There has been a disinformation campaign which alleges widespread Medicaid related dental (orthodontic) fraud, when the actual evidence and rulings determined by administrative courts have since throws this claim into doubt
Austin, TX (PRWEB) February 01, 2013
The President of Texas Dentists for Medicaid Reform, Greg Ewing, submitted testimony to the Texas Senate Finance Committee regarding lack of due process of investigations by the Office of Inspector General HHSC and the claims of high levels of dental Medicaid fraud.
Ewing wrote, "We are making this submission to the Senate Finance Committee because over the last two years there has been a disinformation campaign which alleges widespread Medicaid related dental (orthodontic) fraud, when the actual evidence and rulings determined by administrative courts have since thrown this claim into doubt.(SOHA docket 529-12-3180 HFD vs THHSC/OIG)"
The submission asserts that the OIG will never collect all the money that it claims is owed by dental Medicaid providers for fraud because actual evidence of that fraud does not exist and the claims are being discredited by administrative court decisions. Also that the State will lose money because the level of investigation will end up costing taxpayers millions more.
One point the TDMR submission stresses is that "the investigatory technique of OIG is not based on actual evidence of fraud by providers but merely the fact that they have large practices and are a high volume Medicaid provider.
"Jack Stick, Deputy Director for Enforcement for OIG, told a national webinar on Medicaid fraud last March, that OIG “goes where the money is.” He said, “We have got our division divided into both provider investigations and recipient investigations. And the overwhelming majority of the staff and financial resources were dedicated to recipient investigations. And of course that is just not really where the money is. So we make a conscious decision that we were going to reevaluate our priorities and that we were going to go where the money is.” He continued in relation to the orthodontic billings “we identified the top 50 [orthodontic] utilizers. Identified about $400 million dollars in overpayments. And conducted a series, actually, we are in the middle of conducting a series of investigations on those providers.” (transcript)
"This is also reflected in the case of a medical provider, Carousel Pediatrics of Austin which OIG is trying to get back $18 million in past payments, based on allegations of Medicaid fraud. Carousel is being supported in its fight against OIG by an insurer and the Texas Medical Association which did an independent review of Carousel's operations and billing practices and found no evidence of fraud. They found highly efficient clinics helping the underprivileged."
Dr. Wood gave testimony to the committee today as he is being forced to close his dental clinics because OIG has imposed a 100% payment hold on his Medicaid billings.
The submission is available for download on the Texas Dentists for Medicaid website.