Medicaid Fraud Worse than Common Toothache

Even laughing gas wouldn’t make this funny.  The Wall Street Journal (subscription required) this week picked up a story about Medicaid fraud perpetrated by at least 26 dentist and orthodontists across Texas (originally brought to light by WFAA’s Byron Harris in Dallas).  Our state’s Department of Health and Human Services has denied $8.2 million in Medicaid claims based on this suspicion, after an audit of 600 claims revealed the fraud.

Medicaid doesn’t cover everything, nor should it; cosmetic orthodontics can’t rank with routine teeth cleaning and other preventative care.  What’s fascinating about this problem is the way it happened (Texas Watchdog has a thorough history here).  The explosion in dental Medicaid fraud came in the wake of a 2007 class action lawsuit that claimed the state had been negligent in providing preventative dental care for children enrolled in Medicaid.  During the 80th Legislative Session, legislators approved an additional $1.8 billion to expand Medicaid dental services for kids, and today Texas spends more on this than any state in the union.

This is certainly disturbing information.  Medicaid is already beginning to eat the state budget alive, taking an ever-increasing chunk out of a limited pie; according to the Texas Comptroller’s office, Medicaid accounts for nearly 95% of spending for the Department of Health and Human Services and the Department of Aging and Disability Services.  The additional toll of fraud – not all of which may have been caught in that audit, after all – is a burden we really cannot afford, and as Obamacare looms and expenditures look to increase exponentially, the state can’t let fraudulent acts stand.  Even in a good economy, with a good, balanced fiscal outlook, this would be unconscionable.

The fact is, Medicaid expansion that results in this gluttonous grab for cash carries a greater price.  The services people really need fall by the wayside and people get fewer services in the long run.  With the national spotlight now on the problem, here’s hoping the system’s gamers and manipulators find themselves knocked out of it.

 

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