On Tuesday, May 2, Dr. Juan D. Villarreal D.D.S. was honored by the U.S. Small Business Administration Lower Rio Grande Valley District at a luncheon celebrating Small Business Week. He was presented with the SBA's 2017 Entrepreneurial Success Award at the luncheon held in Mission at the Cimarron Country Club. "Hard work, innovativeness, and service to the … [Read more...]
Texas Medicaid Dentists Prevail Again Over State Agencies in Court
This past Friday, the Texas Supreme Court dismissed a petition from the Texas Office of Attorney General to review a 3rd Court of Appeal decision preventing the Health and Human Services Commission Office of Inspector General from placing payment holds on Medicaid providers for only allegations of program violations. State and federal law only provide for payment holds on … [Read more...]
OIG Settling Old Dental Medicaid Cases, But the OAG Retooling Some of Them
As reported in the press this week, there has been a tremendous effort on the part of the new Health and Human Services Commission Inspector General Stuart Bowen to settle old, outstanding investigations against Medicaid providers—including dentists. Per the Chronicle, Bowen has offered settlements to nearly 100 Medicaid dental providers “to clear the decks” as previous … [Read more...]
Court Sides with Medicaid Dentists and Negates HHSC-OIG Rules on Medicaid Payment Holds for Program Violations
Today, the Texas 3rd Court of Appeals overturned a lower court decision and negated Health and Human Services Commission rules that allow for the Office of Inspector General to place Medicaid payment holds in certain circumstances, basically for only program violations not fraud, and then keep the funds to offset alleged overpayments by the provider. A copy of the decision is … [Read more...]
Another Legal Win for Medicaid Dentist: Appeals Court Tells OIG To Return Payment Hold Monies
The 3rd Texas Court of Appeals has agreed with a Travis County District Court judge and has issued a ruling that the Office of the Inspector General should return over $1.2 million in withheld Medicaid funds to Harlingen Family Dentistry. TDMR received a copy of the decision this morning and the Austin American Statesman has already published the story. Appeal over a year … [Read more...]
Kyle Janek Rules – “Dentists Found Innocent by SOAH, Are Guilty”
On May 7th, Dr. Kyle Janek, the Executive Commissioner of the Texas Health and Human Services Commission, issued his final order in the case of Antoine Dental Center of Houston. Upheld reversal of favorable SOAH ruling on Antoine Dental As expected, Janek overturned SOAH’s payment hold ruling, which was favorable for Antoine Dental. That SOAH ruling found no prima facie … [Read more...]
Medicaid Ortho Case Photos with HLD Scores by Provider and Experts
A recent review of our website content revealed to us that while PDF files containing these photos have always been on the site, perhaps they have not been as prominently displayed as they should be. Medicaid after all is about benefiting indigent children and the controversy is whether or not children such as these should have been treated under Texas Medicaid as the … [Read more...]
Attorney General: HHSC courts are not “trial courts” and HHSC judges are not “judges”
This week the Texas Attorney General filed a remarkable brief to oppose the motion to disqualify HHSC judge Rick Gilpin from a Medicaid payment hold case because he was a senior lawyer in the Attorney General’s office for some 38 years before becoming an administrative law judge with HHSC. The motion to disqualify was brought by lawyers for M&M Ortho of San Antonio. It … [Read more...]
Attorney for Dentists Moves to Disqualify HHSC Judge Based on Texas Constitution
A motion has been filed with the Texas Health and Human Services Appeal Division to have Judge Rick Gilpin disqualified as a hearing officer for cases involving dentists that started while Gilpin was still an attorney within the Attorney General's Office before becoming an HHSC judge. The motion is based on Article 5, Section 11 of the Texas Constitution that “No judge shall … [Read more...]
HHSC Judge Denies SOAH Hearing for Medicaid Overpayment Hearing
The same HHSC judge that overturned a favorable SOAH (State Office of Administrative Hearings) decision in the payment hold case of Antoine Dental of Houston, has denied a motion to have a Medicaid overpayment hearing held at SOAH. HHSC Administrative Law Judge Rick Gilpin denied a set of motions by attorneys for Harlingen Family Dentistry, one of which was to have HFD's … [Read more...]