Tribpedia: Medicaid

When is a State Contract Too Big to Fail?

Dr. Behzad Nazari at his remaining dental clinic in Houston on Friday, April 25, 2014. Nazari sold two of three Antoine Dental clinics after the state began withholding Medicaid payments while they investigated the clinics for fraud.
Dr. Behzad Nazari at his remaining dental clinic in Houston on Friday, April 25, 2014. Nazari sold two of three Antoine Dental clinics after the state began withholding Medicaid payments while they investigated the clinics for fraud.

A Tribune investigation found that while health officials have repeatedly raised concerns with a state contractor for its role in opening the door to a massive Medicaid fraud scheme, they have not severed its multiyear contract worth hundreds of millions of dollars.

Dr. Behzad Nazari at his remaining dental clinic in Houston Friday, April 25, 2014. Nazari operated 3 clinics in Houston with 15 licensed dentists. After the state alleged he had committed Medicaid fraud and began withholding payments, he sold two clinics. He has challenged the state's payment hold in court.
Dr. Behzad Nazari at his remaining dental clinic in Houston Friday, April 25, 2014. Nazari operated 3 clinics in Houston with 15 licensed dentists. After the state alleged he had committed Medicaid fraud and began withholding payments, he sold two clinics. He has challenged the state's payment hold in court.

Company That OK'd Unnecessary Braces Kept Its Contract

While dental providers accused of overbilling Texas' Medicaid program by hundreds of millions of dollars to put braces on poor kids remain in legal limbo, the contractor that approved the procedures — a Xerox subsidiary — is still being paid more than $100 million annually by the state to process claims.    

Helen Hawkins, a certified pediatric nurse practitioner, treats 13-month-old Kevin Gorostieta at Carousel Pediatrics in Austin on Nov. 8, 2012.
Helen Hawkins, a certified pediatric nurse practitioner, treats 13-month-old Kevin Gorostieta at Carousel Pediatrics in Austin on Nov. 8, 2012.

Medicaid Fraud Settlement Worries Health Providers

For health providers who treat the state’s poorest patients, a high-profile settlement between the Texas health commission's office of inspector general and Carousel Pediatrics has raised questions about how the inspector general’s office distinguishes fraudulent intent from human error.

L to R:  Martin Gomez Jr. and his father Martin Gomez Sr. both work, but make so little that they aren't interested in buying healthcare insurance. The Gomez family lives in a colonia near Alton.
L to R: Martin Gomez Jr. and his father Martin Gomez Sr. both work, but make so little that they aren't interested in buying healthcare insurance. The Gomez family lives in a colonia near Alton.

A Focus on Helping Colonia Residents With Health Law

Living in unincorporated subdivisions, where the uninsured rate is between 50 and 80 percent, thousands of residents of impoverished Texas colonias may be largely left with little hope of obtaining health insurance after falling into the "coverage gap.But community-based organizations are working to educate them on their options.

Minister Freedom Gulley led a candlelight vigil in recognition of World AIDS Day on Dec. 1, 2013, in Houston.
Minister Freedom Gulley led a candlelight vigil in recognition of World AIDS Day on Dec. 1, 2013, in Houston.

Many HIV Patients Unable to Enjoy Expanded Coverage

Many HIV patients in Texas are ineligible for subsidies on the new federal health care exchange. Add the state's decision to not expand Medicaid to cover poor adults, and the bulk of those patients are missing out on expanded health coverage.

OIG Loses Another Medicaid Fraud Court Battle

The state health commission’s Office of Inspector General, which says Texas has misspent hundreds of millions on Medicaid orthodontic and dental fraud, has now lost its first three court battles against accused providers. The latest judicial setback has rallied accused Medicaid providers who argue the state’s inability to win in court proves the allegations are unjustified.

A patient at The People's Community Clinic pays her bill as the cashier’s desk.  The Community Health Assistance Program, a program that helps Texans get access to insurance, will run out of federal grant money in a few weeks.
A patient at The People's Community Clinic pays her bill as the cashier’s desk. The Community Health Assistance Program, a program that helps Texans get access to insurance, will run out of federal grant money in a few weeks.

Perry, Obamacare and the Uninsured

Texas Weekly

In the same week that the U.S. Census Bureau released new statistics showing Texas again ranks highest for the rate of people without health insurance, Gov. Rick Perry quietly laid out the next moves in his ongoing effort to derail Obamacare.

Former Texas Attorney General Dan Morales poses at the State Capitol in 1995
Former Texas Attorney General Dan Morales poses at the State Capitol in 1995

Morales Wants State to Examine Sealed Tobacco Records

Former Texas Attorney General Dan Morales wants the state to reopen the tobacco litigation that ended his public career and landed him in federal prison, saying the state might be entitled to some of the billions of dollars that were awarded to outside attorneys in that case.

 

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Dental Board's Review Process Gets Makeover

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After hearing critics take aim at the Texas State Board of Dental Examiners, legislators approved new regulations that they hope will improve the board's efficiency.  This story is part of our 31 Days, 31 Ways series, a monthlong look at how the bills and budget passed by the 83rd Legislature will affect Texans' lives starting Sept. 1.  

New Medicaid Eligibility Calculation Draws Concerns

The Affordable Care Act's new rules for determining Medicaid eligibility has officials at the Health and Human Services Commission worried about an increased burden in processing applications. But proponents of the law say such hurdles are a natural part of major policy reform.

The Economic Debate Behind the Political Debate

This summer’s debate on abortion restrictions turned entirely on politics. It wasn’t about money. But the state's abortion and health care policies intersect in the budget — even though that might not always be part of the debate — and the budget is where the impact of decisions on abortion and Medicaid will be revealed.

Yesenia Alvarado holds her daughter, Medicaid patient Melanie Almaraz, 2, while waiting to see Dr. Alberto Vasquez for treatment of a fever at the Su Clinica Familiar in Harlingen, Texas on Jul. 9, 2013.
Yesenia Alvarado holds her daughter, Medicaid patient Melanie Almaraz, 2, while waiting to see Dr. Alberto Vasquez for treatment of a fever at the Su Clinica Familiar in Harlingen, Texas on Jul. 9, 2013.

Health Care Providers Bracing for Medicaid Enrollment

Texas is not expanding Medicaid eligibility, but enrollment in the program is still expected to climb under new rules created by the federal Affordable Care Act. The Texas Health and Human Services Commission projects 240,000 children currently eligible for Medicaid but not participating will enroll in 2014 and 2015.