Houston insurance company accused of cheating Medicaid
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HOUSTON — The Medicaid Inspector General has been asked to investigate the practices of Texas Children’s Health Plan, the insurance company controlling government medical assistance to nearly one third of Houston children.
The complaint was filed by Children 1st Dental Surgery Center, operators of dental facilities in Dallas and Houston. Children 1st was created to end the lifelong traumas of so many young children who were for decades, physically restrained during extensive dental treatment. Instead, Children 1st puts these young children under anesthesia, making it possible for this medical treatment to be done faster and without distress.
The company has flourished in Dallas, and has been accepted in every insurance network in the State of Texas, except one. The company has faced a boycott by Texas Children’s Health Plan here in Houston, effectively denying thousands of disadvantaged children from easy access to care.
“Texas Children’s Health Plan has engaged in a systematic plan to deny enrollment of qualified providers because they are protecting their own financial interest, and that of their biggest customer, Texas Children’s Hospital,” says Craig Jacobs, Managing Member of Children 1st Dental and Surgery Center. “The numbers do not lie, and it is time Medicaid step in to protect both children and taxpayers.”
Children 1st bills Medicaid $585 per patient for the surgery room used to perform dental work on children under anasthesia. In 2014, Texas Children’s Health Insurance billed Medicaid an average of $1,142.36 for the exact same service. That represents a startling 95% increase in Medicaid costs.
But money isn’t the only issue here. Texas Children’s Health Plan actions are forcing economically disadvantaged children and their parents to take public transportation up to 100 miles to get this trauma ending treatment.
Medicaid payments to Texas Children’s Health Plan totaled more than $1.1 billion dollars during the last two years in the Houston area alone.
“We are reaching out to the Medicaid Inspector General, members of the Texas legislature, and local members of Congress to force this huge insurance company to sacrifice their unnecessary profits for the benefit of children and taxpayers,” says Jacobs. “It is clear they will not help lower Medicaid costs voluntarily.”
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