Showing posts with label Texas Task Force Hunting Down Medicaid Dental Fraudsters. Show all posts
Showing posts with label Texas Task Force Hunting Down Medicaid Dental Fraudsters. Show all posts

Thursday, June 27, 2013

Antoine Dental Centers Creditable Allegation of Fraud (CAF) Hearing

If you haven’t read part 1 of “Ho” Down in Texas I suggest you do so before continuing. Read it here

The group calling themselves Texas Dentists for Medicaid Reform posted only two cherry picked depositions on their website in relation to the Antoine Dental Centers State Office of Administrative Hearings(SOAH).  TDMR again portraying the fraudsters as victims, just like they tried to do with Harlington Dental.  Posted on the TDMR website were Dr. Larry Tadlock’s deposition and Jack Stick’s deposition.  Dr. Tadlock was the expert witness for the state.  Mr. Stick is the Director of Enforcement at OIG. You can catch up on TDMR here.

I guess TDMR didn’t want people to read the actual hearing transcripts, and I can certainly understand why.

 

Monday, May 27, 2013

Dental Medicaid Fraud and Drug Cartels–The Connection In Texas

RioGrandGardianHealth

AUSTIN, TEXAS, May 26, 2013 - The vice chair of the homeland security committee in the Texas House says there is a direct connection between drug cartels and Medicaid fraud being perpetrated along the South Texas border region.

For this and other reasons, state Rep. Allen Fletcher said he offered an amendment to Senate Bill 8 that will allow the Office of Inspector General (OIG) to hire commissioned peace officers for their investigations into Medicaid fraud. Senate Bill 8 is a major piece of legislation dealing with fraud, waste, and abuse in the Medicaid program.

“There is Medicaid fraud all over the state, Dallas, Houston, you name it. The cartels are in Dallas and Houston. But way along the border, and all along the border, McAllen, Brownsville, Cameron County, Hidalgo County, Starr, all those areas, there is huge cartel influence and I assure you that these individuals that are involved in setting up these bogus clinics and hiring these dentists and doctors to file these fraudulent Medicaid claims, it’s cartels,” Fletcher said.

Fletcher is one of just a few retired police officer serving in the Texas House. He investigated white collar crime for Houston Police Department for many years. Fletcher said he spoke to Jack Stick, deputy inspector general for enforcement for the Office of Inspector General Texas Health and Human Services Commission, about carrying an amendment for Stick to allow OIG to have commissioned peace officers working as investigators.

Wednesday, February 20, 2013

Senate Panel Backs Bill That Targets Medicaid Fraud

TTThe Senate Health and Human Services Committee gave its endorsement Tuesday to legislation that tackles Medicaid fraud and could save the state millions of dollars.

Senate Bill 8 will “reduce the epidemic levels of fraud waste and abuse that are plaguing our health and human services,” said Sen. Jane Nelson, R-Flower Mound, the author of the bill and chairwoman of the Senate health committee. She added that “no amount of fraud is tolerable, but given our recent budget challenges it is inexcusable” that the Office of Inspector General has identified more than $6 billion in fraud from 2004 to 2011 tied to Medicaid, the state health program for poor residents.

The legislation will now go to the full Senate.

The committee approved a substitute of the original bill. The approved measure would set up a data analysis team within the Texas Health and Human Services Commission to detect trends in Medicaid claims and take a proactive approach to identifying potential fraud; ensure providers found guilty of Medicaid fraud in Texas or other states would be barred from participating in the state’s program; strengthen prohibitions against directly soliciting Medicaid patients for treatments; and reduce transportation fraud by adding medical transportation services to managed care and setting up a relationship between the Texas Department of Transportation and the Health and Human Services Commission to verify the eligibility of a Medicaid patient for transportation services.

Saturday, December 29, 2012

New DSO Regulations on tap for Texas–Batter up!

dbcTexas legislators to consider new DSO regulations

By Donna Domino, Features Editor

December 28, 2012 -- Dental service organizations (DSOs) in Texas would be subject to greater oversight under a bill being introduced by a Texas legislator who accused the groups of "outrageous actions" involving unnecessary pediatric procedures.

SB 151 is designed to "strengthen the Texas State Board of Dental Examiners' ability to ensure that dental treatment is directed solely by licensed dentists, not by corporate entities." The measure would also require DSOs to register with the board and prohibits them from "interfering with dentists' treatment decisions."

“These types of entities have been involved in some of the illegal and, quite candidly, outrageous actions.”

— Sen. Jane Nelson

The bill was prefiled on December 21 by Sen. Jane Nelson (R-Flower Mound) in advance of the 83rd Regular Session of the Texas Legislature, which reconvenes on January 8. It would require DSOs to register with the state dental board, and it also would allow the dental board to impose administrative penalties and disciplinary actions against DSOs that violate the Texas Dental Practice Act. Similar to in many states, the law states that only licensed dentists can own and operate dental clinics.

Currently, DSOs in Texas are not subject to any state regulation, Nelson noted.

"We need to ensure that these organizations are accountable to the board and, more importantly, that they are not substituting their judgment for that of our trained, licensed dentists," Nelson said in a statement.

Read the entire story at Dr. Bicuspid

Related:

Dental Patient Protection SB 151

Dental Patient Protection: SB 151 strengthens the Texas State Board of Dental Examiners' ability to ensure that dental treatment is directed solely by licensed dentists, not by corporate entities. It requires dental service organizations (DSOs) to register with the Board and prohibits them from interfering with dentists' treatment decisions. It also allows the Board to impose administrative penalties and take disciplinary action against a DSO found in violation of the Texas Dental Practice Act. Before performing dental treatment on a child, SB 151 requires that a dentist inform the child's parent or guardian that they have the option to be present in the treatment room, and it prohibits a dentist from performing the dental treatment or procedure without the parent or guardian present if they desire to be in the treatment room. Currently, DSOs are not subject to any state regulation. "We need to ensure that these organizations are accountable to the Board and, more importantly, that they are not substituting their judgment for that of our trained, licensed dentists. No child should undergo complicated, painful procedures without a parent being involved at every point in the process. These types of entities have been involved in some of the illegal and, quite candidly, outrageous actions involving the enticement of children to undergo costly and oftentimes unnecessary procedures at the taxpayer's expense."

Senator Jane Nelson
P.O. Box 12068, State Capitol
Austin, Texas 78711
Tel. (512) 463-0112
Fax (512) 463-0923

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