TEXAS: Dental Medicaid Fraud Left Unchecked Under Bush
AP/Baltimore Sun reported yesterday on allegations of dentists "bilking" Medicaid in Texas during Gov. George W. Bush's (R) 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 filling. Texas Medicaid 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 that the dentists used a computer linked to state records showing the amount of money children had remaining in their state Medicaid accounts. The information led officials to conclude that the dentists were defrauding Medicaid. Investigators said the use of the more expensive crowns was "profit driven." Dentists, however, 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 investigations 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 investigator for Medicaid, 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 stopping 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 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).