Crooked Teeth: Medicaid Millions

Print
Email
|

by BYRON HARRIS

Bio | Email

WFAA

Posted on December 27, 2011 at 7:23 PM

Updated Monday, Jan 9 at 3:10 PM

NEWS 8 INVESTIGATES  The WFAA-TV news special “Crooked Teeth” highlights an 11-part investigative series that reveals tens of millions of dollars in questionable billings and a troubling lack of oversight of the Texas Medicaid orthodontic program.

Although Texas Medicaid limits orthodontic care to poor children with severely misaligned teeth, “Crooked Teeth” reveals Texas paid more for Medicaid-funded dental orthodontics than the other 49 states combined.

In fact, a number of Texas dental clinics receive more in Medicaid orthodontic reimbursements than the amounts paid annually to entire states like Illinois, Georgia, Florida and California.

The half-hour news special “Crooked Teeth” raises questions about other Medicaid reimbursements nationally, including a troubling payment policy by one of the nation’s largest government contractors. 

Strict Medicaid regulations prohibit payment for braces installed for merely cosmetic reasons. WFAA-TV, however, discovers through statistical analysis and basic “gumshoe” reporting that Medicaid orthodontic payments are widespread in Texas. In fact, dental offices have signs and advertisements that promise “free” braces and travel to children.

WFAA-TV reporter Byron Harris and producer Mark Smith, as part of a nine-month investigation, find Texas regulators seldom deny procedures for hundreds of thousands of children.

“Crooked Teeth,” for example, reveals that nearly 20,000 Texas children under 12 years of age received braces last year. Medicaid is supposed to strictly limit such care because children that young often lack their permanent teeth.


“Crooked Teeth” reports that only a handful of reviewers are assigned to process more than a hundred thousand orthodontic claims annually. Basic math would indicate that this leaves reviewers little time to review each of the claims. Most troubling, the series finds, is that dental claim reviewers are paid, in part, based on the volume of claims they process. “Red-flagging” or denying a claim may slow them down.

The growing number of Medicaid billings has allowed individual dentists and their corporations to collect increasing millions of dollars. The success has caught the eye of Wall Street, with hedge funds investing in Texas Medicaid orthodontic clinics.

“Crooked Teeth” has spurred governmental audits and reviews. The state agency overseeing the program has initiated a series of reforms, including hiring a new dental director, several orthodontists and 10 additional staff members. Also, the state has directed the orthodontic Medicaid contractor to develop a “corrective action” plan. Dental clinics now are required to submit full-cast dental molds in filing orthodontic requests, along with the required X-rays, photos and supporting dental documentation.

Texas lawmakers also have scheduled a series of hearings. If the Medicaid-approved services don’t meet state criteria, possible fines and reimbursements from providers and the state contractor may be levied.

E-mail bharris@wfaa.com

Print
Email
|