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Covering Medicaid fraud and overtreatment Date: 06/02/14

Becca Aaronson
Becca Aaronson


By Mary Otto

For the past two years, as a health writer for the Texas Tribune, Becca Aaronson has been covering the state’s Medicaid orthodontic scandal.

Her most recent stories offered readers an update on the state investigation into allegations of widespread fraud and unnecessary treatment.

In a May 9 piece, Aaronson reported on the decision by the state Health and Human Services Commission to terminate its contract with Texas Medicaid and Healthcare Partnership (TMHP), a Xerox subsidiary that had been processing Medicaid claims for the state since 2004. A 2012 federal audit found the company had been “essentially rubber-stamping” dental claims. In addition, the office of the Texas Attorney General is suing Xerox in hopes of reclaiming hundreds of millions of dollars the company allegedly paid out for medically unnecessary Medicaid claims, she wrote.

Questions about the system were first brought to light in the 2011 “Crooked Teeth” investigation aired by WFAA-Dallas. Aaronson credits that strong coverage with helping get her started on this story.

Q: When did you first dive into this story?

A: There were two triggers that got me interested in the Texas Medicaid program. The first was WFAA-Dallas. They did an amazing investigation. Even the federal government credits them for their work. … The second was the legislative hearing I attended where patient advocates came in and spoke about how the Texas dental board wasn’t doing enough about dental clinics that were owned by corporations taking advantage of Medicaid patients by overtreating them and billing for their services. So there were two things.

Q: How have you decided when to file additional stories over the months and years?

A: When we first started reporting on this story a lot of it was focused on what was happening to the patients who were victimized by providers … that was the main focus for both lawmakers and the media.

We knew it was going to take a long time for them to finish the legal wrangling. The legislature meets every two years so we had a session in 2011 and one in 2013.

During the most recent legislative session one of the big topics for lawmakers was providers who had been accused of Medicaid fraud had said that they weren’t being treated fairly. They organized their own stakeholder group and they brought about new legislation that gave providers rights so if they are investigated for fraud certain procedures are followed.

Q: Then there was your recent work, looking at the Xerox subsidiary that processed the claims. How did that piece of the story evolve?

A: There seemed like there was this gaping hole. What happened to Xerox? During my work on the investigation of the Medicaid providers I built up contacts in the office of the inspector general and the attorney general’s office. They would always tell me off the record that they couldn’t help me or, "Wait, wait. The legal process can take a really long time. We are working on it." They would say that they were trying to hold everybody accountable. But there wasn’t a lot I could report publicly.

Eventually it kind of reached a boiling point. And I finally had some free time … and it was something I wanted to come back to. The rest of my investigation was to look a little deeper into what they were doing to hold them (Xerox) accountable.

Q: How accessible and useful have state and federal Medicaid records been to you in doing your investigation and telling these stories? Any advice for other reporters who find themselves needing to get access to these documents and work with them and understand them?

A: One of the best things you can do is build relationships with sources who are really familiar with the documents. One of the things I was looking at were lawsuits, so I got to know lawyers on both sides and had them explain the case to me. They were often quick to provide me with copies of the lawsuits if something happened because they knew I was following it. It’s always good to get both sides in those things. The other thing is to build relationships inside the agencies, so I knew a lot of what was going on…

Q: What’s next for you and your coverage? Give us a sense of when you think you will get into this again.

A: I recently switched roles at the Tribune. I was covering health care for the last two years. And now I’m on the news apps team. I’m now working on special investigative projects mostly and developing web applications for interactive news stories. I will probably be following this because of personal interest but the ongoing coverage might fall mostly on our new health care reporter.

Q: You had a really interesting animated news graphic that ran with one of your recent stories. Were you involved in creating that? Will that kind of work be part of your new job?

A: Yes. I didn’t do the animation on that. I wrote the script and helped design what it was going to look like. That is part of what my new job involves: trying to tell stories visually so you can bring audiences into them. The purpose that video was so that readers could get up to date on a lot of the background to lead to better understanding of the reporting.

Q: How many people were involved in creating it?

A: I wrote it. I think two of our editors looked at the script. And then our animator Todd Wiseman.

Q: Any other tips for reporters who might be worrying about possible Medicaid fraud or overtreatment in their own states?

A: Medicaid claims data is really complicated. I think that talking to people about what they are noticing on the ground is really good because then you can request data and verify what they are seeing on the ground.

When you are actually working with the data itself you have to know the procedure codes. Sometimes that can be complicated. There are trends in what providers overbill for. They don’t necessarily bill for the most expensive procedure. They bill for the one below that often. So the best advice is actually finding people, talking to the investigators who are into it. The people who are noticing trends.

Becca Aaronson (@becca_aa) develops news applications and works on special investigative projects for The Texas Tribune. She joined the Tribune in 2010 and began covering health care in 2012.