Even if you’re not an aficionado of board games – especially Monopoly – chances are you STILL know the consequences of drawing the “Do Not Pass Go…Do Not Collect $200” card…and it’s NOT good! And Texas Dentists are about to experience a twist on this concept, thanks to an announced crackdown by the Office of Inspector General.
In a recent announcement, the Texas Health and Human Services Office of Inspector General declared their intention to crack down on Dentists who violate the agency’s policies against Medicaid patient solicitation or inducements. The OIG enforces 1 Texas Administrative Code §371.1669, which prohibits a person from offering any cash, gifts or other items that may influence a potential client's selection of a Medicaid service provider:
“…the last OIG Quarterly Report for 2021 highlighted the agency's efforts to stop this crime. In fact, it is reported on page 5 that a dental provider was caught and punished for it.
"‘The OIG settled a case in September against a Richardson dental provider. The dentist billed Medicaid for services not rendered by altering treatment charts and illegally solicited Medicaid clients by using gift cards. The provider agreed to pay $4,066 in overpayment and $8,133 in penalty to resolve this case.’
“The report then publishes a full-page section on dental solicitation…work(ing) with dental providers to prevent fraud, waste and abuse in Texas Medicaid delivery.
“In its latest endeavor, the OIG is collaborating with the Texas Department of State Health Services (DSHS) to share information about illegal dental solicitation with dentists who participate in Texas Health Steps, which provides free dental and medical checkups to children with Medicaid.
“The outreach effort with DSHS Regional and Local Health Operations is currently underway. OIG staff is training DSHS staff in public health regions across the state, giving them a solid understanding of illegal dental solicitation and the OIG's role in detecting and preventing it. The OIG Communications Team produced educational material to remind Medicaid dentists and their staff of the prohibition against patient solicitation; the material outlines the prohibited behavior and the penalties involved. DSHS will share the information with providers across Texas through a variety of communication avenues.”
In a quick review, the report elaborates that “providers may not offer, and clients may not accept:
Cash, cash equivalents or gift cards in any amount
Free or discounted services for a family member to influence their health care decisions
Transportation, unless it's properly arranged with the client's managed care organization or the Texas Health and Human Services Commission
“The OIG may investigate providers who advertise free transportation on their website or providers who hire people to canvass neighborhoods looking for Medicaid-eligible children and pay drivers to transport children for Medicaid services. Providing goods or services of any value could be considered a violation, but that would typically not be the case for non-cash, low-cost items such as a toothbrush valued less than $10.”
However innocuous this may sound, the agency OIG has put some very real teeth behind their intent to begin policing Dentists in earnest!
”If a provider solicits Medicaid clients, the provider may be found guilty of a Class A misdemeanor and a third-degree felony if the dentist was previously convicted of illegal dental solicitation or was employed by the federal, state or local government at the time. The provider may be subject to disciplinary action by the Texas State Board of Dental Examiners, an injunction, civil penalties of up to $10,000 and possible exclusion as a provider from the Medicaid and CHIP programs.”
In another plot twist, not only can Texas Dentists who use (or advertise) gifts or services to attract new Medicaid patients can incur penalties up to $10,000…not to mention the possibility of earning both jail time AND censure from the TSBDE! Yet, this sword apparently does not cut both ways, since this blacklisted activity for Dentists is perfectly acceptable – and COMMONPLACE – for DMOs.
So, until this blatant inequity is addressed and rectified, Medicaid dental providers should be particularly wary about any of their marketing activities which even imply an inducement. Let’s face it, this is your livelihood and not a game…and a new patient is NOT worth drawing that “Go To Jail” card!