Analysis of ADC vs. Texas Health and Human Services Commission

Analysis of ADC vs. Texas Health and Human Services Commission

By Michael W. Davis, DDS, DrBicuspid.com contributing writer

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.

Read the entire article on Dr. Bicuspid

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:

 

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.

Trueblood Dentistry and their string of Carousel chops shops finally forced to close!

In all the raw data I’ve seen out of Texas, this one would nearly always fall in the top 5.  This one alone is said to have stolen $18 million from taxpayers.  Just imagine the hundreds and hundreds of millions, if not billions stolen from scam dentists and dental companies in the state of Texas!  Perp walk please!!

I’m sure the “pity” party has begun.

 

By Chuck Lindell

American-Statesman Staff

Carousel Pediatrics began shutting down its Austin dental practice Tuesday night, displacing about 28,000 low-income pediatric patients, after state health investigators cut off Medicaid payments over allegations of fraudulent activity.

Carousel’s owner, Dr. Glenn Wood, who disputed the fraud allegations, said the loss of about $400,000 a month in Medicaid payments required him to shut down his dental affiliate, Trueblood Dental Associates, and lay off about 40 staff members and six dentists.

Sun Orthodontix raided by FBI–Life in dental fraud is not as rosy as it used to be, is it?

We’re getting there… 

by BYRON HARRIS

Bio | Email

WFAA-TV

Posted on September 26, 2012 at 5:58 PM

Updated today at 6:18 PM

Story TimelineClick to open timeline

Related:

• More from News 8 Investigates

NEWS 8 INVESTIGATES

In the largest action to date, the FBI, state investigators and the attorney general have raided the offices of Sun Orthodontix.

Sun doesn't have locations in North Texas, but it was the second largest biller for braces under Medicaid in 2010.

Part of its huge growth in Texas is linked to Medicaid dental bills. News 8 found Texas dentists were charging taxpayers for putting braces on kids who didn't qualify for them under Medicaid.

Sun collected more than $9.6 million in 2010, according to state records.

FBI agents were part of Monday's raids at Sun offices, which stretch from El Paso to Corpus Christi.

"The FBI doesn't show up when they think you've committed a crime... they know you've committed a crime long before they show up," said Houston attorney Jim Moriarty, who is part of a whistle-blower case against Dallas-based All Smiles Dental Centers.

The joint raid is the largest action so far against a dental firm in Texas.

"I think you may see tens or hundreds of dentists who end up with civil or criminal charges against them," Moriarty said. "I think there is a tsunami of criminal action against crooked orthodontists in Texas."

No criminal charges have been filed against Sun or its dentists. But the company has been in a dispute with Medicaid. The state quit paying Sun Orthodontix earlier this year, questioning its practices.

Sun has taken the state to court for money it says it is owed.

E-mail bharris@wfaa.com

Byron Harris update on dental Medicaid fraud in Texas

June 20, 2012

Read Byron’s complete report here at WFAA

In 1998, Texas spent $16.5 million on stainless steel crowns, in 2010, 12 years later, Texas taxpayers spent nearly $108 million, up 650% in 12 years!

In 1998, Texas spent $16.5 million on stainless steel crowns, paying for 250,000 thousand of them. In 2010, 12 years later, it spent nearly $108 million, on 700,000 crowns. Up 650% in 12 years! Byron Harris reports on why that could be. Hint: think body snatchers!

June 1, 2012
WFAA