Jerry Felkner, DDS, dental director of the Texas Medicaid Healthcare Partnership, which handles Medicaid billing and requests for services such as orthodontic care, quit last fall.
And Texas Health and Human Services (HHS) Executive Commissioner Tom Suehs and Medicaid Commissioner Billy Milwee have both announced they will retire in August.
HHS spokeswoman Stephanie Goodman said it was "absurd" that the departures of Suehs and Milwee were related to the ongoing Medicaid controversy.
"Both have been widely praised for their leadership of the Texas Medicaid program," Goodman wrote in an email to DrBicuspid.com.
However, Christine Ellis, DDS, MSD, a Dallas orthodontist and clinical professor in oral surgery at the University of Texas Southwestern Medical Center in Dallas who is an auditor for Texas' Office of Inspector General (OIG), disagreed.
"I think there's every reason to think they were asked to retire," she told DrBicuspid.com.
Dr. Ellis testified before Texas lawmakers last year and to a U.S. House of Representatives committee on government oversight in Washington, DC, in April regarding Medicaid fraud.
Some 'bad actors'
Goodman acknowledged some fraud in the dental program but asserted that it represents only a few Medicaid cases overall.
“I am very concerned about the level of waste and abuse in the system right now.”
— Texas State Sen. Jane Nelson
"We know, unfortunately, there are some bad actors in the Medicaid dental program, but I think, especially on dental services, it's a very small portion of our provider base," she told DrBicuspid.com. "Unfortunately, in some cases they have harmed some children and certainly bilked our taxpayers for a significant amount of money, but I think they're a very small fraction of the dentists in the program."
Less than 1.5% of the children who go in for screenings get crowns and pulpotomies, according to Goodman. The state HHS has started 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 cases, she added.
"They have levied payment holds on several providers, and the inspector general is sending letters to recover Medicaid money that's been paid," Goodman said. "We're seeing far fewer orthodontic cases approved."
Joy Sparks, attorney for the Texas State Board of Dental Examiners, said the board also is working with the Health and Human Services Commission (HHSC), the OIG, and the attorney general's office to recover money from Medicaid fraud.
"We have had several meetings," she told DrBicuspid.com. "We want to make sure our citizens are protected. They want the money back."
All Smiles Dental Center, a chain of 51 dental clinics in Texas that has been the target of investigations into its Medicaid billing practices, filed for bankruptcy last month. Founder Richard Malouf, DDS, and the dental chain agreed in March to pay $1.2 million as part of a settlement agreement related to charges of Medicaid fraud.
All Smiles received more than $10 million for Medicaid orthodontic services in 2010.
In March, Texas State Sen. Jane Nelson (R-Flower Mound) held a hearing on the HHSC.
"I am very concerned about the level of waste and abuse in the system right now, especially within Texas' Medicaid orthodontics and transportation programs," Nelson stated in a press release issued at the time. "We need to be particularly aggressive in protecting our investment in these services."
In its ongoing series on the issue, television station WFAA recently reported that recruiters are being paid to offer parents free gifts such as pizzas, manicures, and Walmart gift cards to take their children to certain dentists. The recruiters get a bonus for each child they bring in, according to the story.
One-to-one solicitation of patients is illegal, HHS spokeswoman Goodman said. "Soliciting clients is never allowed," she said.
Recruiters were told to bring in 100 patients per month, and they would buy patients meals to keep them from leaving the office while they waited to see the dentist, according to WFAA.
Nelson wrote HHS Commissioner Tom Suehs that she was "deeply concerned about illegal solicitation of patients," according to Nelson's spokeswoman Addie Smith.
In 2010, Texas paid $1.2 billion for dental work on children in the Medicaid program, Goodman said. That included including more than $500 million that was spent primarily for cosmetic braces, according to WFAA. Now WFAA is reporting that in 2011 Texas paid more than $100 million for 690,145 steel crowns on children's teeth, all of them placed in children younger than age 9.
"We certainly had some issues in the orthodontic program that we needed to correct, but our program overall is among the best run in the nation," Goodman said. "We've done a much better job getting children into regular dental exams than most states. Unfortunately, some of those efforts to expand access to services also opened a window for some unscrupulous providers to commit fraud in the state. I think that's a small minority of our Medicaid dentists, but we're taking steps to root them out while still making sure that children on Medicaid can get the help they need."