By: Eric Giunta | Posted: February 8, 2013 2:27 PM
“Employing a person to perform duties outside the scope of their license and billing Medicaid for those services is endangering patients and stealing from the Medicaid program,” Bondi said in a press release.
Bracing Ourselves: How Texas spent $705 million on Medicaid bracesby 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.
Aurora Illinois - An Aurora woman faces charges of illegally practicing dentistry at a North Aurora dental office, police said.
North Aurora police and the Kane County State’s Attorney’s Office have obtained a criminal indictment against the woman for illegal dentistry practice at the North Aurora Dental Associates office on the 100 block of North Lincolnway (Route 31).
The defendant is Silvia Hernandez, 37, of the 400 block of Iowa Avenue, Aurora. Hernandez was indicted last week by a Kane County Grand Jury on the following charges:
The charges come after an investigation of over seven months by North Aurora police detectives.
Charging documents allege that Hernandez knowingly took control of more than $500 but less than $10,000 from someone by portraying herself as a licensed dentist in the State of Illinois, when in fact she was not a licensed dentist, according to a news release.
This investigation began on July 5, 2012 when a female came to North Aurora Dental Associates to report a problem with her braces. When the office staff could find no record of the female ever having been a patient there, she reported that she paid “Doctor Silvia” to put her braces on in this office about four years prior. Staff at North Aurora Dental Associates contacted North Aurora Police immediately.
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?
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.
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.
Tara Rios Ybarra charged in Medicaid fraud case
Oral and Maxillofacial Surgeon and His Employees Indicted – FBI
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”.
Tara Rios Ybarra Unprepared and Clueless on her own bills – You have to see this one!!
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!”
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.
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.
