Texas Dentists Allegedly ‘Bilked’ Medicaid During Bush’s Administration
The AP/Baltimore Sun reports on allegations of dentists "bilking" Medicaid in Texas during Gov. George W. Bush's administration. In 1997, a state Medicaid investigator sent a letter to the governor, saying dentists "were unnecessarily performing more expensive procedures on poor children" in order to receive higher Medicaid reimbursements. The allegations stem from the use of stainless steel crowns in children, which command a higher reimbursement rate than the typical filing. Texas' Medicaid program pays between $68.75 and $85.51 for the crowns, while only reimbursing $27.30 for single surface fillings. Some pediatric dental experts say the crowns make sense for children "who receive care infrequently." Critics, however, say the procedure puts children at "greater risk," since they sometimes need to be anesthetized. In response to the letter, Bush directed a "top aide" to investigate the situation and take "whatever action" deemed "appropriate." After launching an investigation, Galveston officials found a band of "roving dentists" who performed procedures out of a bus "equipped like a dental office." Officials discovered these dentists were using a computer linked to state records that showed the amount of money children had remaining in their state Medicaid accounts. This information led officials to conclude the dentists were defrauding Medicaid. Investigators said the use of the more expensive crowns was "profit driven," but dentists said investigators are "second guess[ing]" clinicians with more experience. Now, critics say pressure from the "influential" dental lobby, which contributed $100,000 to Bush's gubernatorial election, has kept the investigation from stopping the fraud. After dentists complained to the Bush administration about "aggressive audits," two Medicaid investigators were "removed from their jobs." In fact, the state's chief Medicaid investigator Dr. Harold Seiler was fired within a month of Bush's election in 1995 after a "prominent" dentist complained about the audits. But, Texas Health and Human Services Commissioner Don Gilbert said the state is working to stop the fraud. Since 1998, 23 dentists have been excluded from Medicaid. In addition, the state has recovered $1.8 million in "improper payments" to dentists, as well as $3.5 million in payments and penalties. Gilbert said, "I feel we are recovering significant amounts of dollars and doing everything within our power to impress on the provider population [that] there will be consequences" for committing fraud. But Bob Olson, former senior Medicaid fraud investigator, who drafted the original letter to Bush, said little has changed since his retirement in 1997. "What scares me is the lack of concern by the governor's office about the fraud in the Medicaid dental program" (AP/Baltimore Sun, 10/29).This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.