Tag Archives: fraud

Reporting uncovered one of Texas’ largest Medicaid scandals

Mary Otto

About Mary Otto

Mary Otto, a Washington, D.C.-based freelancer, is AHCJ's topic leader on oral health and the author of "Teeth: The Story of Beauty, Inequality, and the Struggle for Oral Health in America." She can be reached at mary@healthjournalism.org.

GraphicStock

GraphicStock

The tip about troubles in Texas’ Medicaid dental system was part of a routine conversation. But it was enough to make reporter Byron Harris start digging.

He and his colleagues at WFAA-Dallas spent nine months scrutinizing data, wearing out shoe leather, following up on leads and trying to get people to talk.

In  2011, the “Crooked Teeth” stories raised profoundly troubling questions about oversight of the Medicaid dental program in Texas; the millions upon millions spent on orthodontic services for beneficiaries; the suspect billing practices of many providers. The 11-part investigative series uncovered one of the largest Medicaid scandals in the history of Texas. Government audits, reform efforts and lawsuits followed in its wake.

Harris continues reporting on the issue. He recently filed another story after federal officials concluded that the state owes $133 million for unnecessary dental work. “Texas paid $191,410,707 for unallowable orthodontic services from 2008 through 2010, according to a federal investigation,” Harris told viewers on June 3. “And officials say the federal government now wants a large portion of that money back.”

In this “How I Did It” article, Harris takes us back to the very beginning of “Crooked Teeth.” He explains how the project began, and how it unfolded. He also shares some wisdom on how to use data to follow up on a tip.

Story ideas emerge between policy, spin at White House Conference on Aging

Liz Seegert

About Liz Seegert

Liz Seegert (@lseegert), is AHCJ’s topic editor on aging. Her work has appeared in NextAvenue.com, Journal of Active Aging, Cancer Today, Kaiser Health News, the Connecticut Health I-Team and other outlets. She is a senior fellow at the Center for Health Policy and Media Engagement at George Washington University and co-produces the HealthCetera podcast.

Photo: White House Conference on Aging

Photo: White House Conference on Aging

It’s difficult to describe the experience of walking into the East Room of the White House as an invited member of the press for the once-a-decade White House Conference on Aging.

Several hundred invited VIPs – family caregivers, home care workers, advocates for seniors, corporate executives and members of Congress – filled the neat rows of chairs for the morning panels. Continue reading

Potential billing abuse by Medicaid dental providers a fertile area for coverage

Mary Otto

About Mary Otto

Mary Otto, a Washington, D.C.-based freelancer, is AHCJ's topic leader on oral health and the author of "Teeth: The Story of Beauty, Inequality, and the Struggle for Oral Health in America." She can be reached at mary@healthjournalism.org.

Once the ACA covers children's dental care, will parents drop their dental insurance?

Photo by ianus via Flickr

An estimated 8 percent of Medicaid dental providers in California submitted questionable bills to the program during one recent year, a recent federal report concluded.

Half of the dentists whose bills raised concerns worked for dental clinic chains.

The findings are the latest in an unfolding examination of Medicaid dental billing practices led by the U.S. Department of Health and Human Services’ Office of the Inspector General (OIG). Continue reading

Florida dentist accused of abuse, fraud in treatment of young patients

Mary Otto

About Mary Otto

Mary Otto, a Washington, D.C.-based freelancer, is AHCJ's topic leader on oral health and the author of "Teeth: The Story of Beauty, Inequality, and the Struggle for Oral Health in America." She can be reached at mary@healthjournalism.org.

CNN filed its “Nightmare Dental Procedures Done on Kids” report under “Stories that Shock,” along with tabloid-worthy accounts of a child being dragged by her school bus and a woman kidnapped after responding to a personal ad on Craiglist.

The piece opens with the surreptitiously recorded sounds of instruments whirring and a child wailing, then shifts to a scene on a public sidewalk in Jacksonville, Fla., where angry protesters have gathered outside the office of a 78-year old pediatric dentist, Howard S. Schneider. Continue reading

Reporting team scrutinizes Medicare Advantage

Liz Seegert

About Liz Seegert

Liz Seegert (@lseegert), is AHCJ’s topic editor on aging. Her work has appeared in NextAvenue.com, Journal of Active Aging, Cancer Today, Kaiser Health News, the Connecticut Health I-Team and other outlets. She is a senior fellow at the Center for Health Policy and Media Engagement at George Washington University and co-produces the HealthCetera podcast.

Fred Schulte

Fred Schulte

The Center for Public Integrity’s series unearthing potential fraud and waste under the Medicare Advantage program had little help — and apparently little interest — from the Centers for Medicare & Medicaid Services. The insurance program, which Congress established to help control health care costs for older adults, could leave taxpayers on the hook for more than $36 billion, as AHCJ member Fred Schulte and the rest of the investigative team uncovered.

In this “How I did it” article, Schulte explains how the series follows up on CPI’s 2012 Medicare costs investigation, the extensive lengths taken to try to obtain CMS records, work-arounds and other sources the team used to piece together a puzzle that paints a clear picture of improper billing, missed opportunities by regulators, lack of oversight, and industry influence.

Despite settlements, fraud allegations in Texas Medicaid program still unclear

Mary Otto

About Mary Otto

Mary Otto, a Washington, D.C.-based freelancer, is AHCJ's topic leader on oral health and the author of "Teeth: The Story of Beauty, Inequality, and the Struggle for Oral Health in America." She can be reached at mary@healthjournalism.org.

Texas Tribune health writer Becca Aaronson has been providing in-depth coverage of the state’s unfolding Medicaid orthodontic scandal.

The allegations of widespread fraud and abuse related to braces for poor children first came to light in the 2011 “Crooked Teeth” investigation aired by WFAA-Dallas.

The “Crooked Teeth” stories revealed that Texas was spending more on Medicaid orthodontic services than the nation’s nine other most populous states combined. The reports raised questions about whether dentists were providing unneeded braces to Medicaid children and sending the program the bill.

Three years later, a state investigation has failed to prove that any dental providers committed fraud.

Continue reading