Texas broadens Medicaid dental fraud probe

2010 09 17 11 09 46 85 Texas Flag 70

The Texas Office of Inspector General (OIG) is investigating the company that processes authorization forms submitted by dentists for dental Medicaid procedures, including orthodontic treatment.

In the latest development in the state's ongoing Medicaid scandal, Affiliated Computer Services, which is owned by Xerox, is being audited for the way it handled Medicaid approval requests that are submitted by dentists and orthodontists, according to an email sent by the Texas Health and Human Services Commission (HHSC) to DrBicuspid.com.

The company is under a contract with Texas and other states to process forms submitted by dentists and determine whether procedures are covered by Medicaid.

"For more than 40 years, Xerox has worked with state government agencies in healthcare and other areas, streamlining business processes in everything from transportation and IT to government-issued benefits, including Medicaid," according to a Xerox statement to DrBicuspid.com. "We are committed to helping our clients deliver efficient, cost-effective services."

Affiliated Computer, which has been under contract with Texas since 2004, reviews and processes Medicaid claims. The contract was expanded in 2007 after a court order required Texas to improve its Medicaid service to 2.8 million of the state's children.

Xerox is conducting its own investigation into the matter and is cooperating with the Medicaid investigation, according to the company.

"Our objective is to operate under the terms of preapproved state contracts and to collaborate effectively with the state's administration to ensure we're maintaining the integrity of the state's Medicaid system," the company said.

The state's attorney general's office has been investigating several orthodontists and dental chains related to Medicaid fraud and overbilling.

The controversy stems the significant jump in spending on orthodontic procedures, which grew from $102 million in 2008 to $185 million in 2010, and the number of children who typically see their orthodontist an average of 12 times a year saw them 22 times in 2010.

Xerox helps administer Medicaid programs in 36 U.S. states and the District of Columbia, and processes $54 billion in annual Medicaid spending, according to Xerox spokeswoman Jennifer Wasmer.

Some 24% of the nearly 80,000 children who last year received orthodontic services from Medicaid were younger than age 12, according to a Dallas News story.

The Texas HHSC is conducting a number of investigations and is working with the OIG's Medicaid Fraud Control Unit to see if dental treatments were necessary in orthodontic and other dental care cases, according to HHSC spokeswoman Stephanie Goodman.

The Texas State Board of Dental Examiners also is working with the HHSC, the OIG, and the attorney general's office to recover money from Medicaid fraud.