State senate to hold Medicaid dental hearings

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by BYRON HARRIS

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WFAA

Posted on December 16, 2011 at 7:52 PM

DALLAS - Since last spring, News 8 investigations have uncovered hundreds of millions of dollars of questionable Medicaid payments for orthodontics for children. The state prohibits Medicaid expenditures for cosmetic dentistry, including braces in most cases.

But records obtained by News 8 under the Texas Public Information Act found that Texas spent $184 million providing braces for poor children under Medicaid last year alone, as much as the rest of the nation combined.

Now State Senator Jane Nelson (R-Flower Mound) plans to hold hearings on the issue.

"We spend billions of dollars every year on Medicaid services for people in Texas, and I am happy to help people who need help," Nelson said. "[...]and if you look at this one small component of Medicaid expenditures and see this kind of abuse, and if you look at this kind of abuse, and I think that's what it is, abuse and potential fraud, we could have a huge problem."

Nelson's committee will have subpoena power. She says other senators have voiced concern about problems which may be indicated by the expenditures, among them - the claims approval process used by the state.

News 8 discovered ACS, the company which contracts with Texas to approve Medicaid claims, compensates its employees by the volume of claims they process. It is called Activity Based Compensation, or ABC.

"If I am the employee and I am getting paid by the number of papers that I stamp and process, I am going to process these as quickly as I can, I am going to get paid more money," Nelson said. "And there is no guard for those applications that have fraud or aren't technically qualified."

Nelson is also interested in examining huge amounts which some orthodontists have collected in Medicaid money from the state.

"Somebody needs to be held accountable for that," she said. "And I am not talking about just paying money back."

E-mail bharris@wfaa.com

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