & Kraus, LLP announces that Dr. Christine Ellis has sued Dr. Richard Malouf and several All Smiles clinics, alleging violations of the Texas Medicaid Fraud Prevention Act.
Dr. Ellis is represented by Waters & Kraus and Jim Moriarty of Moriarty Leyendecker in Houston. Her lawsuit was recently joined by Texas Attorney General Greg Abbott.

"We at Waters & Kraus are proud to represent Dr. Ellis and to be a part of the fight against dental Medicaid fraud," said Waters & Kraus attorney Dan Hargrove. "Whistleblowers like Dr. Ellis represent our best chance to fight serious fraud that drains the public funds and puts important services at risk."

After serving as an auditor for the Office of Inspector General of the Texas Medicaid Program, Dr. Ellis became concerned about dental fraud she had uncovered. When she spoke before the U.S. House Oversight and Government Reform Subcommittee in April, Dr. Ellis testified to a “flagrancy of fraud that is truly unbelievable." Shortly thereafter, Dr. Ellis filed her whistleblower lawsuit.

The lawsuit alleges that the defendants misrepresented to Medicaid the dental and orthodontic treatment they provided, causing Medicaid to overpay them by many millions of dollars. They allegedly submitted claims for services that were not actually provided or were poorly performed, billed for services that were not medically necessary or were more expensive than those actually provided, and unlawfully recruited patients or paid kickbacks to those who did.

Jim Moriarty, of Moriarty Leyendecker, said, “The courage of Dr. Ellis has shown in reporting these allegations deserves the attention and respect of anyone who cares about public health and the responsible stewardship of taxpayers’ funds. We’re honored to work with Waters & Kraus and Dr. Ellis on this important case.”
If the lawsuit is successful, Dr. Ellis will be entitled to 15 to 25 percent of the recovery, in addition to her costs and attorneys' fees. Whistleblower awards encourage people who know about fraud to come forward. The government relies on citizens like Dr. Ellis to identify and fight fraud.

About Waters & Kraus
Waters & Kraus is a national firm with highly skilled lawyers practicing qui tam whistleblower litigation as well as complex civil litigation in four offices, including Dallas, Los Angeles, San Francisco, and Baltimore. Our attorneys have decades of experience successfully representing whistleblowers in a variety of fraud cases. Contact us or call our attorneys at 800.226.9880 to learn more about our practice and how we can assist.

About Moriarty Leyendecker
Houston-based Moriarty Leyendecker has represented thousands of consumers in cases involving allegations of healthcare fraud, consumer defects, and securities fraud during the past 20 years.


Brandy C. Dietz | Public Relations Coordinator
3219 McKinney Avenue | Dallas, TX 75204
Toll Free 800-226-9880 | Phone 214-357-6244 | Fax 214-357-7252
www.waterskraus.com

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.

Saturday, May 05, 2012

Richard J. Malouf–A call for every item this man has had his name attached to or inscribed on to be seized! Not tomorrow, but by 5 this afternoon. And don’t forget his passport!

 

E-mail bharris@wfaa.com

Related:

maloufdancingThis should make every man, woman and child world wide, mad as hell. There should be crowds of people in front of the “gansta's house along side the news trucks.

Richard J. Malouf, just gave the, Department of Justice, the US Attorney’s Office, the citizens of Texas as well as every prosecutor in Texas the finger. But not the one he is using in the picture to the left.

On March 21, 2012 the US Attorney’s office in Texas allowed Richard Malouf to say he would pay them $1.2 million dollars to walk away from fraud charges he committed between 2004 and 2007.

 

Tuesday, April 17, 2012

Texas State Board of Dental Examiners General Counsel Admitted–“If you own a clinic you are practicing dentistry in the state”



There is such a HUGE GI-NORMOUS difference in the way North Carolina’s Dental Board understands the responsibilities given to them and the way the Texas State Board of Dental Examiners understand theirs. It’s truly mind blogging, yes I mean “blogging”.

North Carolina’s dental board hopped all over one dentist trying to skirt the laws and has now taken it to the legislature to make sure the laws against corporations coming between the dentist and the patient are clear.

After 5 years of work and 3 years of jumping through hoops, some Texas citizens finally got a hearing with the state legislature. Three years, now! Three years! Expect at least another 3 or more to clean up the damn mess down there. One good thing, Sherri Meeks, the former Executive Director, resigned just days “We do regulate dentistry. If you own a clinic you are practicing dentistry in the state."- Joy Sparks, TSBDE General Counsel before the hearing, and on more than one occasion it was highly suggested to the board that they now have the opportunity to hire someone who can and will do the job they are paid to do. I guess Texans will just have to wait and see.

At the hearing held on Wednesday, April 11, 2012 by the Texas Legislature Public Health Committee I heard some of the most outrageous statements I think I have ever heard come from members of any governing body, well, other than Nancy Pelosi saying they would have to pass a the Affordable Healthcare Act to see what was in it. That was huge.

Dr. Tammy Gough, the presiding officer of the Texas State Board of Dental Examiners, told the committee they were researching corporate dentistry laws and wanted to “act as advisors to stakeholders and elected officials on the topic because we feel it will probably be addressed in the future with legislation.”
Joy Sparks, general counsel, said this was a “relatively new” issue. And all they do with people who are suspected of the corporate practice of dentistry is turn them over to the local or state prosecutors. She also, indicated they don’t even follow-up on that useless action.

I bet if someone asked the local and state prosecutors how many cases the dental board has ever turned over to them, I could count them on one hand. If I remember, someone on the committee did ask that question. The dental board was also asked they had ever asked for guidance as to what they laws said hat their duties were. Want to guess what that answer was?

Glenn Parker, acting Executive Director, who has been Director of Administration and Licensing since September 1, 2011 said: “I think everybody knows The Board of Dental Examiners is the agency that regulates the practice of dentistry in Texas.”

“We do that by regulating individual practitioners. We have no authority to regulate clinics or clinic owners.”
“We strictly license individual people”

“We report fraud to the HHSC, OIG the AG and recently we’ve been reporting it to the FBI.
When Glenn Parker was asked about why there was a big jump in Medicaid Fraud, Joy Sparks answered for him by saying, “My guess, Representative is that the reimbursement rates increased by Medicaid.”
Representative Carol Alvarado asked if the clinics committing most of the fraud were Corporate owned clinics , franchises or clinics owned by individual dentists or independent.

Joy Sparks stammered, “Representative, I’m not comfortable saying that. We are seeing both. We are seeing individual and we are seeing individual practitioners who are, we have dealt with and we are seeing…uh uh….clinics, who have done it also. I’m not sure what the % would be.”

Rep. Charles Schwertner asked Lisa Jones – TSBDE Director of Enforcement-if there were the same safeguard against the corporate practice of dentistry as there were corporate practice medicine.

Her answered, “Honestly, I don’t know if I can answer that question, we don’t regulate the clinics in any way. We have no jurisdiction over them whatsoever. We don’t keep statistics on how many clinics there are in Texas or how they operate.”

She stumbled and stammered several times trying to not say “corporate” and just use the word, “clinic”. That part was fun.

Glenn Parker then added, “The Dental Practice Act requires the dentist to make all the decisions regarding the treatment of a patient. The dentist who is in charge of…stutter…according to the law …stutter…stutter… of the dentistry decisions”

He then tells what the dental board has “heard” about what is happening. He says they have heard some corporations are requiring their dentists to bill $1000 if the child in 10 or younger, if they are 10 or older, or bill them $1,500 worth of work.

Could possibly the dental board have “heard” these in a Complaint!!!!!???
He then went on to say, “To the degree on which that happens we don’t really Representative Carol Alvarado – “If you guys have been concerned about this, what have you all done?”know.”
To the amazement of the legislative committee he added, “Can we prove that yet, no, we can’t. But I think that is what’s happening to a degree. We do not know how many clinics there are in Texas, dental clinics. We don’t know where they are. We don’t know who the legal own of them is, cause none of that is in the Dental Practice Act to require it.”

Dr. Tammy Gough, the presiding officer followed with, ”we regulate the licensed dentist who is performing the care in these clinics” .Their not running “willy nilly” as far as the actual patient care.” The license dentist is held responsible for maintaining records..and there can be no patient abandonment…”
Representative Carol Alvarado asked, “If you guys have been concerned about this, what have you all done?”  

Pure silence!

Of course there was a lot of testimony on horror stories that would curl your toes. After all the hearing did last for 4 hours, 21 minutes and 21 seconds.

The big admission on the part of the dental board came with Joy Sparks, their general counsel admitted, “We do regulate dentistry.” “If you own a clinic you are practicing dentistry in the state. The problem is ..our remedy is we sanction a license. So if someone is practicing dentistry under a corporate clinic or private equity they are not licensed so we refer those cases, if we think, their … ya know what I’m saying.. we refer those cases to the Attorney General’s office…cause we don’t regulate…….when we asked if they own the clinic they say “I do”.

Then there was this, “They are practicing dentistry without a license. We don’t do anything with people who are practicing dentistry without a license.”
Well, there ya go.

You can continue reading or stop here.

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.

Texas Board of Dental Examiners–Drilled; the truth hurts

Well, it appears Wednesday-April 11, 2012-was an eventful day in Texas, at least when it comes to Corporate Dentistry practices that has invaded the state. The Texas state legislature is finally asking question why these places are in business and who is in charge of letting them do as much damage to the children as Mad Cow does to cattle.

The Texas State Board of Dental Examiners says it’s not them, just like the Georgia Dental Board. Below there are three articles from around the web on the happenings yesterday.

I just have so much to say about this, but I don’t have time today. Smile

Wednesday April 11, 2012

Statesman. Com
Watchdog group, others doubt effectiveness of dental board
By Mary Ann Roser -AMERICAN-STATESMAN STAFF

Published: 9:19 p.m. Wednesday, April 11, 2012

Patients, dentists and lawyers told a Texas legislative committee Wednesday that the state agency that regulates dentists does a weak job of protecting the public from bad care.

But board officials said the Legislature hasn't provided enough money to better regulate 60,000 licensees in Texas.

The problems go beyond that, said members of Texans for Dental Reform, a Houston-based group that monitors the Texas State Board of Dental Examiners and has long sought to air its grievances before the House Public Health Committee.

The group, and other members of the public, came to the committee Wednesday with recommendations and complaints. Among them: The board protects dentists and lacks a standardized way of disciplining them; it defines standards of care on a case-by-case basis, rather than following established care guidelines when investigating dentists; and it allows dentists who have been in serious trouble to get a new license number, making it exceedingly difficult for the public to connect the dots to previous disciplinary actions.

They also said that board members should never act as expert witnesses in lawsuits involving dentists and asked for action against unregulated dental clinics that "overtreat" children to take advantage of increased payments from Medicaid, the state-federal program for the poor.

"Over the past three years, we have found the board resistant, abusive and arrogant towards the public and unwilling to make the changes needed to protect public safety and health," said Gwen Mitchell, president of Texans for Dental Reform.

Dr. Tammy Gough of McKinney, presiding officer of the 15-member dental board since December 2010, said the board has strengthened various rules and is developing a standard way to review complaints and discipline violators. She said she has no problems with a law banning board members from acting as expert witnesses because none do.

But the volunteer board is hamstrung in its work by too little staff, not enough money and a lack of authority over corporate-owned dental clinics accused of exploiting Medicaid, said Glenn Parker, acting executive director of the agency.

Medicaid fraud complaints are turned over to the attorney general, inspector general and law enforcement officials, Parker said.

"We understand there is room for improvement," said Gough, who won praise from various members of the public for her openness to change.

The board could do better if the Legislature allowed it to keep more of the $9.6 million it collects in license fees and other work, Parker said. Instead, its current budget is just $2.7 million, and although it is authorized to employ 36 people, it employs just 29 because it can't afford more, he said.

Board officials also said some changes Texans for Dental Reform and others are pressing for would require legislation.

Houston lawyer Jim Moriarty disagreed that the board lacks authority to go after the corporate-owned clinics that are abusing Medicaid. He has filed suits in New York and Colorado against a network of clinics with operations in Texas and said the board should discipline the dentists in those practices, he said.

Lawyer Charlie Gustin of Houston has sued the Smile Center in San Antonio and told the committee of one case involving a 5-year-old boy who received 20 "baby" root canals and 20 steel crowns in 48 minutes. The boy left the clinic with cement in his mouth, and 14 of the crowns have since popped off, Gustin said.

Smile Center spokeswoman Debbie Clarke said the owner of the practice was unavailable to comment Wednesday "due to his professional responsibilities."

At the hearing, committee Chairwoman Lois Kolkhorst, R-Brenham, said that she wasn't interested in revisiting past problems but that the panel recognizes that the board needs lawmakers' help to get the tools it needs to do a better job.

Dentist Douglas Terry, a Houston-area member of the reform group, said he was encouraged.

"Things are going to change," he said.

Contact Mary Ann Roser at 445-3619


The Texas Tribune
Texas Dental Board is Accused of Ineptitude

  • by Becca Aaronson
  • April 12, 2012

    Texas toddlers being held in restraints as dentists at corporate-run clinics performed unnecessary root canals were among the dental horror stories told Wednesday at a House Public Health Committee hearing at the state Capitol. 

    The Texas State Board of Dental Examiners, which regulates dental licensing in Texas, was the subject of criticism by members of Texans for Dental Reform and unaffiliated residents, who called for legislative reform while levying accusations of ineptitude, a pattern of withholding or obscuring negative information about dentists, and failure to act against corporate-run dental clinics committing Medicaid fraud and harming patients.

    But others came to the board’s defense, saying that the new leadership is trying to fix mistakes from the past and that the board lacks the resources to do its job well. 

    “We have an underfunded and understaffed state board that is not able to accomplish all that we’d like them to accomplish,” said Richard Black, the legislative chairman for the Texas Dental Association and an El Paso dentist. Although it is taking time, the leadership of the board has made “substantial progress,” he said. 

    Both Black and members of the dental board expressed concerns about the recent outcrop of corporate-run dental clinics — and the board’s limited ability to protect the public when unlicensed operators at such clinics interfere with patients’ treatment.

    The Tribune thanks our Supporting Sponsors

    The clinics in question often serve only Medicaid patients and pay one dentist to act as a prop by claiming ownership. The real owners of the clinics — usually private equity firms — are in the dental business for profit, and encourage overutilization of Medicaid services by dictating a “one-size-fits-all treatment plan” or setting quotas for the number of procedures that dentists should perform, said Black.

    Dentists drilling for Medicaid gold is a national issue, as one Washington TV station documented, and more corporate-run dental clinics popped up in Texas after lawmakers raised reimbursement rates for dental procedures in 2009 to motivate dentists to accept Medicaid patients. Joyce Sparks, general counsel to the dental board, said the board has also seen an increase in complaints of dentists violating standards of care since then, which could be linked to the rise in reimbursement rates.

    Jim Moriarty, a Houston lawyer, detailed reports of torturous procedures at corporate-run clinics, in which children as young as 2 are immobilized, sometimes with a restraining device called a papoose, while the dentist inserts multiple stainless steel caps or performs root canals rapidly.

    “They won’t let the parents be present because the parents would be tempted in Texas to pistol-whip them if they knew what they were going to do,” Moriarty said. He’s currently suing one company that operates six dental clinics under various names in Texas and said the dentist who claims to operate those clinics — but actually works and treats patients in Oklahoma — bills Texas $12 million a year to treat Medicaid patients.

    “We want to be part of the solution, but right now we have no tools with which to combat this,” said Glenn Parker, the dental board’s acting executive director. The board only has the authority to license and sanction individual practitioners, which inhibits its ability to monitor or regulate clinics owned by private equity firms or corporations. The only recourse for the dental board is to notify the Office of the Inspector General and other state and law enforcement agencies when they’ve received an accusation of Medicaid fraud.  

    Unless someone comes forward “willing to testify they’re a cover for the private equity fund, so sanction me because I’ve been defrauding you,” the board can’t do anything, Sparks said. “It just doesn’t happen.”

    The board has identified the corporate practice of dentistry as an issue for lawmakers to address in the next legislative session, Parker said, adding that the board wants to get legal authority to regulate those clinics. The board also wants adequate funding to resolve the complaints it receives.

    Unlike the Texas Medical Board, which pays consultants and doctors to investigate allegations of medical misconduct, the dental board relies on volunteers to investigate complaints. There are usually 15 to 20 active consultants — dentists who apply to the board, undergo background checks and training, and then receive approval from at least two board members — to review complaints about standard of care. 

    Parker estimates the dental board receives 500 to 600 standard-of-care complaints a year. At least two of the volunteer dentists must review a complaint and agree on whether a standard of care violation occurred before the case is closed. 

    Board members said they've opened communication with Texans for Dental Reform to address their complaints, but ultimately, the agency needs more investigators and staff. Parker admitted the volunteers often "cherry pick" the easier complaints. “When you have staff turning over, some people do what’s easiest to do, not what’s best to do." 


    The Dallas Morning News

    Texas board says it’s falling short in regulating bad dentists

    SOMMER INGRAM
    Austin Bureau
    singram@dallasnews.com
    Published: 11 April 2012 11:19 PM

    AUSTIN — The agency that polices Texas dentists told lawmakers Wednesday that it doesn’t have enough resources or legal authority to crack down on careless and abusive dentists.

    An advocacy group led the charge against the Texas State Board of Dental Examiners, telling a legislative panel that the regulatory board doesn’t do enough to discipline bad dentists or alert the public which dentists have been sanctioned.

    “We’ve found [the] board to be resistant, abusive, arrogant toward the public and unwilling to make changes needed to protect public safety and health,” said Gwen

    Mitchell, president of Houston-based Texans for Dental Reform. “The consensus is that it only has one agenda, and that is to protect its own.”

    The board, which oversees 15,000 dentists, 32,000 dental assistants and 12,000 hygienists, has long been dogged by complaints of shoddy oversight that leaves patients suffering and dentists unaccountable.

    In response at the House Public Health Committee hearing, board leaders said the agency needs more funding and staff to keep up with the demands of approving licenses and reviewing the 500 to 600 cases it gets each year.

    They can range from pulling the wrong teeth to injuring a patient, from abusing drugs to sexually assaulting a patient.

    Mitchell’s group and others want the board to disclose all complaints filed against dentists and to get rid of those providing dental care without a license.

    But board officials said the Legislature wrote the law so that it can’t disclose complaints lodged against dentists if they are dismissed.
    They said they’ve been limited in enforcement tools and largely depend on the attorney general’s or inspector general’s office to pursue and remedy cases of fraud, especially in Medicaid.

    “It’s not the charge of the board itself to be the lead agency in investigating Medicaid fraud,” said Glenn Parker, the acting executive director. He said that if disciplinary action is taken by the attorney general’s or inspector general’s office, the board takes action.

    He said the dental board collects $9 million annually in fees, but the Legislature allots it about $2 million for its total budget. “We could use a lot more funding,” he said, although he did not give a specific figure.

    Licensing actions The board’s sanctioning method is to revoke or suspend dentist licenses, so board leaders say that leaves them without a way to punish those practicing without a license to begin with.

    Dr. Tamela Gough, presiding officer of the board, said the board regulates individual practitioners but has no authority over clinics or owners of clinics. “We regulate the licensed dentist who is performing dentistry in these clinics — they’re not running willy-nilly as far as patient care,” Gough said. “But in order for us to regulate the actual corporate entity, it would require legislation.”

    Jim Moriarty, a Houston lawyer who prosecutes Medicaid fraud cases, argued that the board is taking the easy way out by saying it doesn’t have the power to punish private entities and those practicing without a license.

    “I’m appalled when I hear the board say they have no control over these people. Texas has some of the best regulations in the country, but the law is just not being enforced,” Moriarty said. “The board sits like an ostrich with its head in the sand saying, ‘If they don’t have a license, we can’t do anything.’”

    Charlie Gustin, a San Antonio lawyer who works with children on Medicaid, told lawmakers about a boy he represented who went in for dental work and ended up worse off than he started.

    He was given double the amount of local anesthetic required for a child his body weight and received 20 baby root canals and 20 stainless steel crowns in less than
    an hour.

    When he went to another dentist for remedial work, 14 of the 20 crowns popped out and the dentist noticed excess cement left in his mouth that can cause infection.

    The dentist filed a complaint with the board and found that the first dentist’s license had been suspended in New York before he came to Texas.


    “But the state board online lists no disciplinary actions,” Gustin said. “We need more disclosure to the public when you have a dentist that’s been kicked out of another state. But according to our state board of dental examiners, he’s clean. And that’s a problem.”

    More fraud complaints
    Joy Sparks, the board’s general counsel, said that over the last two years, Medicaid fraud complaints have increased, probably because reimbursement rates have gone up.


    “The state increased the reimbursement rate to make it more lucrative for dentists to take Medicaid patients. … Once that occurred, there were those who took advantage of the system because it became more profitable to participate in Medicaid.”The House panel said it would consider efforts in the next legislative session to overhaul the dental regulations.

  • Wednesday, March 28, 2012

    FINALLY!! Texas State Dental Board Director resigns before big hearing. Come One, Come All to the April 11, 2012 10:30 Texas State Dental Board Meeting!

    By Mary Ann Roser
    AMERICAN-STATESMAN STAFF

    Statesman.com Article

    Published: 8:47 p.m. Wednesday, March 28, 2012

    Sherri Meek, executive director of the Texas State Board of Dental Examiners, resigned earlier this month and will not be present at an April legislative hearing where board critics plan to testify.

    Meek, who cited personal reasons for her resignation, is using up personal leave time before her resignation takes effect Aug. 31, said the board’s general counsel, Joy Sparks. Glenn Parker, former executive director of the Texas Board of Chiropractic Examiners, has been the dental board’s director of administration for the past several months and has taken over as acting executive director with a salary of $75,000, a $5,000 increase to compensate him for his additional duties, according to a letter from Meek to Parker.

    Parker will be at the hearing of the House Public Health Committee at 10:30 a.m. April 11 in the Capitol Annex, E2.012.

    At the hearing, lawmakers will hear public testimony about various health registries maintained by the state and concerns about the operations of the dental board, including its enforcement practices and a law that allows board members to act as expert witnesses in cases involving dentists, as long as the board does not object.

    “No board member has ever asked for permission to serve as an expert,” Sparks said, adding that she “would have absolutely no problem” with an outright ban on it.

    Members of the Houston-based Texans for Dental Reform say they plan to speak at the hearing and voice their ongoing concerns about the dental board, including uneven and unfair enforcement of the law; “overemphasis on protection of dentists;” and conflicts of interest.

    The hearing is open to the public.

    Sherri Meeks has been there since 2007, that’s when it all went to hell in a hand basket in Texas. I’m sure there were initially good intentions with the Frew v Texas lawsuit, but damn!! If I were a conspiracy theorist, I’d think that Private Equity firms and corporate practice of dentistry bandits (DGPA) were at artful play here.

    I’m not really a betting person either, but I’d wager the Texas State Board of Dental Examiners are going to need a larger venue come April 11 at their 10:30 AM hearing!!  I also think, Sherri Meeks should be dragged to that hearing, hog tied! What a chicken shit, she is!

    What do you think?

    Thursday, March 22, 2012

    Texas, feds take action on orthodontic fraud | wfaa.com Dallas - Fort Worth

     

    NEWS 8 INVESTIGATES

    DALLAS — A Dallas dentist has agreed to pay the state and federal government $1.2 million to resolve allegations that he submitted false orthodontic claims under Medicaid.

    Dr. Richard Malouf, former majority owner of All Smiles Dental Center, allegedly submitted false Medicaid claims between 2004 and 2007.

    News 8 reported on Malouf's lavish homes and two multimillion dollar corporate jets. Malouf did not admit any wrongdoing or liability in his settlement.

    He is one of several orthodontists highlighted for multimillion dollar billings under Medicaid.

    Eleven dental operations statewide have had their state funds suspended for credible allegations of fraud in billing the Texas Medicaid Orthodontics program. This follows a 10-month News 8 investigation of medicaid orthodontics in Texas, which found the state spends more on braces for poor children than the rest of the nation combined.

    "Something's wrong and I want my money back," said Texas Sen. Jane Nelson (R-Flower Mound). Nelson called a hearing to look into how Texas spent $424 million on orthodontics under Medicaid between 2008 and 2010.

    Medicaid does not cover cosmetic orthodontics, but a News 8 investigation found that tens of thousands of children received procedures at taxpayer expense.

    "What we really want is, we don't want people to do it," said Texas Sen. Bob Duell (R-Rockwall).

    Tuesday, March 20, 2012

    Dental Braces: Once Again Texas Makes News with Braces

     

    Dental Braces: Once Again Texas Makes News with Braces

    March 20, 2012 By Jim Du Molin Leave a Comment

    Dental Braces: Once Again Texas Makes News with Braces What is it with Medicaid dental care and braces in Texas?

    The Texas Health and Human Services Commission, which administers Medicaid in Texas for dental braces, has filed a request to be reimbursed for $7.5 million in alleged fraudulent claims it paid to Amarillo orthodontist Dr. Michael Goodwin.

    Federal authorities also moved to seize the commercial and personal bank accounts of Dr. Goodwin and his wife as part of a probe linked to a Medicaid fraud scheme, according to the Amarillo Globe-News.

    In 2008, Dr. Goodwin became an individual Medicaid provider, which allowed him to bill Medicaid only for services personally provided by the orthodontist.

    Soon after the change, the Amarillo orthodontist was reported as scheduling up to 400 Medicaid patients a day and allegedly billing the government for orthodontic treatment he did not perform. The Globe-News further reports that patients and former employees likened the Amarillo Medicaid fraud scheme to “herding cattle.”

    Thursday, March 01, 2012

    Could Texas Medicaid Dental Program Suck Anymore? Yes.

    Just saying…

    Big Changes in Medicaid Dental Coverage Could Mean Increased Wait Time 3/1/12

    Shelley Childers
    CBS 7 News
    schilders@cbs7.com
    March 1, 2012
    ODESSA, TX - Big changes to the Medicaid dental program may mean some children in West Texas have to wait even longer to get treatment.
    It's a change that came with very little warning or information from the Medicaid program.
    Now it has pediatric dentists across the state scrambling to help their patients maintain their appointments.
    "It was a very bad day for pediatric dentists across the state because we do serve the Medicaid population and a lot of patients went without being seen today," said Dr. Joel Edwards, the only pediatric dentist in Odessa who serves Medicaid patients.
    He says Medicaid patients went without being seen because of big changes to their insurance coverage that all took effect Thursday.
    For years Medicaid dental insurance was a state run program, but now it's being handed over to three different insurance companies Delta Dental, DentaQuest and MCNA Dental.

     

    Tuesday, February 28, 2012

    Feds link orthodontist to Medicaid fraud scheme

    By BOBBY CERVANTES amarillo.com Copyright 2012 Amarillo Globe-News. All rights reserved.

    February 29, 2012 - 12:18am

    Feds link orthodontist to Medicaid fraud scheme

    bobby.cervantes@amarillo.com

    Patients and former employees likened the Amarillo Medicaid fraud scheme to “herding cattle.”

    Amarillo orthodontist Dr. Michael Goodwin scheduled up to 400 Medicaid patients a day and frequently billed the government for work he never performed, according to court records.

    In late May and early July, authorities seized $244,235.67 from five JP Morgan Chase commercial and personal bank accounts associated with Goodwin, his wife and his business.

    Goodwin billed the government a total of $1.67 million in fraudulent claims from April 2008 to April 2011, according to a federal forfeiture complaint the government filed Monday seeking to keep the seized money.

    Goodwin, who also has an office in Indiana, has not been charged with a crime. His Amarillo office at 3629 Wolfin Ave. was closed Tuesday and messages were not immediately returned.

    Goodwin and his wife, Patricia, did not file a claim to the seized money, according to the complaint.