State expands Medicaid dental fraud estimates

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by BYRON HARRIS

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WFAA-TV

Posted on October 17, 2012 at 10:03 PM

Updated Thursday, Oct 18 at 12:01 PM

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NEWS 8 INVESTIGATES

Texas Medicaid dental expenditures quadrupled in recent years, from $400 million in 2006 to $1.43 billion in 2011.

The Office of Inspector General is now tracking more than $383 million of potential fraud and overpayment, it told a Texas House of Representatives committee.

In a House hearing on Monday, News 8's investigations of Medicaid dental fraud were praised by state representatives.

"I have to tip my hat to WFAA in Dallas for doing what they've done," said Rep. Lois Kolkhorst (R-Brenham), chairwoman of the Public Health Committee.

The state has suspended payments to 26 orthodontic organizations under a policy called Credible Allegation of Fraud (CAF). The state can hold money back from Medicaid providers if it suspects it was billed fraudulently.

Texas estimates that $229 million in Medicaid payments to put braces on kids' teeth may have been improper. Audits show as many as nine out of 10 payments may have been fraudulent.

For general dentistry, more than $154 million may have been overpaid. Expert analysis shows half the bills checked were erroneous.

Eighty-nine dental providers have had payments withheld under CAF.

The OIG told a the public health committee of the Texas House that more manpower, more interest in fraud, and improved software are helping catch more fraud going forward.

E-mail bharris@wfaa.com

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