On Dental Claims, State’s Bark Worse Than Its Biteby 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.
