Chair and Members of the Committee:
My name is Anthony Goodall. I’m an attorney here in Austin and I represent one of the larger providers of orthodontics care in the State of Texas. I’m here in support of House Bill 1536. We are confident that this bill will provide much needed protections from due process violations from the Office of Inspector General.
To give you some history on my client’s experience, my client was approached by the contractor to HHSC and was urged to open offices in areas where there were shortages of Medicaid providers. Over time, the practices were opened and children successfully treated. Every attempt was made on my client’s part to become the gold standard in how orthodontic services were to be provided under the Medicaid system. As the year 2012 opened, my client was serving Medicaid patients in 6 locations in the state and was scheduled to open the 7th within months. On February 13th, last year, while at my client’s office, the phone rang at 9:00 a.m. Investigators from the OIG had just arrived at one of those offices and were demanding the turnover of numerous patient records. Within minutes, we received a phone call from a second office with the same report. Then the third office, until every office had investigators from the Office of Inspector General in them demanding records, requesting interviews and otherwise disrupting the patient flow for that day and that week.
At the time, my client was undergoing a conversion to a paperless system and some of the records were difficult to prepare in a timely manner. To make matters worse, one of the principal locations had a gas leak in the pipeline along Interstate 10 in front of the office building. Notwithstanding the evacuation of the building, OIG had issued its demand for records and showed little sympathy for the demands placed on the practice. By Friday that week, February 17th, OIG issued a letter placing my client on payment hold due to missing a few of the patients’ cast models of their mouths. In the days that followed, OIG engaged the services of a doctor who had never practiced Medicaid or ever filled out an HLD Score Sheet before. He became OIG’s expert on whether this practice had been submitting proper Medicaid benefit applications. On the 29th of February, OIG issued an amended payment hold letter stating that in addition to the missing physical models, the expert took issue with the HLD Scores submitted to TMHP.
On behalf of our client, we requested a timely “expedited payment hold hearing” to address the validity of the payment hold. We have just recently discovered that the “expedited” payment hold hearing won’t be held until August 19th of this year ¬one and a half years after the payment hold was imposed.
This practice was responsible for thousands of children in treatment and was reluctant to turn them away without completing their treatment–but it simply couldn’t continue treatment for so many without funds. We requested an emergency meeting with Commissioner Suehs to request the release of emergency funds so the practice could continue treatment of the thousands of children in its care. Mr. Suehs turned it over to the Office of Inspector General who called the meeting for April 24th last year. We were told in the meeting:
A. The provider was under suspicion of fraud and there was no way further funds would be released.
B. Only 3% of the patients that received prior approval from TMHP should have been approval and the OIG viewed that as the fault of the provider.
C. If the provider didn’t continue treating the children, despite the payment hold, OIG was working with the Dental Board and would see that the provider lost his license to practice.
D. That OIG wanted to recoup around $48M dollars from the practice.
E. That if we didn’t resolve this real soon, we could expect some adverse publicity in our service area.
That meeting wasn’t quite what we had expected.
House Bill 1536 does not resolve the abuse of power by the OIG in indiscriminately imposing payment holds. Clearly, there is no due process available at the point the payment hold is imposed. Clearly, there is no such thing as an “expedited hearing.” Clearly, informal conferences are a sham. Clearly, there is no impartial review of the application of the “credible allegation of fraud” standard.
House Bill 1536 will not restore losses of reputation, the ruination of practices, take care of the thousands of children who have gone untreated or restore the numerous jobs to those who lost them. Clearly, House Bill 1536 does not prevent OIG from playing judge, jury and executioner at the payment hold stage, but at least if it is enacted, providers can be assured a higher standard of fairness and due process during the overpayment hearings.
I appreciate your time. Thank you very much.
