US Feds to Texas: Pay Back $133M in Unnecessary Medicaid Payments

They say everything is bigger in Texas; apparently that cliché extends to alleged fraud, as well. The United States government believes Texas billed Medicaid for at least $133 million in unnecessary dental and orthodontic claims. In some cases, the feds say, the claims were completely “unjustified” and it wants the $133 million bucks back.

Not so fast, says Texas. In fact, a spokesperson from the Texas health and Human Services Commission, while not disputing the government’s claim, said there would be no pay-back until Texas settles a long-standing legal dispute with the company hired to process Medicaid claims between 2007 and 2012. This is the time period the US government is alleging Texas overbilled for braces and other dental procedures.

Xerox is the company in the middle of this legal battle. Texas believes that Xerox – the contractor it fired and is suing for the inappropriate billing – should foot the bill for the Medicaid overpayments. The Feds say Texas can go after Xerox if it wants, but that the Lone Star State is responsible for the billing mistakes. While the government is requesting a payback of $133 million, apparently an audit in Texas estimates the amount of overpayments at more like $823 million.

Spokespeople for the company and a group of dentists also allegedly involved in the overbilling practices, denied wrongdoing. Medicaid only covers braces for individuals who need them to eat or sleep and that pre-approval is required before the procedures are permitted to take place. The government claims the company was rubber-stamping claim requests for braces and Medicaid-covered orthodontic services.

Whether this is a case of fraud or greed, it’s not yet clear. However, one thing that is very clear is that the Medicare and Medicaid system is being bilked out of billions of dollars every year because of fraudsters looking to make a buck on the back of the American taxpayers. The US government relies on whistleblowers who learn about these schemes and are brace enough to come forward and report them.

If you or someone you know has some information that could lead to a whistleblower lawsuit, consult with an experienced lawyer who can review your case and provide the sound legal counsel. Begelman & Orlow represents whistleblowers in qui tam cases all over the country. Contact our Cherry Hill, NJ office today for a free consultation about your concerns.

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