Outrage on Capitol Hill follows News 8 Medicaid probe

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by BYRON HARRIS

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WFAA

Posted on April 30, 2012 at 10:08 PM

Updated Tuesday, May 1 at 4:42 PM

It's now known as the Texas Medicaid scandal.

News 8 broke the story in an investigation on free braces for children provided under Medicaid over the last year.

Last week, News 8 told you about the core of what is now a federal investigation.

Here is why some members of Congress are mad.

Three days ago, the House Oversight Committee heard about Texas' half-billion dollar problem with free Medicaid braces.

But after some jabs from Congress, the pace has quickened, with witnesses being called in ahead of schedule in some South Texas cases. 

"It would seem to be someone would be watching, particularly the Texas situation," Rep. Jim Jordan (R-Ohio) said. "Where you've got one state doing more this that the rest of the country combined, and yet the first time you found out about it was when the press broke a story on it?"

The line of questioning pursued by Republicans on the committee: If this was on television a year ago, why hasn't the federal government taken action?

"You have before and after pictures. You have photographs of providers who are advertising free braces," Rep. Trey Gowdy (R-South Carolina) said. "So it would not be tough, I don't suspect, to send an investigator to these 'free braces' clinics to find out what percentage of patients they actually denied. With that bevy of evidence, what has CMS [Center for Medicaid and State Operations] done about the Texas Ortodontia scandal?"

The answer from CMS director Cindy Mann was: It's not that simple. 

While federal funds pay for more than half of all Medicaid, it is states who track the programs, evaluate the claims, and pay the doctors. 

Mann said that Texas orthodontia claims were masked under rising Medicaid dental expenditures in Texas.  What she did not mention is that in general, free braces for kids under Medicaid is not funded at all in Texas. 

Dr.  Christine Ellis, a North Texas orthodontist who analyzed dentists' claims for the Office of the Inspector General after News 8 stories aired, found that 90 percent of the claims she examined were fraudulent.

"Have any orthodontists lost their license to practice medicine?" Rep. Gowdy asked.

While federal authorities could revoke a dentist's right to collect Medicaid in a state and the nation, it has no power to take away a license. Only attorneys general or the Department of Justice can take criminal action in Medicaid fraud.

Mann told the panel that the Department of Justice has been brought into the case.

"Here you had Texas charging, or paying, more than the rest of the country combined," Rep. Michael Burgess (R-Texas) said. "It seems like that had to get someone's attention at some level."

Mann was asked how much money her agency has collected in restitution for violations. Her answer: None, so far.

But in one San Antonio case where Texas halted Medicaid payments to dentists last year over questioned claims, the dentists are counter-suing to keep their money. They argue that since the state approved the claims in the first place, they should get their money.

To uncover Medicaid spending, News 8 paid for data from the State of Texas for procedures and payments to the top billing orthodontists in the state for three years.

Federal officials don't routinely do that.

Then we contacted all the states to see how much they were billing, to develop a per capita comparison. 

The federal government says it doesn't do that, either.

E-mail bharris@wfaa.com

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