Home Courts Texas Supreme Court upholds $1B Medicaid dental fraud decision against Xerox

Texas Supreme Court upholds $1B Medicaid dental fraud decision against Xerox

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The Texas Supreme Court has found Xerox responsible for $1 billion in fraudulent Medicaid payments made while the company was responsible for pre-authorizations for Texas Medicaid patients’ dental work.

According to a Texas Tribune report, the decision upheld a Texas Court of Appeals ruling that Xerox subsidiary Texas Medicaid and Healthcare Partnership was at fault for the mismanagement and inappropriate authorization of payments for Medicaid dental services between 2003 and 2010, when Texas Medicaid payments for orthodontic services grew by more than 3,000 percent from $6.5 million to $220.5 million, even though enrollment in the program only grew 33 percent. In 2012, an investigation by federal and state auditors determined that the contractor was responsible for enabling a “massive Medicaid fraud scheme” costing hundreds of millions of dollars.

The State of Texas filed an initial lawsuit against Xerox in May 2014. However, the state also finalized a contract with Accenture, another subcontractor under Xerox, to handle the processing of the Medicaid claims. The Norwalk-headquartered Xerox did not respond to the court’s ruling, and a spokesperson for Texas Attorney General Ken Paxton said the court affirmed “the legislature’s intent to protect taxpayer dollars, deter unlawful acts and punish those who steal from Medicaid.”

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1 COMMENT

  1. This is a landmark case. BUCA’s beware as this case sets precedence in withholding data from the self funded employer and co-fiduciary responsibilities under an ASO agreement. I have spent the last 20 years fighting for employers to ascertain clients data and to fulfill fiduciary responsibility under ERISA. Great article.

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