Welcome to our new Texas Medicaid news section.
HHSC Moves CHIP Cases into TIERS
CHIP cases are now in the TIERS eligibility system. This transition
brings important changes for CHIP health care providers. By October 1,
2013, CHIP members will have a new CHIP ID number. Providers must bill
CHIP services under the new CHIP ID number for services provided on or
after October 1, 2013.
The new CHIP ID will be a nine‐digit number (not an
alphanumeric) recognizable to TIERS. Providers should confirm if the
client is enrolled in CHIP or Medicaid because the new ID will look
similar to a Medicaid ID number. You can call the CHIP Provider Line
at 1‐800‐645‐7164 to verify eligibility of CHIP and CHIP Perinatal
clients or contact the member’s health plan.
Providers must use the old alphanumeric CHIP ID number for services provided before October
1, 2013, with one exception. ...
Texas Medicaid Law Could Transform Life Insurance Industry
Texas dramatically changed its Medicaid eligibility law recently, in a
move that is already having a profound effect on the life insurance
industry -- yes, the life insurance industry. Traditionally, to enroll
in Medicaid, the state-run health insurer of last resort, individuals
needed to be nearly destitute. So to qualify, many people spent down or
surrendered their assets (including life insurance) in order to become
eligible for this needed medical coverage. The new law in Texas,
however, enables individuals with a life insurance policy to enter the
Medicaid program provided they obtain a life insurance settlement and
use the proceeds specifically for long-term care.
Today, Americans are living longer but saving less while healthcare
expenses continue to rise. Traditional retirement savings strategies are
not working as growing long-term care expenses loom for all of us.
Whether we care to admit or ...
What's next for Medicaid in Texas?
Throughout the recent legislative session, Gov. Rick Perry held the
position that Texas would not participate in the expansion of Medicare.
The
governor stood firm on that, despite offers from the Health and Human
Services Secretary to create a "uniquely Texas” approach to its
implementation.
Perry’s stance had state Democrats pleading with the governor to change his mind.
"I
was extremely disappointed, primarily because I think it was the right
thing to do, and secondarily because we had come up with a compromise
that seemed workable, that had strong bipartisan support, that had
majority support, that could have passed," Democratic Rep. Donna Howard
said.
Instead, lawmakers made it a requirement they had to approve
any expansion of Medicaid eligibility, so unless they're called back
for a special session, they'll have to wait until ...
Judge Rules to Exclude Whistleblower from Texas Medicaid Hearing
Texas Dentists for Medicaid Reform have posted to
their website the ruling from a Texas State Office of Administrative
Hearings judge that relator Christine Ellis has no standing to
appear in a Texas Health and Human Services Commission Office of
Inspector General Medicaid provider payment hold hearing concerning
"credible allegations of fraud."
Medicaid expansion gap in Texas could leave poor shortchanged
WASHINGTON — The decision of some states not to expand Medicaid means
that the nation's poorest — those the Affordable Care Act would have
helped the most — may not receive any help at all.
That's because
the 2010 law was written to provide Medicaid coverage for those making
less than 100% of the federal poverty level, $23,550 for a family of
four, in all 50 states. Because those Americans were to get Medicaid
coverage, they were not made eligible for the federal tax subsidies that
would help them pay for health insurance they will be required to buy.
However,
when the Supreme Court ruled last year that the requirement for most
uninsured Americans to buy insurance was constitutional, it also ruled
that the states did not have to expand Medicaid to continue receiving
federal funds for their ...
New annuity decision aids Medicaid planning in Texas
The Eighth Circuit Court of Appeals
(one of the highest courts in the U.S.) has re-affirmed that Medicaid
annuities are still a very important and powerful way to obtain Medicaid
coverage for nursing home residents in all states including Texas.
This decision, just published today on
the Court website, involved a married couple who purchased a $400,000
Medicaid annuity as a way of removing that amount of money from their
"countable" assets for Medicaid purposes. As a result, the husband (in
the nursing home) was able immediately to qualify for Medicaid and the
at-home wife was able to receive the benefit of the $400,000 without
having to "spend down" all that money. She will receive monthly payments
of $2,735 for 13 years.
Although such planning with Medicaid
annuities is most beneficial for married couples, there are a ...
IS ANY INCOME EXCLUDED WHEN APPLYING FOR MEDICAID ELIGIBILITY IN TEXAS?
Understanding the concept of income eligibility sounds simple but
how Texas treats income differs under different scenarios. The
following are some of the more common examples. For one, money received
from the sale of an asset (resource) is not income. Another example, the
sale of a home does not create income.
Loans received in the past by a Texas Medicaid applicant, which are due and
payable are not counted as income. However regular payments to the
Medicaid applicant from family members over an extended period of time
which are impossible to repay, given the applicant’s current and/or
future financial status, are not considered loans by the State of Texas. They
are instead treated as income.
Where children have been paying for their parent’s care, we can
often get that money back to the children through the sale of the
parent’s ...
Texas premiums will rise with Medicaid expansion opposition
AUSTIN — Texas’ refusal to expand Medicaid will cause private health
insurance premiums to rise by an average of 9.3 percent for people who
buy their own coverage, a new study finds.
GOP lawmakers, strongly
encouraged by Gov. Rick Perry, decided not to add poor adults to
Medicaid’s rolls. That means about 1.3 million fewer Texans will have
health coverage by 2016 than if the federal Affordable Care Act were
fully implemented in the state, according to the study by the nonprofit
research organization Rand Corp.
About 320,000 adult Texans just
above the poverty line will take advantage of the Affordable Care Act’s
federal subsidies and buy coverage in the individual insurance market,
the researchers said. Those are people who would have been enrolled in
Medicaid as the federal law was written and before that part ...
Final Arguments Filed in Texas Orthodontic Medicaid Case Before the State Office of Administrative Hearings
Texas Dentists for Medicaid Reform have made available legal briefs for download on their website
Austin, TX (PRWEB) August 30, 2013
This past week attorneys for Houston-based Antoine Dental Center
(ADC) and those representing the Texas Health and Human Services
Commission Office of the Inspector General filed their closing arguments
in the pending State Office of Administrative Hearings (SOAH) case
(SOAH DOCKET NO. 529-13-0997).
The case challenges the 100% payment hold that has been in force
against ADC since April 2020, the filings indicate. The court documents
also show that the payment hold was levied against ADC by the Office of
the Inspector General based on "credible allegations of fraud.”
Texas Dentists for Medicaid Reform have posted an article about the
filings and made available the legal briefs for both ADC and OIG for
download ...
Ross Perot Foundation Gives $1M to Planned Parenthood Engaging in Medicaid Fraud
The foundation affiliated with billionaire businessman and former
presidential candidate Ross Perot has given $1 million to the
Texas-based Planned Parenthood abortion business that was found to have
engaged in millions in Medicaid fraud.
Texas Attorney General Greg Abbott announced on July 24 that his office had obtained a $1.4 million settlement against Planned
Parenthood Gulf Coast for Medicaid fraud, with the settlement to be
split between the state of Texas, the federal government, and the
whistleblower who uncovered the fraud. But that hasn’t stopped the Perot
Foundation from supporting the Texas arm of Planned Parenthood with a $1 million gift.
The total settlement is actually $4.3 million – almost $3 million more than previously known — meaning the amount of
fraud the Planned Parenthood abortion company engaged in was likely a
higher amount than that.
How Rick Perry's And Bobby Jindal's Medicaid Snubs Boost Private Insurance Costs
Health insurance rates for individuals purchasing private coverage could jump 8
to 10 percent in Louisiana, Florida and Texas where state political
leaders have decided against expanding the Medicaid health insurance
program for the poor under the Affordable Care Act, new research indicates.
In a new study from the nonprofit research organization RAND Corp., researchers said
the lack of an expanded Medicaid program will force more lower income
people into the individual insurance market via exchanges created by the
health law to provide more private coverage. STORY
State Awaiting Feds' OK to Boost Medicaid Payments
Under a
provision of the Affordable Care Act, payments to primary care doctors
under Medicaid — the joint state-federal insurer of children, the
disabled and the very poor — are supposed to rise to the same level as rates for Medicare, the federal health
program for the elderly. It's an increase intended to encourage more
physicians to take on Medicaid patients.
But the increase, which was set to
take effect in January, has been postponed in Texas and several other
states because the federal government has not yet approved their
strategies for boosting payments, said Stephanie Goodman, a spokeswoman for the Texas Health and Human Services Commission.
U.S. Probes Whether Medicaid Programs Over-Prescribe Antipsychotics To Children
Health officials are investigating whether health care
professionals are prescribing antipsychotic drugs too often to children
on Medicaid. In the meantime, a Texas compounding pharmacy has become
the latest to have its products recalled over meningitis concerns.
The Wall Street Journal: U.S. Probes Use Of Antipsychotic Drugs On Children
Federal health officials have launched a probe into the use of
antipsychotic drugs on children in the Medicaid system, amid concern
that the medications are being prescribed too often to treat behavioral
problems in the very young. The inspector general's office at Department
of Health and Human Services says it recently began a review of
antipsychotic-drug use by Medicaid recipients age 17 and under. And
various agencies within HHS are requiring officials in all 50 states to
tighten oversight of prescriptions for such drugs to Medicaid-eligible
young people ...
New Texas Medicaid Eligibility Calculation Draws Concerns
With key components of the
Affordable Care Act set to take effect in January, state officials are
worried that a change in the determination of Medicaid eligibility could
increase costs and decrease efficiency in processing applications for
Medicaid and other benefits programs.
Under the law, family incomes and sizes — used to
determine if a family qualifies for Medicaid — will be determined based
on tax filings, a different process than what is used for the
Supplemental Nutrition Assistance Program and Temporary Assistance for
Needy Families, said Stephanie Goodman, a spokeswoman for the Health and
Human Services Commission.
Because eligibility for Medicaid and the Children’s
Health Insurance Program will now be calculated using different metrics
than SNAP and TANF will use, HHSC could see an increase in workload,
Goodman said, which could result in a delay ...
Sebelius said: We're Open to "Uniquely Texan" Approach
The federal government is open to expanding Medicaid coverage under
the Affordable Care Act in a way that is more tailored to Texas’
preferences, Health and Human Services Secretary Kathleen Sebelius said
Thursday while visiting Austin City Hall.
"We are eager to have discussions with Texas about a program that
could look uniquely Texan,” Sebelius said. "But as far as I know, those
conversations, at least with the state officials, are not taking place
right now.”
The federal government has committed $90 billion to extend health
benefits to adults below the federal poverty line through Texas’
Medicaid program, which currently provides coverage to poor children,
the disabled and extremely poor parents. But that money won’t reach
Texas unless Gov. Rick Perry and the state Legislature approve expanding Medicaid benefits to poor
adults — a position ...
Doc-Owned Hospitals Thriving In Texas Despite Ban From Medicare, Medicaid
In the meantime, Brooklyn deals with imminent hospital closures and what it means for care in the New York City borough.
Dallas Morning News: Physician-Owned Hospitals Expand In Dallas-Fort Worth
George Ten Eyck is prepped for surgery by Christine Varela, a registered
nurse, at Victory Healthcare in Hurst. The facility is part of a
physician-owned chain that is growing despite not taking Medicare or
Medicaid patients. Physician-owned hospitals in North Texas are finding
ways to expand despite being banned from accepting Medicare and Medicaid
patients (8/5).
Kaiser Health News: Cascading Hospital Closures Loom Over Brooklyn
WNYC's Fred Mogul, working in partnership with Kaiser Health News and
NPR, reports: "Brooklyn, New York, home to hipsters, an NBA team and a
seemingly unlimited supply of new ultra-chic boutiques and restaurants,
seems to be increasingly inhospitable to hospitals. Despite the efforts ...
Increased Risk Of Complications After Spine Surgery For Medicaid Patients
Among patients undergoing spinal surgery, Medicaid beneficiaries are at higher risk of experiencing any type of
complication, compared to privately insured patients, reports a study in
the journal Spine. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.
"Medicaid insurance status is a risk factor for perioperative
complications," according to the research by Dr Jacques Henri Hacquebord
of University of Washington, Seattle, and colleagues. They believe
their study draws attention to the "often unacknowledged" problem of
under-insurance.
Insurance Status Affects Spinal Surgery Outcomes
The researchers analyzed outcomes in a database of nearly 1,600 patients
undergoing spinal surgery over a two-year period. Type of insurance was
evaluated as a predictor of any type of complication or adverse outcome
within two years after surgery.
211 Texas, Get Help in Texas from 2-1-1 Texas - 211 Texas Medicaid
2-1-1 Texas, or Texas 211 - is a program operated by the
Texas Health and Human Services Commission (HHSC). 211texas.org is committed to helping Texas
citizens connect with the services they need.
Whether by phone or internet, their goal is
to present accurate, well-organized and easy-to-find information from over 60,000 Texas state
and local health and human services programs.
2-1-1 Texas provides efficient access on the internet or by phone to the most appropriate sources of help and information from anywhere in Texas. Anyone can call 2-1-1 or go to 211texas.org for free information and referrals to health and human service agencies, nonprofit and faith-based organizations, disaster relief resources, and volunteer opportunities.
For example, the 2-1-1 helpline in Dallas maintains a comprehensive community resource database of services providing assistance with health care, employment, educational, legal, housing, counseling, and transportation needs, and much more.
...
Medicaid and Pain Killer Addicts
Painkiller addicts hit Medicaid limits
Michael Ollove, Pew/Stateline Staff Writer
Tо Mark Publicker, а doctor іn Portland, Maine, whо
practices addiction medicine, it's а clear case оf discrimination. Yоu
wouldn't deprive а diabetic оf insulin. Yоu wouldn't stop giving
hypertension drugs tо а patient wіth high blood pressure аftеr
successful treatment. Yоu wouldn't hold bасk а statin frоm а patient
wіth high cholesterol.
Yеt Publicker's patients face severe limitations оn thе amount аnd
duration оf medicines thеу tаkе tо fight thеіr addictions tо pain pills.
And thе consequences оf thоѕе policies bу Medicaid аnd private insurers
аrе аt lеаѕt аѕ dire аѕ thеу wоuld bе fоr thоѕе wіth оthеr ѕеrіоuѕ
ailments іf thеу wеrе denied proven treatments, hе said.
"People wіll die," Publicker said.
Mаnу private insurance companies аnd state Medicaid agencies асrоѕѕ thе
country impose ...
Health Care Providers Bracing for Medicaid Enrollment
Under Gov. Rick Perry’s leadership, Texas will not expand Medicaid
eligibility to poor adults. But enrollment in the state’s health program
for indigent children and the disabled will still swell in 2014 under
new rules created by the federal Affordable Care Act.
Texas’ health care provider safety net and the state agency that
oversees Medicaid are preparing for the anticipated increase and other
challenges that lie ahead.
The Texas Health and Human Services Commission projects 240,000
children currently eligible for Medicaid but not participating will
enroll in 2014 and 2015, as families seek coverage to comply with the
individual insurance mandate, which takes effect on Jan. 1. An
additional 200,000 people could enroll in Medicaid as a result of other
new requirements created by the law, according to state health
officials. MORE...
Central Texas MD Faces Federal Fraud Indictment
TYLER (July 16, 2013)—The owner of five Texas hospitals, including
one in Cameron, has been named in a federal indictment charging him with
Medicare fraud.
Tariq Mahmood, 61, from Cedar Hill, on April 11 was named
in the indictment by a federal grand jury in the court’s Eastern
District of Texas, based in Tyler, and is charged with conspiracy to
commit more than $1 million in health care fraud in nine separate
counts.
Court records show Mahmood owns five hospitals in Texas,
including the Central Texas Hospital, in Cameron, Cozby Germany Hospital
in Grand Saline, Renaissance Terrell Hospital in Terrell, Community
General Hospital in Dilley, and Shelby Regional Medical Center in
Center.
Mahmood, who has denied the charges, appeared before U.S. Magistrate John D. Love in April and had a bond set at $25,000.
MORE......
Health Insurers Bracing For Medicaid Enrollment
Health Providers Bracing for Medicaid Enrollment
By BECCA AARONSON
Undеr Gov. Rick Perry’s leadership, Texas wіll nоt expand Medicaid eligibility tо poor adults. But enrollment іn thе state’s health program fоr indigent children аnd thе disabled wіll ѕtіll swell іn 2014 undеr nеw rules created bу thе federal Affordable Care Act.
Texas’ health care provider safety net аnd thе state agency thаt oversees Medicaid аrе preparing fоr thе anticipated increase аnd оthеr challenges thаt lie ahead.
Thе Texas Health аnd Human Services Commission projects 240,000 children сurrеntlу eligible fоr Medicaid but nоt participating wіll enroll іn 2014 аnd 2015, аѕ families seek coverage tо comply wіth thе individual insurance mandate, whісh takes effect оn Jan. 1. An additional 200,000 people соuld enroll іn Medicaid аѕ а result оf оthеr nеw requirements created bу thе law, ассоrdіng tо state health officials.
Thіѕ presents а challenge fоr health ...
Amerigroup Medicaid
Amerigroup Medicaid
Medicaid is America's publicly financed health care insurance program for low income American citizens and legal residents. Medicaid covers children, pregnant women and people with disabilities. Medicaid includes Family Care - providing health insurance for uninsured adults and parents of CHIP (Medicaid-eligible children).
Texas Medicaid can cover some people who are on Medicare, as well: low-income elderly and people with disabilities. These people are sometimes referred to as dual eligibles. For these individuals, Medicaid supplements Medicare-covered services by paying for Medicare premiums, members’ cost-sharing requirements and long-term services and supports (LTSS).
Amerigroup serves Medicaid members in 12 states including Texas and offers a wide range of benefits:
Physician, hospital and pharmacy services for children and adults
Services that many private insurers and Medicare do not cover, such as transportation and long-term care
Many of the added Amerigroup services make health care ...
Pharmacists Push Transparency in Medicaid Pricing
As a business owner, would you sign a contract that requires you to
purchase a product, give that product away and then request payment from
a third party without knowing how much you’d receive? What if you also
didn’t know how much you’d be reimbursed before signing the contract,
and that the other party could change that reimbursement rates without
notice?
That’s the situation facing Texas pharmacists participating in Medicaid managed care.
"The lack of transparency there makes it very difficult for an
independent pharmacist to find out what they’re going to be reimbursed,”
said state Sen. Charles Schwertner, R-Georgetown, a surgeon and fourth-generation pharmacist. MORE...
History of Medicaid in Texas
History of Medicaid - in Texas and other states
Medicaid wаѕ created bу thе Social Security Amendments оf 1965
whісh added Title XIX tо thе Social Security Act. Texas officially
adapted thе Medicaid program іn 1967. Thе Medicaid program today іn Texas іѕ administered bу Health and Human Services Commission (HHSC). Medicaid wаѕ created аѕ аn entitlement program tо hеlр states provide
medical coverage fоr low-income families аnd оthеr categorically related
individuals meeting eligibility requirements. Candidates include blind peopl, aged, disabled аnd pregnant women.
In essence, Medicaid serves аѕ thе nation’s primary source оf
health insurance coverage fоr low income populations. Eасh state
administers іtѕ оwn Medicaid program, establishes thеіr оwn eligibility
standards, determines thе scope аnd types оf services thеу wіll cover,
аnd sets thе rate оf payment. Benefits vary frоm state tо state, аnd
bесаuѕе ѕоmеоnе qualifies fоr ...
Continuing to work with states to build new systems of health coverage
By Cindy Mann CMS Deputy Administrator and Director, Center for Medicaid and CHIP Services
CMS is committed to working in partnership with states in administering their Medicaid and Children’s Health Insurance Programs (CHIP) and to providing flexibility in pursuit of our shared goals.
Premium assistance has been a longstanding option in both Medicaid and CHIP and is one way to accomplish those shared goals. CMS provided guidance in December of last year on how states might use these options to develop state-based solutions that meet both the state’s unique needs and requirements of the programs
In response to some questions that have been raised by states, today we are issuing some clarifying guidance. Today’s Frequently Asked Questions explain the basic requirements that apply when a state chooses the premium assistance option and the guidelines we would apply when a state requests a waiver to implement premium assistance. ...
Big Medicaid gap looms for some American seniors
WASHINGTON — Nearly 2 in 3 uninsured low-income people who would qualify for subsidized coverage under President Barack Obama’s health care law may be out of luck next year because their states have not expanded Medicaid.
An Associated Press analysis of figures from the Urban Institute finds a big coverage gap developing, with 9.7 million out of 15 million potentially eligible adults living in states that are refusing the expansion or are still undecided with time running short.
That a majority of the neediest people who could be helped by the law may instead remain uninsured is a predicament unforeseen by Obama and congressional Democrats who designed a sweeping extension of the social safety net. The law’s historic promise of health insurance for nearly all U.S. residents would not be fulfilled as envisioned.
South Texas to share in HHS grants for Medicaid and CHIP enrollment push
July 2, 2013
The U.S. Department of Health and Human Services’ (HHS) has awarded
nearly $3 million in grants to several Texas organizations that will
work to identify and enroll eligible children for Medicaid and the
Children’s Health Insurance Program (CHIP).
Community Action Corp. of South Texas will receive more than $820,000 in grant funding from HHS. Read more...
Obamacare's Medicaid Expansion Shortfall Shuts Millions Out of Health Care
July 03, 2013
Rose Ruiz earns $8 an hour taking care of a 67-year-old diabetic on Medicaid in Austin, Texas. At an annualized rate of $16,640, she can’t
afford to buy her own medical insurance. Her best shot at getting
coverage was through the expansion of Medicaid mandated under the
Affordable Care Act. But because of a U.S. Supreme Court decision that
the law’s Democratic authors in Congress never anticipated, millions of
low-wage workers who were supposed to be helped by Obamacare will
probably end up without coverage. Read more....
Bill to limit Medicaid abuse passes Texas legislature
DALLAS -- Last August, News 8 discovered children were being lured into
vans with cash and promises of pizza, taken to dentists offices, and
injected with painkillers without their parents’ permission.
Then, records show, unneeded dental work was done on the children, and Medicaid was billed.
More than a dozen children were taken into the vans, with many going to
All About Dentistry, a clinic in Mesquite. All About Dentistry is now
closed. The dentist who performed the work was Dr. Seyed Masoud
Shariati, a 2004 graduate of Baylor Dental College. MORE.....
Health Officials Decry Texas' Snubbing Of Medicaid Billions
The state of Texas is turning down billions of federal dollars that
would have paid for health care coverage for 1.5 million poor Texans.
By
refusing to participate in Medicaid expansion, which is part of the
Affordable Care Act, the state will leave on the table an estimated $100
billion over the next decade.
Texas' share of the cost would
have been just 7 percent of the total, but for Gov. Rick Perry and the
state's Republican-dominated Legislature, even $1 in the name of
"Obamacare" was a dollar too much.
"Texas will not be held
hostage by the Obama administration's attempt to force us into this
fool's errand of adding more than a million Texans to a broken system,"
Perry said.
Texas Republicans have moved steadily to the right —
to where the very ...
Texas Legislature passes measure to prevent Medicaid expansion
AUSTIN, Texas (Reuters) - The Republican-majority Texas
House and Senate on Sunday sent Governor Rick Perry a proposal to
prevent the state from expanding its Medicaid program as outlined by
President Barack Obama's healthcare reform law.
Perry, a Republican, notified the Obama administration
last summer his state would not expand Medicaid, which provides
healthcare for low-income people. He repeated his opposition in an April
news conference at which he called expansion "foolish." Read more..
Texas Medicaid
Program Description Medicaid is the State and Federal cooperative venture that provides
medical coverage to eligible needy persons. The purpose of Medicaid in Texas is to improve the health of people in Texas who might otherwise go without
medical care for themselves and their children.
The
mission of the program is to improve the health of Texans
by:
· Emphasizing prevention
· Promoting
continuity of care
· Providing a medical home for Medicaid
recipients
· Ensuring that each recipient can receive high
quality, comprehensive health care services within the recipient's
community
General Program Requirements In order to qualify for this benefit program, you must be a
resident of the state of Texas, a US national, citizen, permanent resident,
or legal alien, in need of health care/insurance assistance, whose financial
situation would be characterized as low income or very low income. You ...
Delta Dental no longer providing services for Texas Medicaid and CHIP Dental Services Program
Announcements
- Delta Dental no longer providing services for Texas Medicaid and CHIP Dental Services Program
- On December 1, 2012 Delta Dental will no
longer be a provider of dental services for the Texas Medicaid and CHIP
Dental Services Program. Medicaid Providers: To find
out what new dental plan the member has, please visit the Your Texas
Benefits provider portal or ask the member for a dental plan ID card.
You may have the member contact 1-800-964-2777 for information. Texas CHIP Providers: To find out what new dental plan the member has, ask the member for a dental plan ID card or call 1-800-645-7164.
- Prior Authorization of NEW Orthodontia
- Effective October 1, 2012, Delta Dental is
unable to process prior authorization requests for NEW orthodontia cases
for Texas Medicaid or CHIP Members. Providers should submit these prior
...
Feds Accuse Texas Doctor In $350 Million Medicare Fraud
When it comes to schemes to defraud Medicare and Medicaid, there seems to be no limit to the ingenuity and tenacity of would-be scammers.
Still, a Texas doctor and six co-conspirators indicted for an alleged long-running home health care scheme look to have set a new record for a one practice: at least $350 million in fraudulent Medicare bills and $24 million under Medicaid over nearly six years ending in late 2011.
Dr. Jacques Roy, of Rockwall, Texas, and other doctors who worked with him certified more than 11,000 Medicare beneficiaries during that time so they could receive care in their homes, according to a federal . The government says that figure is more than any other group of doctors in the whole country during that time. MORE..
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