Texas Health and Human Services Commission Inspector General Doug Wilson told Sen. Judith Zaffirini and other members of the Senate Committee on Health and Human Services at their August 14th hearing on Medicaid fraud, waste and abuse that his agency lifts payment holds on an ongoing basis when the provider produces evidence otherwise.
This is certainly not the situation when the State Office of Administrative Hearings finds there is no state evidence against a provider. Or a dentist is going bankrupt despite being told he didn’t commit fraud by OIG’s own staff.
OIG doesn’t respect SOAH decisions to lift payment holds or give back Medicaid funds
There have only been two payment hold hearings for dental Medicaid providers in the last three years despite the large number of outstanding cases. In both situations, SOAH judges found the providers innocent of OIG allegations of fraud, waste and abuse. Yet, OIG hasn’t respected the decisions, contrary to Wilson’s words to the senators. Wilson, in fact, has told at least one Medicaid dentist that SOAH doesn’t know anything about Medicaid.
In the case of Harlingen Family Dentistry, OIG has refused to return over $1.3 million the agency withheld despite the SOAH decision and a further mandamus from the Travis County District Court ordering them to do so.
In the other, Antoine Dental of Houston was under a 100% payment hold and SOAH ordered it discontinued because of the lack of evidence against Antoine. However, HHSC Executive Commissioner Kyle Janek overturned the SOAH decision, putting the agency in the position of a dictatorship – investigator, prosecutor, judge and jury.
Life savings and retirement gone for dentist told by OIG he didn’t commit fraud
Dr. Paul Dunn has also testified previously and again at this hearing that he is going bankrupt and his retirement saving are gone because of the payment hold he is under despite former director of enforcement Jack Stick telling Dunn in a face-to-face meeting that Dunn had not committed fraud. Dunn is 67 years old.
The excerpt of Wilson’s testimony is now on YouTube and below.