In the wake of a Texas lawsuit that claims Xerox wrongly approved Medicaid claims for orthodontic services that were not medically necessary, some of the dentists being pursued for orthodontic overpayments are now suing Texas for "protecting" Xerox.
On May 9, Texas Attorney General Greg Abbott filed a lawsuit against Xerox, alleging the company wrongly approved hundreds of millions of dollars' worth of Medicaid claims for orthodontic services that were not medically necessary. The civil suit was filed against Xerox and its ACS Healthcare subsidiary to recover allegedly fraudulent Medicaid payments for orthodontic services that were approved by Xerox.
State officials also terminated the company's $168 million contract "after Xerox staff approved thousands of requests for braces that weren't medically necessary."
Xerox denied culpability and instead blamed the dentists who submitted the allegedly fraudulent claims.
Now, several lawsuits have been filed in Travis County District Court by dentists who are being pursued in court by the state for orthodontic overpayments, according to a statesman.com story. The complaints say that rather than prosecute Xerox for its failure to properly evaluate dentists' prior authorization requests, the state and the attorney general protected Xerox. The suits claim Texas didn't allow Xerox to hire additional medically licensed staff and told the company to continue its prior authorization practices.
The complaints allege that state regulators gave Xerox a pass, while at the same time trying to recover tens of millions of dollars from the dentists, as a legal shield, according to the story. If regulators had acknowledged the company's fault it would open Texas to claims against it by federal regulators for allowing ACS to continue.
Texas protected Xerox for more than six years, fearing that revealing the state's culpability would subject Texas to a federal clawback for hundreds of millions of dollars, according to the dentists' lawsuits.
Xerox was responsible for reviewing dental and orthodontic claims submitted to the Medicaid program since 2003. A 2008 audit questioned whether Xerox was meeting policy guidelines for Medicaid claims, but the contract was still renewed in 2010.
