Showing posts with label WFAA TV. Show all posts
Showing posts with label WFAA TV. Show all posts

Wednesday, February 20, 2019

After WFAA investigation, company settles with State of Texas for record $235.9 million

Xerox Corporation and its former subsidiary, Conduent, agreed Tuesday to a record $235.9 million settlement with the State of Texas, according to the Texas Attorney General's Office. 
It was the largest single Medicaid fraud-related settlement in a case filed by the Texas Attorney General.

The settlement comes after a three-year WFAA investigation that uncovered millions of dollars in alleged overbilling by Texas dentists targeting low-income children for unnecessary and often harmful dental and orthodontic work.

Read entire story at WFAA website

Related:

 WFAA's Byron Harris reports 

Tuesday, March 12, 2013

WFAA’s dental fraud investigations recognized and lauded by Forbes

Ending White House Tours Instead Of Ending Medicare And Medicaid Fraud -

Merrill Matthews, Contributor
March 7, 2013

forbes

“White House Tours will be canceled effective Saturday, March 9, 2013 until further notice,” according to a White House email.  Meanwhile, billions of dollars pour out of Medicare and Medicaid because of waste and fraud.  Indeed, eliminating Medicare and Medicaid fraud, rather than White House tours, would offset the sequester cuts for the next decade.

two idiotsI don’t know how much money President Obama thinks it saves by canceling White House tours, though I’ll bet it’s a lot less than one of his golfing trips on Air Force One, which costs about $180,000 an hour to fly.

But we do have several estimates of how much Medicare and Medicaid fraud cost.  Typical estimates, which have been echoed by the Obama administration, put the figure in the $60 billion a year range for each program.

A study by the Rand Corporation pegged Medicare and Medicaid fraud at about $98 billion in 2011, roughly equal to the future annual budget cuts (actually, reductions in the rate of growth) imposed by the sequester.

The Government Accountability Office’s (GAO) most recent estimate for Medicare, released in February, claimed there was a total of $44 billion in improper payments in 2012.  That figure is a little lower than the $48 billion for 2010.

Not all of the GAO calculation is fraud.  It includes overpayments and underpayments, unnecessary services, coding errors and other problems.  And there is fraud that isn’t detected by the GAO report.  But you get the idea; it’s a big problem and getting bigger as criminals and the mob get more brazen in their efforts.  For example:

Tuesday, March 05, 2013

Texas AG Greg Abbott disappointed in Dallas DA Craig Watkins’ “sweetheart deal” with Richard Malouf

Sweethearts?

sweethearts2

A good example of why you can’t count on local DA’s to enforce the laws!


WFAABio | Email
WFAA
Posted on March 5, 2013 at 10:05 PM
Updated today at 9:54 PM

Dallas County District Attorney Craig Watkins accepted — then returned — a 2009 campaign donation from the wife of Medicaid dentist Dr. Richard Malouf, who was under investigation at the time by Watkins' office for allegations of Medicaid fraud.

The Texas Attorney General’s Office says Watkins’ settlement of the case was a "sweetheart deal."

Malouf checkDallas dentist Dr. Richard Malouf is the founder and former owner of All Smiles Dental Centers in Dallas. From 2008 through 2010, All Smiles billed the state of Texas more than $20 million for putting braces on children under Medicaid.

For the past five years, federal, state and local officials have been investigating Malouf for Medicaid fraud.

The Dallas County DA's office was one of those doing the investigating. Watkins' office received a criminal referral from the AG about Malouf.

In 2009, Malouf's wife, Leanne, wrote Craig Watkins — who was running for re-election as Dallas County DA — a $10,000 campaign donation, News 8 has learned.

Soon after, Watkins was asked to attend a meeting at the office of one of Malouf's attorneys, according to Heath Harris, the first assistant in the DA's office. News 8 wanted to talk to Watkins himself about the sequence of events. His office said he was ill and unavailable. Heath Harris spoke on behalf of Watkins.

Dallas District Attorney Craig Watkins Letter to Stephanie Leanne Lott Malouf Jan 5 2010 Redacted

At the meeting at the attorney's office, Heath Harris said, Watkins was introduced to Malouf.

Malouf wanted to talk to Watkins about his criminal case, Heath Harris said.

"This Malouf person is trying to talk to him about a criminal matter," Heath Harris told News 8. "It's my understanding he [Watkins] immediately shuts him down. And he leaves."

Watkins returned $10,000 to Leanne Malouf with a cashier's check in January, 2010.

Thursday, January 17, 2013

Texas Vows to crack down on dental Medicaid fraud

I’m guessing Texas is not exactly the best market anymore for the Medicaid dental mills and DSO’s in general.

by BYRON HARRIS
Bio | Email
WFAA
Posted on January 16, 2013 at 6:48 PM
Updated yesterday at 9:55 PM

NEWS 8 INVESTIGATES

AUSTIN — State Sen. Jane Nelson (R-Flower Mound) put it simply Wednesday, speaking to a group of reporters at a news conference in Austin:

"It is infuriating to hear of the kind of problems that are taking place... problems that are particularly serious in Medicaid dental, orthodontia and transportation for Medicaid patients," she said.

For the past two years, News 8 has been investigating the Texas Medicaid Dental program and hundreds of millions of dollars the state has spent on orthodontics under Medicaid.

Sen. Nelson specifically mentioned the parents of Medicaid children who had been solicited by "marketers" bearing free gifts and cash, the subject of several News 8 stories.

Senate Bill 8 is designed to cure some of those abuses.

"It strengthens the prohibitions against solicitation of Medicaid clients," Nelson said. "We heard story after story about that. We are going to prohibit that and make sure it doesn't take place."

So far, the bill does not specifically prohibit handing out gifts and cash to parents to induce them to take their children to certain dentists. Nelson says hearings over the next two months will flesh the bill out.

The legislation also articulates the Inspector General's role in uncovering and reporting fraud, and bans a dentist from participating in Medicaid if found guilty of fraud.

The bill moves Medicaid Transportation into managed care, and directs the Department of Health and Human Services to reduce inappropriate ambulance use.

Even though the specifics of this bill haven't yet been hammered out, there's already huge opposition to it. That's a sign, Nelson says, that as it is, some dentists are making lot of money.

E-mail bharris@wfaa.com

Saturday, December 22, 2012

A special Christmas blessing goes out to the orthodontists who have volunteered to see these victimized children!

For the past several years, hundreds of Texas Orthodontic clinics have put braces on children who didn't need them, all to bilk the Medicaid system - stealing your tax dollars. Now that the Feds and State of Texas are hunting down the dirty dogs. What did the owners do? Well they locked their doors and ran; being the cowards they are. Now, ten’s of thousands of children have been abandoned, braces still on and treatment unfinished. Now, volunteers are stepping in.

 


 

Roderick Williams, 11, got his braces more than two years ago. When we met him, all that remained were brackets. His wires were broken. His orthodontist was out of business.

His mom, Denecia Williams, was at a loss.

"Now what do I do?" she said. "And it's been a hassle ever since."

Like hundreds of other Texas kids,  Roderick was stuck without anyone else to remove what was still left in his mouth. Now there is.

 

Wednesday, December 19, 2012

After 18 months of reporting, WFAA’s Byron Harris reports; black market for Medicaid Dental patients is going strong

wfaaThank you Phyllis Gonzales! You are one brave woman! We need more Phyllis Gonzales’ that’s for sure.

WFAA
Posted on December 18, 2012 at 10:13 PM
Updated today at 9:01 AM

NEWS 8 INVESTIGATES

The black market for Medicaid Dental patients is going strong, despite the state’s tightening of the payment system for providing dental care to poor children.

Phyllis Gonzales said she was paid more than $1,000 by 1-Stop Dental in Hurst over a two-month period. In exchange, she said she brought about 60 kids and their parents to the dentist’s office.

There, she said parents got between $20 and $35 for switching their children to the dentist working there.

It’s illegal to pay a parent to switch dentists under Medicaid, according to the Texas Department of Health and Human Services.

The 1-Stop story came to News 8’s attention because of flyers stuck under car windshield wipers at DART station parking lots.

“The policy was basically to bring as many patients as possible,” Gonzales said. “The payment [to Gonzales] was $10 per child, with bonuses of $100 once you reached ten children."

Thursday, December 13, 2012

Thousands more children abused at private owned “chop shops” - 1-Stop Dental, First Impressions Dental, Gold Star Dental. Parents are paid $35 to bring their child for “treatment”!

These are just 3 of 30 or more operated by a very close knit group of criminals with DDS after their name in Texas. I’m sure we will be hearing more on this cartel.

Hey, Ms. Lisa Re, is this one ok with you as well? I assume it must be, it’s the same story we hear about Small Smiles of which you are such a big fan!!

Here is Byron Harris’ latest report:


by BYRON HARRIS


Bio | Email
WFAA
Posted on December 12, 2012 at 10:38 PM
Updated today at 9:35 AM

NEWS 8 INVESTIGATES

The darkest side of Medicaid dental

wfaaDALLAS -- In the eighteen months since News 8 began reporting on the Medicaid dental program, we’ve discovered hundreds of millions of dollars paid out by Texas that other states don’t pay for at all. We’ve discovered children being lured from their neighborhoods into dental chairs, just for the Medicaid dental fees they’d bring. And we’ve outlined how gift cards have been used to entice parents to bring their kids to certain dentists.


The State of Texas is now cracking down on those practices through enforcement and new systems for reimbursing dentists. But that’s only increased the competition for new, young Medicaid patients and the income they can bring to a dental office. In their worst forms, might be described as tempt and torture.


The Switch Bonus
In the parking lots of Dallas DART stations, crude flyers are being tucked under commuters’ windshield wipers.


“Get paid to take ur [sic] kids to the dentist. The dentist is giving $20.00-$35.00 per kid,” the flyer reads.

Thursday, October 18, 2012

Texas expands Medicaid dental fraud estimates to $154 million

 

;

by BYRON HARRIS Bio | Email WFAA-TV Posted on October 17, 2012 at 10:03 PM Updated today at 12:01 PM Story

NEWS 8 INVESTIGATES

WFAATexas Medicaid dental expenditures quadrupled in recent years, from $400 million in 2006 to $1.43 billion in 2011. The Office of Inspector General is now tracking more than $383 million of potential fraud and overpayment, it told a Texas House of Representatives committee.

In a House hearing on Monday, News 8's investigations of Medicaid dental fraud were praised by state representatives. "I have to tip my hat to WFAA in Dallas for doing what they've done," said Rep. Lois Kolkhorst (R-Brenham), chairwoman of the Public Health Committee.

The state has suspended payments to 26 orthodontic organizations under a policy called Credible Allegation of Fraud (CAF). The state can hold money back from Medicaid providers if it suspects it was billed fraudulently. Texas estimates that $229 million in Medicaid payments to put braces on kids' teeth may have been improper.

Audits show as many as nine out of 10 payments may have been fraudulent. For general dentistry, more than $154 million may have been overpaid. Expert analysis shows half the bills checked were erroneous. Eighty-nine dental providers have had payments withheld under CAF.

The OIG told a the public health committee of the Texas House that more manpower, more interest in fraud, and improved software are helping catch more fraud going forward. E-mail 

E-mail bharris@wfaa.com

Friday, July 13, 2012

In all fairness Malouf did take his business model from the DeRose family in Pueblo, Colorado… and they have their own footballs stadium and city for that matter…

Who said you can’t make any money seeing to the oral health of our nations poor.

WFAA-TV Byron Harris reports:

WFAA

Posted on July 12, 2012 at 10:30 PM

Updated today at 9:37 AM

DALLAS - The Texas Medicaid dental scandal is moving into a new phase. A construction phase.

One of the dentists charged with fraud in billing Texas taxpayers tens of millions of dollars for unneeded braces on children is in a new spurt of expanding his mansion.

He's building a water park on the property.

It's happening out of public sight, among the high-dollar homes on Dallas' glitzy Strait Lane. All the homes are big here, but the home of dentist Richard Malouf, former majority owner of All Smiles Dental Centers, is even bigger.

Plans for the expansion are on file with the Dallas Planning Commission.
"There's going be a gymnasium, a rock climbing wall," said real estate columnist Candy Evans. "There's plans for a bowling alley upstairs. There's going to be exercise rooms."

The complex, which began taking shape six years ago, began with one chateau. Malouf's Medicaid dental empire was expanding, and he sold a major share to a private equity fund.

Now he's sinking his earnings into a new mansion next door, along with a private Schlitternbahn in the back acreage, along with a second swimming pool to match the one at the original mansion.

All this is happening as two suits charge Malouf with massive fraud, brought by the Texas Attorney General and private attorneys under the False Claims Act.
Attorney Jim Moriarty is one of a consortium of attorneys in the action, led by Waters & Craus in Dallas. They say samples of Malouf's records show that 100 percent of his Medicaid claims were false.

"Frankly, it borders on being obscene," Moriarty said of the mansion expansion. "The taxpayers of the State of Texas paid to build that house, and are paying to expand that house for a guy who claims to have made his money treating the people of Texas."

"I think the only other park I know of is in Jupiter, Florida," Candy Evans said.
That one belongs to singer Celine Dion. A comparison of photos of Dion's estate with those of Malouf's, obtained by News 8, show that Malouf's water park may be bigger.

In Texas, a family's home is immune from seizure. But the lawyers in the false claims action against Malouf say his home may be fair game.

"If that home is purchased with stolen money, or that home is based on money that has been earned by falsehood or deceit, then that home is not protected at all," Moriarty said.

Malouf has several groups of attorneys, since his former company, All Smiles, is in bankruptcy in addition to his pending false claims suit. His most recent criminal attorney did not get back to us.
Related:

Wednesday, July 11, 2012

More Casamassimo propaganda; he needs more money from Medicaid. He says the same crap year after year, and never is enough ever enough. Kinda of like a drug addict chasing the dragon isn’t it.

I’m so sick of people like Paul Casamassimo, DDS spewing his bullshit. He has a vested monetary incentive to mouth off this crap and people just keep right on publishing it. Amazing! I’m sick of him and the elites like him saying people on public assistance are no show losers. And I’m sick of him trying to say the American taxpayer should pick up the bill for doctors who have missed appointments, or empty chairs as he puts it.  Empty chairs may be a problem. Shit, don’t have 14 chairs you need to fill, Dr. Cass-ass! Think about it, you fool! BTW, are you still on the “advisory board” of that child abusing, scumbag company Small Smiles Dental?? If Cassamassimo would stop helping corporations steal Medicaid dollars to line their pockets there might be more money for us to pay for empty chairs and those missed appointments. Of course, that’s just how I see it… and I’m an idiot…so who cares what I think, right?

 

Dentists, Medicaid don't mix
Dental care for poor faces challenges of culture, funding

Marionstar.com

You're at a job interview, so smile. But if you're missing teeth, you're less likely to get hired.

Ohio's Medicaid-eligible population largely ignores dental health, dental professionals say. This means minor problems turn into big problems, which frequently end up with the dentist yanking out the problematic tooth.

Texas Attorney General, Greg Abbott, seeks to recover millions from Dr. Richard Malouf and All Smiles Dental Centers

In March Dr. Richard J. Malouf agreed to pay $1.2-million to settle fraud charges in Texas. That was just the beginning for Dr. Richard Malouf’s woes.

Dr. Richard J. Malouf and Valor Investment thought they could create enough shell companies to hide their flagrant fraud of the Medicaid system in Texas. They thought wrong.

Initial reviews of records seem to indicate 90% of the services for which Dr. Malouf and Valor billed Medicaid, did NOT meet standards and were unnecessary. In other words, 90% of Dr. Malouf’s income was stolen from taxpayers, not just Texas taxpayers but all taxpayers. (Medicaid is funded with both state and federal funds)

Laws in Texas, as in most states,  say that each defendant is liable for the amount of payment they obtained either directly or indirectly from unlawful acts-fraud. They are liable for:

  • Two times the amount of the payment,
  • Interest,
  • Fees,
  • Expenses,
  • Cost incurred by the AG and the Whistleblower to investigation and recover the stolen funds.

In two Whistleblower suits recently unsealed the following corporations, professional corporations or limited liabilities are named:

All Smiles Dental Centers – ASDC Holdings, LLC owned by Valor Private Equity in Chicago, IL.
All Smiles Dental Center, Inc owned by ASDC Holdings, LLC
All Smiles Dental Professionals, PC – Dr. Adrian Codel
Dr. Richard J. Malouf, DDS
Lewisville Smiles, PLLC
St. Francis Smiles, PLLC
Garland Road Smiles, PLLC
Jacksboro Smiles, PLLC
Jacksoboro Smiles by Wire, PLLC
Valleyview Smiles, PLLC
Plano Minyards Smiles, PLLC
Haltom City Smiles, PLLC
Haltom City Smiles, PLLC
Haltom City Smiles, PLLC dba All Smiles Dental & Orthodontics
Northwest Highway Smiles, PLLC
Fort Worth Smiles by Wire, PLLC
Garland Road Smiles by Wire, PLLC
Garland Road Smiles, PLLC dba All Smiles Dental and Orthodontics
S. Hampton Smiles, PLLC
Park Plaza Smiles, PLLC
Park Plaza Smiles, PLLC dab All Smiles Dental and Orthodontics
Richard J. Malouf DDS P.A
Richard J. Malouf, DDS P.C.
2009 Strait Land Family, L.P.
Camelia Family Limited Partnership
RGS Dental Management Services, LLC
RMAL Holdings, LLC
Discount Dental Supply, LLC
As Property Holdings, LLC
M5 Holdings, LLC
Hypermart Lot 6, LLC
Dr. Raffy Kouyoumdjian

(the guys highlighted should go on a no fly list, they may try to skip the country)

The number of people and companies Greg Abbott has named blows the number entities the Connecticut AG filed suit against in May off the charts – Conn AG files suit against dental practice over billing – 28 named. This would make for a great reality TV series – “Battle of the Attorney General’s” or '”Operation Bring Back the Bacon

Anyway, hats off to Texas AG Gregg Abbott for trying to bring the bacon back home. With any luck at all his office will be covered up with these suits.

 

April 2012 Ellis Whistleblower Lawsuit


June 25, 2012 Whistleblower suit

Castillo Whistleblower Lawsuit

Yes, Malouf is trying to escape these claims by filing bankruptcy. Let’s see how far that gets him in this case. Just remember, Salmon swim up stream.

Wednesday, June 27, 2012

Texas Attorney General Lawsuit–Dr. Richard Malouf–All Smiles Dental Centers

wfaaTexas AG lawsuits spurred by WFAA dental investigation

 

Posted on June 26, 2012 at 12:38 PM

Updated today at 9:40 AM

Related:

DALLAS - A year-long WFAA investigation into questionable Medicaid dental payments has resulted in the Texas Attorney General filing lawsuits this week.


Greg Abbott charges that a Dallas dentist and his corporate entities bilked taxpayers out of millions for fraudulent orthodontic work on poor families.


Dallas dentist Richard Malouf amassed a multi-million dollar mansion, corporate jets and luxury vehicles through his dentistry, News 8 has found.


He and his former firm, All Smiles, declared bankruptcy following a series of reports detailing how he and other dentists around Texas gamed the welfare system by billing for unnecessary dental work.
WFAA found that over the past few years, Texas has paid out more in Medicaid orthodontic claims than all other 49 states combined.
All Smiles billed Medicaid for at least $15 million over two years, which is twice as much as the entire state of Illinois. The Attorney General’s lawsuits, filed in Austin Monday, seek to recoup “two times the amount of the overpayments.”


WFAA’s findings have spurred outrage among lawmakers and hearings in Austin and Washington D.C.


Madelayne Castillo, a former All Smiles employee, and Dallas orthodontist Dr. Christine Ellis filed separate whistleblower lawsuits in April and May alleging fraud by Malouf and his corporations.
Both lawsuits remained sealed while the Attorney General’s office investigated the claims. On Monday, Abbott’s office joined those lawsuits by refiling them in the state's name.


In April, Dr. Ellis testified before the U.S. House Oversight and Government Reform subcommittee that Malouf and other dentists were responsible for “flagrancy of fraud that is truly unbelievable."
In May, WFAA reported that All Smiles bankruptcy documents showed that Malouf owns 28 percent of the company, and Valor Equity of Chicago had the remaining 72 percent.
A subsidiary of Valor is a named defendant in one of the Attorney General’s suits.


Abbott alleges Malouf and others violated of the Texas Medicaid Fraud Prevention Act.

“The defendants knowingly or intentionally submitted false information, and misrepresented material facts, when seeking prior approval for orthodontic services,” the lawsuit states.
“Defendants submitted claims for services which they did not provide, and misrepresented or concealed the true nature of the services which they provided,” it states.


“Defendants also knowingly paid or received consideration as a condition of the provision of dental/orthodontic services by unlawful recruiting and paying kickbacks for the recruiting of Medicaid clients,” it continues.


The suits allege that Malouf and the other defendants billed for work that was not medically necessary, and in some cases, performed it with unqualified dental workers. They also “upcoded,” or billed for orthodontics which were more expensive than what was actually provided, the suit states.

by BYRON HARRIS and JASON TRAHAN

Bio | Email

WFAA

Thursday, March 01, 2012

Texas dental centers recruiters solicit Medicaid patients outside food stamp offices promising ipods and more


 

 

WFAA
Posted on February 29, 2012 at 10:03 PM
Updated yesterday at 10:49 PM

NEWS 8 INVESTIGATES

Thousands of kids get free dental care under Medicaid in Texas. Texas taxpayers foot the bill, including putting crowns on the teeth of toddlers who don't yet have their permanent teeth.

A News 8 investigation finds that some dentists want that Medicaid business so badly, they hire recruiters to bring in patients.

At a Texas Health and Human Services Office on Masters Road near Dallas, a man quietly stands in the parking lot, waiting for mothers who've just received food stamps to emerge from the waiting room.

He is a recruiter. He's handing out cards for Happy Teeth Dental, just two doors down in the same complex.

At another HHS office across town, two women also wait for new food stamp recipients. They're handing out cards for Lancaster Dental a few miles away.

And at another HHS office just up the road, Bear Creek Family Dentistry has a small kiosk set up to recruit new patients.

Tuesday, February 07, 2012

Babies for braces? News 8's Medicaid investigations continue | wfaa.com Dallas - Fort Worth

 


DALLAS - No one would say being a single mom is easy. Especially being a single, teenage mother.
But the State of Texas appears to be encouraging teenage girls to become pregnant so they can receive free dental care under Medicaid.


Our investigation last year found hundreds of millions of dollars of taxpayer money spent for free braces on kids' teeth under Medicaid. That spurred a federal investigation, because cosmetic braces aren't supposed to be paid for under Medicaid.
If that is an example of good intentions gone bad, Latricia Banks and her mom, Patricia Jones, may exemplify a good idea gone terribly wrong.


For them, home is a tiny, wooden house in the shadow of Dallas' skyscrapers, which they share with Latricia's 82-year-old grandfather. It is a household held together with love, not money. Medical and dental care came mostly through Medicaid.
A little more than two years ago, Latricia's mom got a postcard in the mail, like many people in the neighborhood.  Access Dental was offering to provide free braces for qualified children like Latricia, then 17 years old.

Friday, December 16, 2011

Texas - State Senate to Hold Hearing on Medicaid Dental

Texas - State Senate to Hold Hearing on Medicaid Dental

 

Byron Harris
WFAA

December 16, 2011

DALLAS - Since last spring, News 8 investigations have uncovered hundreds of millions of dollars of questionable Medicaid payments for orthodontics for children. The state prohibits Medicaid expenditures for cosmetic dentistry, including braces in most cases.

But records obtained by News 8 under the Texas Public Information Act found that Texas spent $184 million providing braces for poor children under Medicaid last year alone, as much as the rest of the nation combined.
Now State Senator Jane Nelson (R-Flower Mound) plans to hold hearings on the issue.

Friday, November 11, 2011

Xerox owned company contributing to dental Medicaid fraud; Fraud from the dental office to the billing processor exposed

It’s apparent to me that neither private companies or government operated health care can operate and deliver healthcare to American’s for a fair price, since theft of taxpayer dollars is part of the business plan.  I’ve said all along that people who think Obama Care will solve the problems are so wrong.  Some seem to think the government will actually operate it—which somehow would be better.  But that simply isn’t the case folks.  The government will hand out contracts to greedy corporations to oversee and operate.  The same corporations who donate and lobby our lawmakers.  All I can see Obama care doing is giving the government the ability to add their favored companies to the free-for-all raiding of the taxpayer money pot. 
 
 
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."





Saturday, October 08, 2011

Taxpayers spent $13 million on orthodontic transportation in Texas

Children picked up and escorted to dentist office for orthodontic treatment when dentist was not even in the state. 

Dollars are scarcely available to treat children who are in  very serious and real need, yet hundreds of millions freely distributed for unnecessary and useless braces on children in the Medicaid system.

These are just two of the allegations in the latest installment from Byron Harris of WFAA-TV in Dallas.


by BYRON HARRIS
Bio | Email
WFAA

Taxpayers spent $13 million on orthodontic transportation | wfaa.com Dallas - Fort Worth

Posted on October 6, 2011 at 11:42 PM

Last year, Texas taxpayers spent $184 million so kids on Medicaid could get free braces. Taxpayers did not just pay orthodontists for doing work many in the middle class consider a luxury. Under Medicaid, the public spent $13 million on orthodontic transportation.

Children got picked up, taken to orthodontists' offices, had their braces installed or worked on and were taken home again. Medicaid pays for up to 26 trips per patient. Many experts say that's evidence of a well-intentioned program gone wrong.


In his office in Dallas, Dr. Deji Fashemo looks at a three-dimensional photo of a child who badly needs orthodontic help. It is a mouth so crammed with teeth it's painful to look at. So in need of structural repair, the patient can hardly open to brush his teeth.

 

Saturday, September 03, 2011

Busy week for wasteful and abusive dentistry in the news–Corporations should be feeling the heat about now

In Rick Perry's Texas: Medicaid Is Wasting Millions -- On Braces

Sat, 09/03/2011 - 12:22am — Joe Conason

Republican presidential frontrunner Rick Perry complains constantly about Washington’s “culture of runaway spending,” wasteful government programs, and federal intrusions into the affairs of the states. In Fed Up, the book he published last year, the Texas governor bitterly criticizes Medicare (which he terms “unconstitutional”) as well as the health care reforms passed by President Obama and by Mitt Romney in Massachusetts, which he regards as infringements on freedom.

Before Perry goes after Romney and Obama on medical spending, however, perhaps he ought to try putting his own state’s government in order first. According to a new investigation by a Dallas television station, the Medicaid program in Texas – overseen by Perry – is wasting millions of dollars annually on orthodontic braces for children who may not even need them.

But the story gets worse: Texas Medicaid wasting big money on unnecessary braces due to lax regulation by the state –and those millions are going straight to for-profit clinics owned by hedge funds.

Reviewing Dallas ABC affiliate WFAA’s investigation, health care expert Trudy Lieberman explains in the Columbia Journalism Review how the teeth of poor children in Texas became a golden opportunity for wealthy investors on Wall Street. Last year, the state spent more than $184 million to provide braces for 120,000 children – many of whom apparently did not qualify for orthodontic care under the state’s own criteria, according to WFAA investigative reporter Byron Harris. That is more than twice as much as Texas spent on the same program three years ago –and the same amount as all of the other 49 states combined.

“Judging by the increased payouts,” Harris noted, “the teeth of Texas children are growing more crooked each year.”

Read complete story here