Recently, the Texas Supreme Court ruled that Conduent, a Xerox subsidiary, must defend the State's False Claims Act case on its own. Conduent sought to add providers to the State's action, accusing Conduent of widespread Medicaid fraud stemming from its "porous" Medicaid pre-authorization process for dental and orthodontic claims. The complaint alleges that unqualified clerks pre-approved 90% of the the pre-authorization applications, most of which were for procedures that were cosmetic, and not medically necessary. Indeed, clerks were reprimanded if their pre-authorization numbers were not high enough to satisfy the management.
The State of Texas seeks $2 Billion in damages and penalties. The federal government has claimed the State owes it $133 Million as a result of the U.S. Government's payment of the fraudulent claims. Texas has begun paying that money back to the U.S. Government.
If the pre-authorization entity in Florida engages in similar practices authorizing non-medically necessary dental procedures, it would be ripe for a government investigation.
Please click on the below link to read more about the Texas Supreme Court's opinion.