Texas Spending on Medicaid Orthodontic Care Declines Dramatically

May 20, 2014 — The Texas Medicaid program is still recovering from the millions of dollars it has lost due to alleged dental Medicaid fraud. Fraudulent filings by Texas dental providers hurt taxpayers, who foot the bill, and patients, who sometimes receive shoddy treatment. Under the False Claims Act, dental clinic workers are encouraged to bring a whistleblower lawsuit on the government’s behalf to put a stop to fraudulent false claims. When a settlement is reached, the whistleblower is financially rewarded. The qui tam language in the statute provides tipsters with a sizable portion of the government’s recovery.

Texas Begins to Recover Medicaid Dollars Allegedly Misspent on Unnecessary Dental Care

Almost three years ago, the Texas Health and Human Services Commission’s Office of Inspector General (OIG) launched fraud investigations into Medicaid dental clinics that were billing the state for millions of dollars in allegedly unnecessary dental services. The problem received much-deserved attention in the media, with WFAA-TV in Dallas reporting in 2011 that Texas was doling out more for Medicaid orthodontic treatment than the country’s nine next most heavily populated states combined.
Since that time, a February 2013 legislative report has revealed, state spending to Medicaid orthodontia providers has fallen from $130 million in fiscal year 2011 to $25 million in fiscal year 2012. The number of actual services provided has also decreased dramatically, from 1.4 million to 401,000. Texas Medicaid spending for preventive dental care and diagnostics has also declined, reports the Texas Tribune.
The state has also begun to recover some of the Medicaid dollars it spent to reimburse Medicaid dental providers for allegedly unnecessary services that did not fall within state guidelines for payment. To date, Texas OIG has recouped $10.4 million in settlements with ten Texas providers of orthodontic and dental procedures for children in the underserved community.

Reduced Fraudulent Billings In Connection With Dental Medicaid Fraud

It is difficult for government investigators to catch all the dental Medicaid fraud that occurs. Before the state becomes aware of the problem, a noticeable pattern of improper billing must be established. Dental practice insiders, however, may have first-hand information about billing irregularities right from the start. Waters & Kraus has dental Medicaid fraud lawyers in Texas, California and the Washington D.C. area who have collaborated successfully with whistleblowers many times. Contact us by email or call us at 855.784.0268 to discuss how we can protect your personal interests while safeguarding public healthcare programs like Medicaid.

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