AG seeks to recover fraudulent Medicaid funds for dental work

AUSTIN – The Texas Attorney General’s Office has filed a lawsuit against a company that has allegedly been fraudulently receiving payments for dental work through Medicaid.

The AG filed a civil lawsuit May 8 in state district court against Xerox Corp. and its wholly owned subsidiary, ACS State Healthcare LLC. 

Xerox has served as the vendor responsible for reviewing dental and orthodontic claims submitted to the Medicaid program since 2003.

Under state law, orthodontic services are not generally eligible for coverage under the Medicaid program. Only the most acute cases where orthodontic disfigurement poses a health risk to a patient are eligible for Medicaid coverage, according to a press release. Cosmetic orthodontics are not covered by the Medicaid program.

The state’s suit seeks to recover Medicaid payments that Xerox approved for orthodontic services that were not medically necessary and therefore not authorized by law.

The Attorney General’s Office, together with the Texas Health & Human Services Commission (HHSC) and the HHSC-Office of Inspector General formed a dental and orthodontic fraud task force in June 2012 to investigate fraudulent overbilling by dental and orthodontic Medicaid providers.

One of the results of the task force’s investigation was the discovery that Xerox had not been properly reviewing orthodontic claims as required by its contract with the state, according to the AG’s complaint. Further, the task force uncovered evidence revealing that Xerox systemically approved orthodontic claims that were not authorized by state law.

The state’s law enforcement action is seeking injunctive relief, civil penalties and restitution of overpayments made by the Medicaid program as a result of Xerox’s unlawful conduct.