Friday, July 31, 2015

Another one of those “studies” paid for by Kool Smiles parent company suggests more Medicaid money is needed for dental benefits to serve children in Texas!

I know it’s hard but try to stop laughing and read this ridiculous press release.
(Benevis was formerly NCDR (Kool Smiles), owned by private equity firm FLL Partners.)

Study Finds Only 26.5% Of Texas Children Eligible For Medicaid Dental Coverage Frequently Visit Dentist.

PRNewswire (7/30) carries a release announcing that a new survey by the Benevis Foundation, conducted by Kennesaw State and Emory University researchers, finds that “only 26.5% of Texas parents with children eligible for Medicaid dental coverage consistently bring their children to the dentist as frequently as they should,” with parents citing financial hardships as the primary barrier to more frequent dental visits. Geoffrey Freeman, spokesperson for the Benevis Foundation, said, “This suggests that parents may not be aware of the complete coverage of their benefit, or that there may be secondary costs – such as transportation or unpaid time off work – that keeps these families from visiting the dentist as often as they would like.”

Thursday, July 02, 2015

Grassley Seeks Key Agency Updates on Medicaid Pediatric Dental Fraud

These answers should be interesting don’t’ ya think? I can answer. Little to nothing to “prevent” and even less to “punish”.


Jul 02, 2015

WASHINGTON – Sen. Chuck Grassley is asking key government agencies what they’re doing to prevent and punish Medicaid dental fraud, including billing for unnecessary treatments for children, in light of inspector general audits and related media reports documenting worrisome practices.

“Some dentists are clearly performing unwanted and unneeded medical procedures on children without the consent of parents and bilking Medicaid for the privilege,” Grassley wrote to Attorney General Loretta Lynch and Department of Health and Human Services Inspector General Daniel Levinson. 

Grassley’s letters cited Health and Human Services Office of Inspector General audits of questionable billing practices for Medicaid pediatric dental services in four states: California, New York, Louisiana and Indiana.  All of these audits identified questionable billing practices that suggest Medicaid dental providers are performing medically unnecessary procedures on children.  Grassley wrote that this conclusion has been echoed by a variety of news sources that have reported on troubling practices performed by dentists treating children in Medicaid, including a Florida-based dentist who allegedly subjected hundreds of children to unneeded tooth extractions, improper dental fixtures, and other troublesome procedures.

Grassley asked Lynch for the number of criminal and civil fraud referrals from the Health and Human Services Office of Inspector General related to Medicaid dentistry chains in the past five years, with a listing of the referrals by state and how each criminal and civil case was resolved; details of the number of ongoing Department of Justice Medicaid dental chain fraud investigations by state; and a description of the Department of Justice’s plan to address the findings by the Health and Human Services Office of Inspector General that indicate health care fraud in the context of dental procedures provided to children in Medicaid. 

Grassley asked Levinson for the steps the inspector general’s office will take, or has already taken, to increase the auditing of dentistry offices that are recipients of federal dollars; the number of criminal and civil fraud referrals from the inspector general’s office to the Department of Justice relating to Medicaid dentistry chain activity in the past five years; details of the Medicaid dentistry audits the office performed by state in the past five years, with a note on whether the audit resulted in criminal or civil referral to the Department of Justice; the number of ongoing Medicaid dental fraud investigations by state; and a description of the progress on following up on billing fraud and unnecessary procedures in Medicaid pediatric dental services. 

In 2013, following a year-long investigation, Grassley and then-Finance Committee Chairman Max Baucus of Montana issued a report and recommendations urging the administration to ban dental clinics from participating in the Medicaid program if the dental clinics circumvent state laws designed to ensure only licensed dentists own dental practices to prevent substandard care.  In 2014, the inspector general moved to disqualify a firm from Medicaid.  

Grassley’s latest letters are available here and