Federal auditors are examining Medicaid charges for dental braces for Texas children after a television station found the state spent as much on orthodontic services last year as all 49 other U.S. states combined.
Texas spent $184 million on orthodontic treatment for children under Medicaid last year _ nine times more than California spent during the same time period, according to state records obtained by WFAA-TV during a six-month investigation.
The state says the federal-state program for the elderly, poor and disabled is not supposed to pay for children to get braces for cosmetic reasons, though some dentists and orthodontists told WFAA that does happen. The state attributes at least some of the difference between what Texas and other states are spending to a 2007 court ruling that found Texas children needed improved access to health care under Medicaid.
The Texas Health and Human Services Commission said it began investigating after WFAA started asking questions about Medicaid charges. The commission then received a letter last month from the U.S. Department of Health and Human Service's Office of Inspector General stating that it was conducting an audit of the state agency's pre-authorization process for orthodontic treatment.
The purpose was to review the state's controls and make sure that "only medically necessary orthodontics cases are paid," according to a copy of the letter provided to The Associated Press on Friday. The federal government's audit will cover payments from Sept. 1, 2008, through May 28, 2011.
During that time, taxpayers spent a total of $424 million for orthodontic treatments for children covered by Medicaid, according to state records that show $100 million spent in 2008, $140 million in 2009, and $184 million in 2010.
ACS/Texas Medicaid & Healthcare Partnership, a private contractor in Austin, authorizes orthodontic treatments that are paid for by Medicaid in Texas.
It's the job of the contractor's dental director, dentist Jerry Felkner, to approve braces for children younger than 12 under. Felkner could not be reached for comment Friday.
Felkner's supervisor, Billy Millwee of the Texas Health and Human Services Commission, said his office noticed a jump in Medicaid orthodontic claims after the 2007 ruling in a lawsuit against the state. Millwee also stated that Medicaid is not paying for Texas children to get braces for cosmetic reasons.
Stephanie Goodman, a Texas Health and Human Services spokeswoman, told the AP that children under 12 can get braces that are paid for by Medicaid only in severe cases, or when they've lost all their baby teeth. Yet last year, of the 79,895 people who got dental braces under Medicaid in the state _ 24 percent of them _ or 18,898, were children under 12, according to Goodman.
"That number raises alarms for us," Goodman said. "It should not be that high. We're looking at that closely."
Goodman said the agency was taking a number of steps to address the situation, including asking the state's inspector general to review the agency's orthodontic Medicaid program; asking the contractor what they're going to do to shore up the process given that there are some areas where the agency's rules were violated; tightening the pre-authorization process; and taking a closer look at the requests for service.
But Goodman also pointed to the 2007 ruling, stating that since then, Texas "has done a much better job than other states" in improving access to Medicaid. Though, in this case, she said, "We've turned the faucets up too high."