SA orthodontics office banned from state Medicaid program

State investigation found false statements, unnecessary procedures

An orthodontics office with six San Antonio locations has been banned by the state from receiving Medicaid payments.

The state has alleged that M&M Orthodontics "failed to meet the dental standard of care" in treating patients between 2005 and 2008 and now owes the state millions of dollars in overpayments and penalties.

Taylor McCalla, 14, who has pink braces on top and blue on the bottom, was a patient at M&M. She got a shock on her last visit when they told her they are not treating Medicaid patients anymore.

"Like, I wasn't a very happy person that day," McCalla said.

Amalia Ibarra, 12, got that same message.

Her mother, Isabel, and Taylor's mother, Charlene Cummings, wanted to let people know what was happening.

"We're trying to find another place but it's very difficult," Isabel Ibarra said. "No one wants to take transfers."

"I just wondered how many kids were getting their braces pulled off at home by their parents because they didn't feel they had another option," Cummings said.

M&M's participation in Medicaid was terminated after a state investigation found the company made false statements, misrepresented the severity of some patients' conditions, did procedures that were not medically necessary and installed unneeded orthodontic appliances.

Now M&M owes the state.

The state says M&M Orthodontics was overpaid $8.2 million and to that they assessed the penalty of $6.6 million.

The state says orthodontist Diana Malone was overpaid $2.1 million and she was penalized another $2.1 million.

But the lawyer representing M&M told a state Senate committee that Diana Malone and Scott Malone are just two of many orthodontists the state is attacking unfairly.

Dr. Robert Anderton wrote: "…the doctors have done what the state of Texas asked them to do- provide more orthodontic care for more children at an agreed to fee. The Texas Medicaid program has evolved into an unsustainable nightmare."

Taylor has a new orthodontist now.

Amalia's nightmare isn't over.