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Dentists warn that Medicaid audits could harm children's dental care in Nebraska

LINCOLN — National and state dental leaders are raising the alarm over Medicaid audits that they say threaten the care of young children in Nebraska with mouths full of rotting teeth.

The audits led one pediatric dentist in Lincoln to stop seeing Medicaid patients, a step that left the Lincoln-Lancaster County Health Department’s dental program without anyone to treat the most severe cases.

He quit this fall after paying $50,000 to the government in a settlement agreement and another $75,000 in legal fees.

Three other pediatric dentists face the prospect of having to repay as much as $200,000 for questioned procedures.

“The end result is that the audit has harmed children’s access to oral health care while recovering a pittance of overall Medicaid spending in the state,” the dental leaders wrote in a letter to Nebraska’s top Medicaid official.

The Nov. 6 letter was signed by the presidents of the American Dental Association, American Academy of Pediatric Dentistry, Nebraska Dental Association and Nebraska Society of Pediatric Dentistry. It called for the Nebraska Department of Health and Human Services to halt current Medicaid audits and make changes in any future ones.

Dr. Jessica Meeske, a pediatric dentist in Hastings, said Thursday that the dental leaders have not received an answer to their letter.

HHS officials issued a statement when The World-Herald asked about concerns raised in the letter. The statement says that the audits are required by federal law and that the federal Centers for Medicare & Medicaid Services has contracted with a private firm, AdvanceMed, to do them.

“We understand and appreciate it takes time for providers to respond to an audit,” the statement said. “The purpose of an audit is to ensure that taxpayers dollars are being spent appropriately.”

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Meeske said the biggest issue in the audits has been whether to use crowns or fillings for children with severe early childhood cavities.

These are children whose average age is 4 and who have cavities in more than half of their 20 baby teeth. Because of their age and the extent of their dental disease, they have to be treated under anesthesia in a hospital operating room.

“These aren’t kids with little holes in their teeth; these are kids that are really sick,” Meeske said.

Pediatric dental guidelines call for using stainless steel or white plastic crowns in such cases. The crowns last longer than fillings, which means that the children are less likely to need anesthesia again. Those are the guidelines that the audited dentists followed.

But NCI AdvanceMed, the company contracted to do the audit, said fillings should have been used as the “least costly restoration” in many of those cases. The company audited a sample of 40 of the Lincoln dentist’s cases, including one in which it approved of the first 17 crowns he used to fix a 3-year-old’s teeth but said he should have used a filling on the 18th tooth.

The auditors then calculated an overpayment total by extrapolating findings from the sample to 568 of his patients. They concluded that he should repay the difference between crowns and fillings for that group, or about $88,000.

Meeske, who looked at the Lincoln dentist’s cases, supported his choice of treatment. So did the dental leaders.

“This dentist considered the least costly option in the context of the life of the tooth, the risk factors for future disease and the life of the child,” the letter said.

The leaders said the audit was flawed because it did not follow the treatment guidelines for the profession. In addition, the reviews were not conducted by pediatric dentists. Initial reviews were performed by a general dentist who does not treat many Medicaid patients, Meeske said. Reviews on the first round of appeals were conducted by a registered nurse.

The result put the audited dentists in a professional bind, she said. If they followed their professional training and practices, they would be at odds with Medicaid. If they treated children as the auditors required, they could be in trouble with their licensing board.

An AdvanceMed spokeswoman referred questions about the audit to CMS, the federal Medicaid agency. A CMS spokeswoman pointed the finger at Nebraska Medicaid.

The CMS spokeswoman said auditors follow dental policies established by state Medicaid agencies, rather than professional guidelines, in determining whether a particular treatment is appropriate and qualifies for Medicaid reimbursement. She also said state Medicaid agencies set the qualifications for reviewers used by the auditors.

“The auditors followed Nebraska Medicaid dental policies as well as Nebraska audit procedures,” she said.

The HHS statement did not specifically address questions about why the department allowed audits that called for dentists to contradict professional guidelines or about whether officials are concerned about the effects of the audits on access to care.

“Just like insurance, Medicaid covers certain services under certain circumstances and does not direct treatment decisions,” the statement said. “This particular audit is required by federal law and is being performed by a company hired by the federal government. Specifically, federal law provides for auditing of claims to identify whether fraud, waste or abuse has occurred or is likely to occur.”

The issue has drawn the attention of state lawmakers. The Legislature’s Health and Human Services Committee plans a briefing on the subject Friday morning.

Check out nearly 100 stunning photos of Nebraska

Police reports link former Huskers to seven total incidents of sexual assault

Seven sexual assault reports filed with Lincoln police are connected to either one or both of the former Husker players accused of sexual misconduct.

Public reports from the Lincoln Police Department do not list the names of suspects or victims.

But The World-Herald made a public records request for reports involving Andre Hunt or Katerian LeGrone.

In response, Lincoln police provided five reports of nonconsensual sexual penetration and two reports of inappropriate touching of private parts.

Included in those reports was an Aug. 25 sexual assault that allegedly occurred at the players’ off-campus apartment. Hunt, 20, and LeGrone, 19, were arrested Tuesday evening in connection with that assault. They have not yet been charged.

A Title IX investigation was conducted into that allegation, and the men received a 2½-year suspension from the University of Nebraska-Lincoln. They have appealed the decision and want to have a formal hearing on the matter. Their attorneys have said they did nothing wrong.

The additional six reports date back to the summer of 2018, with at least three of the alleged assaults occurring in the same UNL dorm room.

A university spokeswoman said student addresses are protected by federal educational privacy regulations and declined to provide the names of the students who lived in that dorm room.

The additional six reports have been made since Dec. 6, after ESPN reported on the Title IX investigation into Hunt and LeGrone.

  • An 18-year-old female said she was penetrated without consent at a dorm room at the University Suites, a coed housing facility at 1780 R St., on Aug. 17, 2018.
  • Another 18-year-old woman reported that a rape occurred in that same room sometime between August and October 2018.
  • A 19-year-old woman told police that she was raped there in early September 2018.
  • A 19-year-old woman told police that she was raped there on Feb. 7.
  • Two women, ages 18 and 19, said they were inappropriately touched on April 13. One incident occurred near 14th and Superior Streets. The other report did not provide an address.

In the Aug. 25 incident that led to the men’s arrest, a 19-year-old woman reported to police that she was raped at Hunt and LeGrone’s off-campus apartment.

Hunt and LeGrone are listed on the public police report of that incident because it is marked “cleared” and arrests have been made in the case, Lincoln police said.

LeGrone was arrested on suspicion of first-degree sexual assault, and Hunt was arrested on suspicion of aiding and abetting first-degree sexual assault.

The arrests came a week after the Title IX investigation report was obtained by ESPN. The report says “a greater weight of the evidence” supported that the two men “engaged in sexual assault and sexual harassment, in violation of university sexual misconduct policies.”

Hunt was released from the Lancaster County Jail on Wednesday on a $100,000 personal recognizance bond. LeGrone posted 10% of $50,000 bail Wednesday and appeared in Lancaster County Court on Thursday afternoon wearing street clothes.

LeGrone’s arraignment was continued until Dec. 20, the same date as Hunt’s next hearing.

Lincoln attorney Chad Wythers, who represented LeGrone at Thursday’s hearing, declined to comment.

Season starts early; number of cases 'pretty sizable and probably going to go up'

As warned early last month, Nebraska is seeing an early surge in influenza this year.

Dr. Tom Safranek, Nebraska's state epidemiologist, said the season appears to be running about four weeks ahead of schedule. The last time it took off this early was in 2003-04.

While the state's flu spread is officially listed by federal officials as "regional," Nebraska has the dubious distinction of being one of 12 states with high levels of influenza-like illness. Not all patients get tested for the flu, so that measure is often used as a gauge of how much flu is out there. The rest of the states on the list are all south of Nebraska.

"I would say we're in the middle of it right now," Safranek said. "Our numbers are pretty sizable and probably going to go up."

He and other health officials urged people who haven't already gotten the flu shot to do so without delay, particularly those who are most vulnerable— the very young, the very old, pregnant women and those with compromised immune systems.

That last category includes people taking medications that hinder their immune response, said Dr. Scott McPherson, medical director of Clarkson Family Medicine at the Old Market Health Center.

It takes about two weeks after getting the shot to develop full immunity.

Locally, the Douglas County Health Department on Monday reported a continued increase in flu activity, with 1,066 lab-confirmed cases recorded by Saturday. Two outbreaks in long-term care facilities had been reported. The Three Rivers Public Health Department, which covers Dodge, Saunders and Washington Counties, also noted increasing flu activity, with one outbreak at a long-term care facility.

In addition, the Omaha area ranks among the top 10 markets for flu activity on the Walgreens Flu Index, which is compiled based on the drugstore chain's weekly retail prescription data for antiviral drugs, the medications used to treat influenza.

"We're high this year for this time of year," said Debbie Hartle, a pharmacist at the Walgreens at 90th and Blondo Streets.

In addition to seeing people come in for prescription flu medications and over-the-counter drugs to manage symptoms, Walgreens is also giving flu shots, which are in good supply.

In response to the local surge, Nebraska Medicine this week began offering walk-in flu clinics, where people experiencing flu symptoms can get treatment without an appointment. That's well ahead of the setup of last year's clinics, which opened in early February. This year's walk-in clinics will be available at the Eagle Run Health Center near 129th Street and West Maple Road and Clarkson Family Medicine at 1319 Leavenworth St.

McPherson said the clinics are intended to make it easier for patients to get in quickly and to free up resources in emergency rooms to deal with critical illnesses and injuries.

Dr. Rudolf Kotula, an infectious disease physician with Methodist Physicians Clinic, said the early flu surge doesn't necessarily mean that the season will be worse overall. Australia's flu season, which runs ahead of the U.S.'s, began this year in April, two months earlier than usual, but then plateaued.

Safranek notified health care providers in early November that the flu could make an early appearance after seeing a steady trickle of positive tests in September and October.

The strain of flu virus that's dominating so far in Nebraska is a type of influenza A called H1N1, which first turned up in 2009. The good news, Safranek said, is that it's usually a little less severe than some others. But health officials are seeing a sizable number of children sickened, he said. Not only are they getting hit pretty hard, but they could pass the virus and create a second wave.

But in some other parts of the country, an influenza B strain that typically shows up later in the season has dominated the flu lists.

Influenza isn't the only source of misery in the area. Dr. Robert Penn, medical director for epidemiology at Methodist Hospital, said eight to 10 other viruses that cause respiratory symptoms are also circulating.

That list includes respiratory syncytial virus, which normally causes mild, coldlike symptoms but can be serious in infants and older adults. Douglas County health officials said in their weekly report that the number of positive RSV tests remains high.

Still, there are steps people can take to protect themselves and those around them, starting with the influenza vaccine. While it's not always perfect, health officials said, the vaccine is the best protection we have. Even if it doesn't prevent flu entirely, it can lessen symptoms and duration and keep recipients out of the hospital — or worse.

Dr. Mark Rupp, an infectious disease specialist with Nebraska Medicine, said testing of this year's vaccine is promising so far.

"Our early information is that the vaccine is well matched to this year's strains, so hopefully it has the maximum chance to be effective in preventing flu," he said.

Dr. Renuga Vivekanandan, an infectious disease doctor with CHI Health, said peoplewho've been exposed to the flu — say, by a spouse or child who tests positive — can ask a health care provider for antiviral drugs, such as Tamiflu.

Same goes for those who've just developed symptoms. The medication is most effective if started within the first 72 hours.

The doctors said people can also protect themselves by avoiding sick people and staying in when they're sick; washing hands frequently; disinfecting surfaces if possible in areas frequented by those who are sick; avoiding touching their eyes, nose or mouth; and practicing good health habits such as getting plenty of sleep, being physically active, managing stress, drinking plenty of fluids and eating nutritious food.

julie.anderson@owh.com, 402-444-1066, twitter.com/julieanderson41

Divisions sharp as Judiciary panel moves toward vote on articles today

WASHINGTON (AP) — The House Judiciary Committee took the first steps Wednesday evening toward voting on articles of impeachment against President Donald Trump, beginning a marathon two-day session to consider the historic charges with a lively prime-time hearing at the Capitol.

Democrats and Republicans used the otherwise procedural meeting to deliver sharp, poignant and, at times, personal arguments for and against impeachment. Both sides appealed to Americans' sense of history — Democrats describing a strong sense of duty to stop what one called the president's "constitutional crime spree" and Republicans decrying the "hot garbage'' impeachment and what it means for the future of the country.

Rep. David Cicilline of Rhode Island asked Republicans standing by Trump to "wake up" and honor their oath of office. Republican Rep. Mike Johnson of Louisiana responded with his own request to "put your country over party." Rep.

Lou Correa, D-Calif., shared his views in English and Spanish.

One Democrat, Rep. Val Demings of Florida, told the panel that, as a descendant of slaves and now a member of Congress, she has faith in America because it is "government of the people" and in this country "nobody is above the law." Freshman Democratic Rep. Lucy McBath of Georgia emotionally talked about losing her son to gun violence and said that while impeachment was not why she came to Washington, she wants to "fight for an America that my son Jordan would be proud of."

Republican Rep. Jim Jordan of Ohio said Democrats are impeaching because "they don't like us" and read out a long list of Trump's accomplishments.

"It's not just because they don't like the president, they don't like us," Jordan added. "They don't like the 63 million people who voted for this president, all of us in flyover country, all of us common folk in Ohio, Wisconsin, Tennessee and Texas."

The committee is considering two articles of impeachment introduced by Democrats. They charge Trump with abuse of power for asking Ukraine to investigate Joe Biden while withholding aid as leverage, and obstruction of Congress for stonewalling the House's investigation.

On Thursday, the committee is likely to vote to send the articles to the full House, which is expected to vote next week. That could come after hours of debate over Republican amendments, though the articles aren't likely to be changed. Democrats are unlikely to accept any amendments proposed by Republicans unified against Trump's impeachment.

Democrats are also unified. They have to agreed to the language, which spans only nine pages and says that Trump acted "corruptly" and "betrayed the nation" when he asked Ukraine to investigate Joe Biden and the 2016 U.S. election. Hamstrung in the minority, Republicans wouldn't have the votes to make changes without support from at least some Democrats.