HHSC Sued for Its Refusal to Release Medicaid “Credible Allegation of Fraud” Payment Hold Information

court of lawA suit to compel the Texas Health and Human Services Commission to release the full list of names of Medicaid providers that have been placed under a “credible allegation of fraud” payment hold since 2010 has been filed in Travis County District Court. The action is being brought by the Austin law firm of Riggs & Ray which represents a number of Medicaid dentists who have been placed under such holds by the state.

Open records request for information

The lawsuit stems from a Public Information Act request by Riggs & Ray attorney Jason Ray.  Ray wanted to obtain the information because the State Board of Dental Examiners in their self-evaluation report for the Texas Sunset Advisory Commission had stated that corporations were “crafting business structures that ultimately allowed the corporations to exhibit undue influence on Medicaid dentists.”

Per the suit, Ray wanted to find out if this was the case and which dentists and dental corporations the TSBDE might be referring to. As HHSC must per state law send out letters to the dentists and dental corporations informing them of the placement of a “credible allegation of fraud” payment hold on their Medicaid funds, Ray asked for copies of such letters or a list of the names of those to whom letters had been sent.

Only partial disclosure and seeking to keep the rest secret

However, HHSC only released 20 such letters and claimed the rest were confidential and is seeking to withhold them, seeking an opinion from the Office of the Attorney General.

Ray states in his filing that “There is nothing special about the letters. The letters are garden-variety public records because they were sent to notify the providers of the HHSC’s findings and to inform the providers of their appeal rights. The letters are in the public domain because they were mailed to the providers themselves. There is nothing that would prevent the letters from being widely distributed by the providers; that is, the letters do not contain any HIPAA protected health information or confidential information.”

He also states that he “already possesses at least 12 examples of the letters that HHSC is refusing to release.”

Another bombshell in the wings?

Consequently, it is not understandable why HHSC is not releasing the letters.  One can only wonder what further embarrassing bombshell might be lurking for the Commission in those pages.

A copy of the lawsuit can be downloaded here:

Original Petition – file stamped


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