These overzealous claims have been taken as fact by the general public and elected officials which leads to erroneous conclusions. The vast majority of Medicaid providers are ethical and practice within the law and for the benefit of their patients
Austin, Tx (PRWEB) January 09, 2013
The past Friday, the Pulitzer prize winning website Politifact.com published a so-far unreported article that partially debunks the statement that "Texas spent more on Medicaid orthodontic funding than the other states combined" by calling it a half-truth. The website defines a “half truth” as a "statement [that] is partially accurate but leaves out important details or takes things out of context." PolitiFact says on its website that it "is a project of the Tampa Bay Times to help you find the truth in American politics. Reporters and editors from the Times fact-check statements by members of Congress, the White House, lobbyists and interest groups and rate them on our Truth-O-Meter." It was awarded a Pulitzer prize in 2009 for its coverage of the 2008 national elections.
Politifact.com became interested in the claim after Rep. Lois Kolkhorst, the chair of the Texas House Public Health Committee, told a Texas Tribune Festival breakfast meeting last September that "it’s unacceptable that the state of Texas spent more than all 49 other states combined, according to many, many reports and even our own data." The statement was relayed to Politifact by a journalism student from the University of Texas.
G. Gardner Selby, the chief political writer for the Austin American-Statesman, was responsible for researching and writing the piece for Politifact. He found that the flawed claim went back to the original reporting done by Dallas TV station WFAA and their reporter Byron Harris in early 2011. And as time went along, use of the poorly researched statement built up steam and was used by both members of the Texas Legislature and the U.S. House Committee on Oversight and Government Reform.
Selby revealed the following:
1. Harris and WFAA never contacted all 49 states. In fact, he only contacted the ten most populous states and then estimated the rest.
2. Prior to Harris' request, the states in question had never compiled the information relating to orthodontia before.
3. That the different states provide different levels of Medicaid coverage for orthodontia, thereby making any true spending comparison difficult.
4. The national state-by-state Medicaid orthodontia spending data for 2010 is not even available yet from the federal government.
5. No one in the Texas government checked out WFAA facts fully or got the true information. Neither did the federal government.
6. Per a chart sent to Selby by HHSC spokeswoman Stephanie Goodman (which is available through a link in the article and appended to this release), Medicaid orthodontia spending actually increased at a lower rate than other Medicaid-funded dental services from 2006 to 2011.
As the claim that Texas was spending more than the rest of the nation together has fueled a massive investigation into alleged Medicaid fraud by large orthodontic dental clinics and providers in the state, this debunking throws the merits of this investigation into question. All Medicaid orthodontia claims were pre-approved by the state's private contractor, the Texas Medicaid and Health Partnership. Yet, the Office of the Inspector General under the Health and Human Services Commission is seeking to recoup some $226 million dollars from a handful of providers, per the article.
The Texas Dentists for Medicaid Reform, a newly organized group based out of Austin, applauds the research done by Politifact and Selby. It is now including references and links to it on their website.
"These overzealous claims have been taken as fact by the general public and elected officials which leads to erroneous conclusions. The vast majority of Medicaid providers are ethical and practice within the law and for the benefit of their patients," claims Dr. Tara Rios, a former member of the Texas House and a dentist who is on the board of the Texas Dentists for Medicaid Reform. "This article just falls into line with what we are seeing now in the press and the courts about how successful dentists and doctors are being targeted unfairly. It is very useful research."
Last year, a ruling by a judge with the State Office of Administrative Hearings (SOHA Docket No. 529-12-3180) stated that Harlingen Family Dentistry, a large dental practice with 13 dentists in Harlingen, had not committed fraud nor misrepresentation in its Medicaid billings despite a credible allegation of fraud hold put on their Medicaid funds by the Office of Inspector General. The ruling also stated that the judge found OIG's expert witness not credible in assessing that 84 out of 85 of HFD's cases he reviewed were not eligible for Medicaid funding. Further, the ruling outlined that the problem was the subjective nature of the scoring of the orthodontic difficulties of patients by different dentists.
Despite the decision, Harlingen Family Dentistry has remained under investigation by OIG which retaliated by investigating the pediatric and general dentistry sides of the clinic.
Both the Texas Tribune and the Statesman have recently published stories highlighting problems with OIG's approach to fighting Medicaid fraud. Both articles go over the case with Carousel Pediatrics in Austin from which OIG is trying to collect $18 million. The medical practice has the support of the Texas Medical Association and an insurer. The articles state that after a review of Carousel's operations by TMA experts, they could not find any indications of Medicaid fraud.
At the heart of the matter is the alleged lack of due process of Medicaid fraud investigation as outlined by Jack Stick, the Deputy Director of Enforcement for OIG. In a webinar last March for the National Conference of State Legislatures entitled "Containing Medicaid Costs: State Strategies to Fight Medicaid Fraud and Abuse," Stick 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...We have adopted an aggressive approach to credible allegations of fraud. We now will place a credible allegations of fraud hold on a payment. I’m sorry, I’m on a vendor at the intake phase...So in Texas, we have had problems with orthodontists and dentists abusing the system. So we identified the top 50 utilizers. Identified about $400 million dollars in over-payments. And conducted a series, actually, we are in the middle of conducting a series of investigations on those providers."
"It is interesting that in the Politifact article it says HHSC is investigating 50 dental practices for alleged Medicaid fraud. These appear to be Stick's 50 top billers with no other indications of alleged fraud needed. This shows there is a serious problem here with due process for Medicaid providers, not just dentists," says Dr. Juan Villarreal, owner of Harlingen Family Dentistry and a board member of Dentists for Medicaid Reform. "In the same webinar, Stick said he anticipated in closing down 2,000 durable medical equipment providers and that opening such an enterprise was "a sort of a neon light saying investigate me for fraud." These are disturbing comments and providers need to be protected from witch hunts."
The Texas Dentists for Medicaid Reform has been formed to provide an active voice for Texas dental Medicaid providers to the public and government of Texas. It is concerned about the future of Medicaid for the over 3 million children who are now eligible for this broken program. It wants to see legislation put in place so that healthcare providers are protected and are treated fairly so that the indigent children in the state can be helped.