Harlingen Family Dentistry is a large dental practice in Harlingen, Tx. It has 13 dentists and over 130 staff and was started in 1983 by Dr. Juan Villarreal. HFD had two orthodontists, one board certified, and another dentist who was qualified to treat Medicaid orthodontic patients. The Texas Tribune listed HFD as the 17th top billing clinic for Medicaid orthodontics in 2011. In late 2011, HFD came under a Medicaid payhold by OIG for credible allegations of fraud. Dr. Villarreal went to the State Office of Administrative Hearings to dispute the allegations of fraud and payhold.
The decision from the SOHA judge, upheld by an HHSC Administrative Court judge, found:
1. No evidence of fraud or misrepresentation;
2. OIG expert witnesses were not credible;
3. The subjective and vague nature of HHSC policy in scoring orthodontic difficulties for Medicaid patients were at fault for the differences of scoring between HFD dentists and OIG experts.
The following are court documents:
OIG closing argument, June 5, 2012
Exceptions filed by OIG to decision, September 4, 2012
Proposal for Decision to HHSC Commissioner, September 27, 2012
Decision confirmed by HHSC Administrative Judge Susan Fekety, October 10, 2012
OIG motion for rehearing, October 30, 2012
Final decision denying OIG motion by Judge Fekety, January 7, 2013
Letter to HHSC Commissioner requesting meeting, January 16, 2013