Medicaid dentistry tackles patient abandonment after investigation

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by BYRON HARRIS

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WFAA

Posted on July 27, 2012 at 7:42 PM

DALLAS - As Texas cracks down on questionable Medicaid dental payments, dentists' offices are going dark all over the state.

From 28th Street in Fort Worth, to Eureka Circle in Wichita Falls, to Amarillo, dentists who've already collected money from the state to treat Medicaid patients are now turning away those patients, because the dentists' Medicaid claims are being rejected. There are more than 4,300 Medicaid dentists in the state.

Tens of thousands of patients are affected. In 2010, Medicaid paid for braces on about 80,000 kids in Texas. Treatment commonly takes two years.

Since March, the Medicaid dental is managed by three Managed Care Organizations (MCO's)  which have stiffened standards. One MCO said 91 percent of new claims are being rejected.

Moms whose kids already have braces on their teeth are being told children's braces must come off halfway through treatment, that they must go to another clinic far from home, or that there will be no more treatment whatsoever.

Friday, Dr. John Roberts chaired his first stakeholder meeting as Texas HHS dental director. The old director left after News 8 discovered hundreds of millions of dollars of questionable payments under Medicaid orthodontics.

Dentists learned the three MCO's have different payment rates and differing standards. But the overall impression was that moving forward, the children with braces already on their teeth would receive treatment somehow.

"There are plans in place to continue treatment on patients, to re-evaluate patients, and to complete every patient's braces," said Dr. Robert Morgan of Children's Medical Center in Dallas, who attended the  meeting.

The meeting was also broadcast over the web for reporters and interested parties.

It was not clear how the process would exactly work.

If the state reassigns patients to new dentists, regardless of their original need for braces, it will cost millions for treatment which may have been unnecessary in the first place.

One example is All Smiles Dental Centers, which is being sued by the state for fraud. All Smiles told The Dallas Morning News it is eliminating orthodontic treatment at 13 clinics. One witness in the state's case against All Smiles said 95 percent of the dental chain's claims in a 300-patient sample were fraudulent.

All Smiles did not respond to News 8 efforts for clarification.

E-mail bharris@wfaa.com

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