OIG expands illegal dental solicitation education effort

The OIG proactively works with dental providers to prevent fraud, waste and abuse in Texas Medicaid delivery. Its latest effort is a collaboration 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 who receive Medicaid benefits.

The outreach effort with DSHS Regional and Local Health Operations is currently underway. OIG staff members are 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 also 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.

Solicitation basics

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. 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 Texas Health and Human Services.

The OIG may investigate providers who advertise free transportation on their website, hire people to canvass neighborhoods looking for Medicaid-eligible children, or 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 at less than $10.

Solicitation penalties

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.