Texas officials struggle to prove orthodontists committed fraud

A recent court ruling in favor of a Texas orthodontics provider adds to the state's longstanding inability to prove claims that dental providers overbilled Medicaid tens of millions of dollars, according to the Austin American-Statesman.

In the latest case, an appeals court ordered Texas to release $3 million in reimbursement owed to Antoine Dental Center located in Houston. In 2013, the inspector general accused the provider of improperly submitted claims for tooth-repair procedures.  

The state has yet to win a case against any of the dental providers it previously accused of fraud, according to the paper, although it has settled for a combined $20 million with nearly 100 dental providers initially accused of more than $820 million in fraud. Last year, the feds requested Texas return $133 million after the state approved Medicaid payments that didn't meet prior authorization requirements.

The cases may reflect shortcomings within the previous administration of the Texas Department of Health and Human Services Commission. Last year, following a no-bid contract scandal with a fraud detection company, the agency hired a new inspector general and initiated sweeping changes to the way it investigates fraud. Under the previous inspector general, the state identified more than $1 billion in Medicaid overpayments, but recovered just $5.5 million.

To learn more:
- read the Austin American-Statesman article

Related Articles:
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Performance audit, 21CT fallout bring wave of changes to Texas HHSC
Medicaid analytics deal in Texas raises eyebrows
After claiming providers committed $823M in dental fraud, Texas settles for just $20M
Unnecessary orthodontic payments reach $191 million in Texas

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