Tuesday, July 31, 2012

Interactive map of Texas physicians who accept Medicaid

From the Texas Tribune, click here for an interactive map showing the number of physicians who accept Texas Medicaid. 

Monday, July 30, 2012

All Smiles' version of "take the money and run"

From the Dallas Morning News
In a rare move, one of the largest dental providers in the Dallas area is systematically turning away thousands of its young Medicaid patients as it shutters its entire orthodontic operation by the end of the month.  All Smiles Dental Centers, a Dallas-based company, will close all 13 of its orthodontic offices after an audit of those operations by the state’s Medicaid program last fall.

The audit was part of a broader investigation into possible Medicaid fraud throughout Texas.  “We agreed to wind down our orthodontic offices and ended up dismissing about 12,000 patients in the Dallas-Fort Worth area,” Michael Lozich, All Smiles’ chief compliance officer, said Thursday.  “We’ve been trying to help them find new providers.”
 . . .
Dr. Christine Ellis, a Dallas orthodontist who audited Medicaid’s billing records for dental services, said Thursday she faulted the providers for their “truly unbelievable” and “not accidental” practices.
In April, she told a congressional committee investigating Medicaid fraud, “They only were interested in treating kids without real problems. Once they had them in braces, they delivered inefficient care and a whole lot of additional unnecessary appliances to increase their payment from Medicaid.”

Five years ago, Texas decided to pump $1.4 billion into dental services for indigent children.

Wednesday, July 25, 2012

Fiscal intermediaries -- paying the fox to guard the henhouse

Why is there so much fraud in the government health care programs?  In part because the government relies on private contractors to act as fiscal intermediaries.  Even the AMA recognizes, in its own cautious way, that fiscal intermediaries are failing the government and taxpayers.  From a recent AMA white paper:
Contractor Oversight

In addition to an overall reduction in the number of federal program integrity audits, the contractors that conduct these audits should be subject to vigorous CMS oversight. While the AMA has worked productively with CMS program integrity audit staff, in general, it appears that many contractors proceed without sufficient CMS guidance or ongoing supervision. 

For example, in June 2012, the Government Accountability Office (GAO) reported that over a five year period, the MIC [Medicaid Integrity Contractors] contractors cost $102 million and returned less than $20 million, resulting in an overall loss to the federal government of $82 million.  Following this report,  CMS committed to end the contracts of three of the five MIC contractors. While we welcome CMS’ response, this report is very troubling and signifies that there is a lack of appropriate oversight by CMS of program integrity auditors.

And see this nugget from the GAO:

The Centers for Medicare & Medicaid Services (CMS) estimated that $21.9 billion (8 percent) of Medicaid’s federal expenditures of $270 billion in fiscal year 2011 involved improper payments, the second highest amount reported by any federal program. Improper payments include those made for treatments or services that were not covered by program rules, that were not medically necessary, or that were billed for but never provided.  Since 2001, we have reported numerous times on improper payments and our concerns about the adequacy of fiscal oversight in Medicaid.  The challenges inherent in overseeing a program of  Medicaid’s size and diversity make the program vulnerable to improper payments.  Because of the program’s risk of improper payments, as well as insufficient federal and state oversight, Medicaid has been on our list of high-risk programs since January 2003.

Here is the AMA white paper.
Program Integrity White Paper

Here is the GAO study.
GAO National Medicaid Audit Program -- CMS Should Improve Reporting and Focus on Audi Collaboration With th...

And here is a recent US House Committee report showing that Medicaid fraud is spreading like cancer.
Uncovering Waste Fraud and Abuse in the Medicaid Program Final 3

Tuesday, July 24, 2012

The big Medicaid budget squeeze

Medicaid is an ever-growing volcano of cost to state governments, squeezing out programs such as education and infrastructure.  From our perspective, states are doing a terrible job prosecuting health care fraud, a major cause of the exploding cost to Medicaid. 
Created by Congress in 1965, Medicaid is hijacking state politics. Although the federal government covers a majority of costs (typically, 57 percent), the rapid rise in the states' share compels cuts in other programs or steeper taxes.  In the last decade, Medicaid spending has increased at nearly twice the rate of states' tax revenues, notes the Volcker-Ravitch report.
From the WSJ:
Rising Medicaid costs and pension expenses for public employees threaten states' abilities to provide basic government services as they continue struggling with unreliable tax bases in a weak economy, according to a task-force report.
Here is the full report.
Report of the State Budget Crisis Task Force Full

Here is an earlier report.
USA Inc. - A Basic Summary of America's Financial Statements

Monday, July 23, 2012

Texas has updated its Medicaid stats (the numbers keep growing)

Click here.

Bexar County, which is my count, had 250,000 people enrolled in Medicaid for the month of June. The total Bexar County population is 1,750,000 -- a ratio of 1 out 7. 

Another story on Texas Medicaid dental fraud


Wednesday, July 18, 2012

All Smiles CIA - another slap on the wrist

Below is the Corporate Integrity Agreement that All Smiles entered into on March 20, 2102.  For too many of these corporate owned dental mills, fines and fees seem to be just a pothole on the path to Medicaid millions.   To fraudsters like these, rules are for the little people. 

All Smiles Dental Center Inc 03202012(1)

Tuesday, July 17, 2012

This is your brain on Medicaid fraud

Watch the story.  Click here for the article. 


Monday, July 16, 2012

All Smiles Qui Tam Press Release

Based upon the interest in our qui tam case against Malouf and All Smiles, please see our press release below.  

Friday, July 13, 2012

Dr. Malouf . . . meet the Texas Attorney General

Click here for the story.  Hats off to the Texas AG.  But will the government let Malouf and his cohorts walk like last time?  Hope not because Texas Taxpayers and Texas kids deserve better.