VIDEO: Federal audit blames Texas agency for dental bills

Published on Tuesday, 12 August 2014 10:30 - Written by

AUSTIN (AP) — A federal audit has found a Texas state agency to blame in an ongoing fight over who is responsible for hundreds of millions of Medicaid dollars potentially misspent on unnecessary dental and orthodontic procedures.

The Austin American Statesman (http://bit.ly/1kYmpLX ) reports the U.S. Department of Health and Human Services' Office of Inspector General audit was released Monday.

The report indicates 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 audit states the contractor's dental director did not follow state policies in approving the procedures, but that responsibilities for any losses ultimately fell on the state human services commission.

Texas dropped Xerox as its Medicaid claims processor in May after about 10 years of working together. The state is already suing the company to recover money for dental work it said wasn't necessary.

The state asserts in the lawsuit that "Xerox permitted an unprecedented loss of Medicaid funds to predatory and unscrupulous dental providers."

The state spent $1.1 billion on Medicaid dental claims between 2004 and 2012, according to the lawsuit, which doesn't specify how much of that may have been fraudulent. Texas Medicaid payments for orthodontic care rose 3,000 percent between 2003 and 2010, a period during which enrollment rose only 33 percent.

Xerox said its pre-authorization team was simply following state guidelines.

"The entire program Xerox implemented was designed by (Texas) HHSC, and Xerox received HHSC approval on each of its processes while providing monthly reports to HHSC from the beginning of the program," Kevin Lightfoot told the newspaper in an e-mail.