- Associated Press - Saturday, June 6, 2015

HOUSTON (AP) - Texas should repay at least $133 million in Medicaid funding misspent on unnecessary dental and orthodontic procedures, according to a federal audit.

The amount is part of an ongoing legal fight over responsibility for a spike in costs for braces and other dental care in Texas between 2007 and 2012, the Houston Chronicle (http://bit.ly/1HSruu7 ) reported Saturday.

The federal government has maintained the Texas Health and Human Services Commission for years didn’t address the practices of Xerox Corp., the contractor it hired to pre-authorize the dental procedures.

The fight over blame for the overspending dates to 2008, when auditors first discovered signs that Texas dentists and orthodontists were putting unneeded braces on teeth of the state’s poorest children. Subsequent audits found annual spending on Medicaid orthodontic services grew from $67 million in fiscal year 2006 to $229 million in fiscal year 2011.

Under federal rules, Medicaid recipients only are allowed to get braces that are needed to eat or breathe. The procedure also must be pre-approved before braces are put on.

By 2010, the state’s Medicaid program for dental and orthodontic work was spending more on braces than the other 49 states combined, according to federal auditors.

Last year, Texas formally blamed Xerox for the overspending, firing and suing the contractor. It since has said that its estimate for the amount of overpayments had grown to $823 million.

The federal government has made clear it considered Texas “ultimately responsible” for the overpayments.

Texas Health and Human Services Commission spokeswoman Linda Edwards Gockel said her agency would not pay the federal government until the state had resolved its lawsuit against Xerox.

Gockel said the Medicaid program has greatly improved since the overpayments, noting the state has shifted to a managed care system that has saved money and improved services.

“A recent study of third-graders with and without Medicaid found that those with Medicaid were more likely to be treated for cavities and more likely to get preventative treatments than those without Medicaid,” she said.

Xerox spokesman Kevin Lightfoot said his company was not allowed to participate in the federal government’s audit.

“At all times, the state of Texas, through the Health and Human Services Commission, knew and approved of the prior authorization process that (Xerox) administered and received monthly reports on the authorized treatments,” Lightfoot said. “Throughout the length of the orthodontic Medicaid contract from 2004 through 2014, Xerox always performed its work in good faith and with transparency.”

___

Information from: Houston Chronicle, http://www.houstonchronicle.com

LOAD COMMENTS ()

 

Click to Read More

Click to Hide