Good afternoon Mr. Chairman and Committee Members. I am Dr. Vivian Teegardin from Harlingen. I am a General Dentist employed by Dr. Juan Villarreal with Harlingen Family Dentistry and have practiced there for the past 24 years. I am also on the board of the Texas Dentists for Medicaid Reform. I am here to give my support for Bill 1536.
Frankly, I am a dentist and not a lawyer, so I am talking more about my personal experiences than anything else.
I have been involved in this issue because our practice which now consists of 13 dentists and 130 staff was a high volume provider of orthodontic Medicaid services in Texas. We had three dentists providing orthodontic services to the Medicaid eligible children that came to us – two orthodontists, one of which was board certified, and myself.
It was with some shock that I found our offices being investigated by the Office of Inspector General back in mid-2011 and then that we were accused of Medicaid fraud. There had been no complaints that we were aware of. Worse, when we started getting some of the facts of the investigation, we were told that the OIG dental expert had decided that 84 out of 85 orthodontic cases he reviewed did not qualify for Medicaid and that we were under a credible allegation of fraud payment hold. This was unbelievable.
I was not involved in all the ins and outs of dealing with OIG and the legal case as this was the province of Dr. Villarreal and he has made a separate written submission. He could not be here today because he had a long arranged commitment out of state.
But personally, let me tell you I have felt sick about this whole matter since it started back in 2011. And this has taken a toll on my health as I have recently been diagnosed with hypertension, which I attribute to the strain from the entire process of being under these allegations. One of our orthodontists, Dr. George Franklin, retired because of the strain he felt from having his professionalism undermined by allegations of fraud.
Initially I was relieved when I heard that the judge from the State Office of Administrative Hearings had found that we had not committed fraud or misrepresented what we had done. This was last September, a year after the payment hold had been placed and the allegations made. This is way too long in my estimation.
However soon after our office was again visited and investigated by OIG. I thought we had been cleared of criminal charges and it was shocking. Our office manager, Marisol Alanis, will address her dealings and concerns with the conduct of this expanded investigation.
Another thing is that it took until last month to get OIG to recognize the decision of the SOHA judge and actually lower our payment hold as ordered by the judge, which had been at 40% of all our Medicaid billings.
My understanding of Bill 1536 is that it comes into play at the overpayment stage of OIG investigation process. While this is good, it seems to me that there also needs to be due process provisions dealing with how an investigation is conducted and when a payment hold is first placed. The fact that it has taken over a year to deal with that issue, at a cost of several hundred thousand dollars does not seem fair to me. We haven’t even gotten to the overpayment hearing stage yet.
I just want to further state that I got into taking Medicaid patients because I believed in giving back to the community and helping needy children. I felt it was a very positive thing to do. Even though we are no longer getting Medicaid funds for the children we started into orthodontic treatment, we are fortunate to have the resources to be able to complete them and I am glad to help them.
However, this kind of heavy handed treatment with our practice has dampened our enthusiasm to help Medicaid and I believe it sets a bad example as to what other dentists can expect if they come under investigation. This is bad for Texas and it is bad for the Rio Grande Valley which has a lot of Medicaid eligible children.
We are against Medicaid fraud and people that defraud the system should go to jail. But there needs to be due process for providers to sort out the guilty from the innocent.
I thank you for looking into this and seeking to improve matters for Medicaid providers.