Texas State Audit Report Showing Deficiencies in Medicaid Contractor Released on Texas Dentists for Medicaid Reform Website

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The 2008 Texas Medicaid Healthcare Partnership Prior Authorization Audit by the Office of the Inspector General HHSC placed on website to highlight that Texas authorities knew about private contractor’s deficiencies for years but did nothing

Texas Medicaid Healthcare Partnership  Prior Authorization Audit

Texas Medicaid Healthcare Partnership Prior Authorization Audit

Providers have been accused of 'fraud', but we were green-lit by ACS every step of the way. We acted in good faith, but now that the mismanagement of this program is a political football, we've been turned into scapegoats."

The Texas Dentists for Medicaid Reform have made available on their website the 2008 audit of the Texas Medicaid and Health Partnership (TMHP), the state’s private Medicaid contractor. The audit conducted by the Office of the Inspector General (OIG), Health and Human Services Commission (HHSC), shows that the Texas government was aware that the agency’s handling of Medicaid orthodontic pre-approvals was deficient back in 2008 yet nothing was done.

In 2011, Dallas TV station WFAA reported that orthodontic Medicaid expenditures were exceedingly high in comparison to other states, leading to allegations of Medicaid fraud in Texas. HHSC officials, including the Office of the Inspector General, testifying before legislative committees starting in early 2012 and continuing to the present have focussed on dental Medicaid providers, not TMHP. TMHP is actually ACS State Healthcare LLC, which is under contract with HHSC and administers the claims processing for Texas Medicaid and other state health-care programs. ACS is a XEROX company.

"Providers have been accused of 'fraud', but we were green-lit by ACS every step of the way," said TDMR board member Dr. Juan Villarreal. "We acted in good faith, but now that the mismanagement of this program is a political football, we've been turned into scapegoats."

The audit entitled "Performance Audit Report, Texas Medicaid Healthcare Partnership Prior Authorization Audit" -- was delivered to principals both at the Texas Medicaid Healthcare Partnership (TMHP) and the HHSC. It focused on the area of pediatric orthodontics.

Highlights included:

  • The overall finding of the audit was "partial compliance."
  • The number one problem area identified was in the "orthodontic prior authorization" (PA) "requests process."
  • Specifically, OIG found that "not all documentation... (was) reviewed."
  • Despite being required by contract to "provide sufficient medical staff", "(t)he PA dental team members" (at ACS) "... (did) not have the dental licenses necessary" to determine if treatments met the for threshold for approval.
  • According to ACS, at least 90% of orthodontic PA requests were not reviewed.
  • The audit was disputed by ACS. They held that their contract did not require them to exercise any oversight over orthodontic services a provider claimed qualified for Medicaid.
  • ACS offered to add a "sample step" (pulling some requests for further review), but it might "require a change order" (to their contract).

"This leads to questions," said Chuck Young, spokesperson for Texas Dentists for Medicaid Reform (TDMR). "How much money did ACS make on Texas Medicaid orthodontics? Why isn’t OIG claiming how much money they are going to collect back from ACS? If there was already a segment of Texas Medicaid that was overheating to the tune of one hundred million taxpayer dollars per year, why was this not brought up at the 2009 -- or 2011 -- legislative sessions?”

“We are making this document available on our website so that all Medicaid providers, dental and otherwise, become aware of these questions,” concluded Young.

Texas Dentists for Medicaid Reform is a 501(c)4 founded by dental practitioners "concerned about the future of dental care for the over three million Texas children eligible for Medicaid."

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