Byron Harris
November 11, 2011
DALLAS - Claims procedures discovered in a News 8 investigation of "Your tax dollars aren't working," said a former claims specialist, one of several News 8 has interviewed. "You're paying for [dental] services that shouldn't be paid for."the Texas Medicaid Dental program may apply to the whole country, because of the payment process employed by a major government contractor.
In a series of investigative reports over the last several months, News 8 discovered hundreds of millions of dollars in Medicaid billing for orthodontics. Now it appears the problems, which have triggered a federal audit, may be linked as much to the way the claims are approved, as they are to the individual dentists involved.
It turns out that the claims examiners are paid by quantity, and not
Employees who might have been making $20 per claim two years ago, now are making $10 per claim. To take home the same pay, they have to push nearly twice as many claims through the system.
"People didn't know how they were going to make their mortgage payment, their car payment, pay their babysitter because every time they turned around, their pay was being reduced again because corporate felt they were making too much money," a former employee said. necessarily quality, under a program called Activity Based Compensation, or ABC. The more claims they process, the more money they make, creating a strong incentive not to take too much time with each one.
"Your tax dollars aren't working," said a former claims specialist, one of several News 8 has interviewed. "You're paying for [dental] services that shouldn't be paid for."
