Dentist Says Armed Agent Came to His Office After Senate Testimony

Dr. Paul Dunn testified before the House Human Services Committee last week about his experiences with the Health and Human Services Commission Office of the Inspector General and SB 1803.  Dunn testified last year before the same committee and more recently this past August before the Senate Health and Human Services Committee.

Going bankrupt despite being told didn’t commit fraud

Dunn had been initially placed under a 100% payment hold for “credible allegations of fraud.”  He was told at an informal resolution meeting that he didn’t commit fraud but the payment hold was only reduced to 49%.  Since then he has been on the edge of bankruptcy at 67 years of age.  He is now being told he owes OIG $2.7 million, up from the original $1.2 million.

Armed investigator shows up after testimony

After his recent testimony before the Senate committee, the next week, he told members of the House committee, an armed investigator showed up to request two patient files that OIG had already been given two years before.  This is on the video at 7:20.

The following is his written and video testimony which is up on YouTube.

Good afternoon and thank you for hearing my testimony today.

I’m Dr. Paul Charles Dunn. I am a general dentist; I graduated from Baylor College of Dentistry in 1974 and have practiced my entire career in Levelland, Texas, a small town 30 miles west of Lubbock. I’ve been a Medicaid provider since the month I graduated from dental school, and over time my practice has become 90% Medicaid. I am the Medicaid provider for an extremely large area. Children travel to see me.

Several years ago, case workers started saying that kids could get free braces just by asking. When I explained to parents that their children didn’t qualify they would complain. After many months of this, I worked with the HHS supervisor in Lubbock to speak to these front line employees to explain to them how the system worked. And I made presentations like this across the state from Amarillo to Houston. I was only reimbursed for my travel expenses at these meetings, which were approved by both HHSC and TMHP.

Then in January of 2013, OIG placed a payment hold on my practice based on four cases of possible “fraud”. I met with them and demonstrated that there was no fraud on the cases they’d listed. They actually agreed with me, but indicated that the orthodontic cases that I’d had pre-approved by TMHP should not have been approved in the first place, and that therefore I owed them $1.2 million dollars.

Despite the payment hold, I’ve managed to keep my dental practice by laying off most of my staff. In March of this year, a year after my first meeting with them, I finally met with OIG again to discuss paying back what had now become $2.7 million. But my practice is no longer a viable business; I can’t pay my lab costs, let alone take on a $2.7 million dollar debt. Besides, I don’t think I should pay OIG anything, because I didn’t do anything wrong.

SB 1803 requires providers to “advance security” for their share of the cost of a SOH hearing but OIG Rules require an up-front cash payment. The fee for my SOAH hearing would be at least $45,000 and when it is all complete, probably closer to $75,000.

SB 1803 says that the security requirement can be eliminated by the ALJ “for good cause” at an expedited hearing but OIG requires the payment of the cash costs before there can be any hearing.

As a payment hold has been in place, I have been unable to pay the up-front cash to have a hearing and can’t even get an expedited hearing to consider whether or not good cause exists to require the cash payment until I pay the cash.

I believe SB 1803 should be amended so that where a provider is facing a payment hold, there should not be a requirement that a provider advance half the costs of the hearing. I also believe the costs should be capped at $5,000 or taken out of monies already being held by OIG.

When I first met with OIG they agreed that I didn’t defraud Medicaid, and said they wanted to keep good doctors like me in the program. But not only have they put me out of the program, they’ve destroyed my forty year practice. If that’s how they treat “good doctors”, I’d hate to see what they do to the bad ones. Thank you.

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