Texas Dentists for Medicaid Reform: 'Reform' for whom?

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by BYRON HARRIS

WFAA

Posted on March 4, 2013 at 6:21 PM

Texas Dentists for Medicaid Reform has all the trappings of a public interest group: The State Capitol is featured prominently on its website; the Texas star is in its logo; the word "reform" is in its title.

But TDMR, as it calls itself, acts like a private interest group.

Last month, the organization held a dinner at the Omni Southpark Hotel in Austin. TDMR's website invited the public, but the event was not public after all.

An e-mail informed KVUE's sister station WFAA that they would not be allowed to attend.

Board member Dr. Juan Villareal would not disclose who the organization's donors are.

"Donors can be anonymous, and a lot of them don't want their names mentioned," Villareal told WFAA, adding that TDMR does not have members, only donors.

"We basically take donations from people who are interested in our cause," Villareal said.

So what is the cause? "Due process" is a phrase overheard in the hallway outside the dinner venue.

TDMR offered WFAA an interview with a lawyer — presumably on its payroll — to explain the term "due process."

A look at the name tags outside the dinner show many of the invited guests have had their Medicaid payments suspended under a doctrine called Credible Allegations of Fraud (CAF). Under CAF, physicians and dentists can have their Medicare or Medicaid payments withheld if the government believes they've committed fraud.

Dr. Villareal had $1.2 million in Medicaid dental payments to his clinic, Harlingen Family Dentistry, suspended under CAF. He appealed his case and won in an administrative hearing, but says he still hasn't received his money.

TDMR's board consists of Villareal, his partner, and another dentist who was charged with Medicaid fraud.

TDMR's website traces to an office labeled "SLS Worldwide Transportation" at a strip mall in Austin. The same address is also home to a website for Dr. Richard Malouf, a Dallas dentist who's being criminally investigated for fraud by the state of Texas.

And the SLS Limousine office is home to the website of Harlingen Family Dentistry, Villareal's dental office.

"TDMR is not so much about the money, as it is about denying due process" Villareal said. "That's the main concern."

"Due process" may summarize Medicaid reform for TDMR's donors.

But Dr. Morna Staffel said that doesn't speak for a Medicaid system she and many other dentists wrestle with every day.

"I don't think there is a group that's speaking out for the legitimate and the ethical dentists... either general dentists or pediatric dentists," she said.

Dr. Staffel's office regularly has to re-do work done by some of the dental chains supporting TDMR.

"Yesterday, in fact, I had to do dental treatment on three different children who'd been treated at another dental clinic during a 12-month period," Dr. Staffel told WFAA. "Eighty percent of the restorations that had been placed either were improperly placed, or done incorrectly, or failing."

That work will need to be redone, she says, but getting Medicaid to pay for it is a slog.

"It's very time-consuming. It requires a great deal of my office staff time." Dr. Staffel said. "In the end, if we don't do the treatment, the child gets hurt."

She said her office often ends up doing the work for free.

Dr. Staffel wants parents — even those on Medicaid — to know they have a choice in dentists. And if they feel their children are not getting treated properly, they can go elsewhere.

So who really is Texas Dentists for Medicaid Reform? Thirty-nine dental chains have had their Medicaid payments withheld under Credible Allegations of Fraud.

As for many other Texas dentists, reform means something else.

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