Medicaid fraud in Texas
Fri, 14 Oct 2011 11:05:00 GMT —
Last year, Texas taxpayers spent more than $180 million so kids could get free Medicaid braces on their teeth, but that didn't just pay for the office visits, it also paid for their round trip.
They got picked up, taken to the dentist, got the braces, and taken home.
One problem with the kids getting the braces free is, some of them didn't even need them.
Experts say that's evidence of good intentions, gone wrong.
A teenager's mouth, so crammed with teeth, it's painful to look at.
A mouth so in need of fixing, its owner can hardly open it to brush.
A cleft palate, where a tooth, called an ectopic tooth, can't grow in.
These are the poignant cases the Texas Medicaid orthodontics program is designed to help, but state records point to a program off course.
Instead, here is the Orthodontics Centers of America in Athens, Texas.
At this clinic last year, under Medicaid, Texas taxpayers shelled out $1.6 million for braces. The procedures were all approved by the state.
"Do most of your friends have braces? Yeah. Do they have bad teeth? No not really," said Jessica Anaya of Athens.
Not only did taxpayers pay for the dental work.
They paid to collect children from miles around and take them to the clinic in vans like this.
The cost for the vans... $142,000 last year.
More than 1,700 trips, according to state records.
"If any part of the system is abused by people who don't necessarily qualify, resources are finite. So that is taking away from somebody who would be able to get care received," said Dr. Deji Fashemo, a Dallas Orthodontist.
Last year, Goodwin Orthodontics in Amarillo, Texas collected more than $2.6 million from Medicaid for children's braces and another $171,000 just to bring them to the office.
In June federal agents raided Goodwin.
According to a search warrant, Michael Goodwin spent roughly half of each month at another clinic he owns in Indiana.
He allegedly filed more than 23,000 fraudulent Medicaid claims over three years, and federal agents sought to seize his checking accounts.
Goodwin's office is currently closed, and he was unavailable for comment.
Many orthodontists say the majority of patients getting Medicaid are not like those shown and many are getting cosmetic braces.
Add the transportation cost to the office cost and the total bill just for last year was nearly $200 million.