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State Ends 1 Medicaid Dental Care Contract; Investigates Dental Fraud

Health Care

 

As part of its ongoing work to oversee the Medicaid dental program for children in Texas, the State is ending its contract with one of its three Medicaid managed care plans effective Dec. 1, 2012. About 1 million children enrolled with Delta Dental will be transferred to the two remaining dental plans, Dentaquest and MCNA. This will require many families to find a new dentist who is willing to serve children with complex needs and accept new patients.

A boy has his braces cleaned and adjusted at the orthodontist.

A joint task force is investigating more than 400 dentists and orthodontists across the state for potential Medicaid fraud in an effort to recover misused funds. Photo: iStockPhoto.

Meanwhile, a joint task force is investigating more than 400 dentists and orthodontists across the state for potential Medicaid fraud in an effort to recover misused funds. The joint task force was created by the Texas Health and Human Services, the agency’s Office of Inspector General and the Attorney General’s Office. The agency identified more than $370 million in potential overpayments for Medicaid dental and orthodontic services, according to HHSC Inspector General Doug Wilson. A report by the U.S. House Committee on Oversight and Government Reform last spring indicated that Texas spent as much on orthodontic services in 2010 as every other state combined.

Some of the fraud cases involve dental clinics that illegally solicited Medicaid patients, offering them free food or gift cards in exchange for signing up for a dental exam. “A doctor can’t offer a Medicaid client cash, a gift card, amusement park tickets or similar items as an incentive to get them to go to their office or clinic,” Wilson said. “That’s a violation of the laws that prohibit solicitation of Medicaid clients, and violations can carry a penalty of up to $10,000 per incident.”

If a doctor, dentist or other Medicaid provider offers you free gifts, you can call the Office of Inspector General hotline at (800) 436-6184. For more details regarding illegal gifts, see “Inspector General: Law prohibits free gifts for Medicaid clients”. For additional information on dental fraud investigations, read the Texas Tribune article, “Lawmakers Want Answers on Dental, Orthodontic Fraud.”