March 5, 2014 — A Texas judge has upheld payment holds on Medicaid payments for Houston dental clinic Antoine Dental Center (ADC), citing credible evidence of Medicaid fraud. The clinics billed about $8.1 million for orthodontic services in less than three years.
The 36-page ruling was issued February 28 by Judge Rick Gilpin, an administrative law judge for the Texas Health and Human Services Commission (HHSC).
Reimbursements for Medicaid claims by ADC, which has two clinics in Houston, have been on hold since 2012, pending an investigation by the HHSC and the Texas Office of Inspector General (OIG) for Medicaid fraud involving orthodontic care. ADC ranked in the top 25 providers for Medicaid payments; about 70% of ADC’s patients were Medicaid recipients, the ruling stated.
“The fact that ADC billed for comprehensive orthodontic services when their patients did not qualify for that treatment is a program violation and warrants a payment hold.”
— Administrative Law Judge Rick Gilpin
ADC has appealed the payment holds, and a judge ruled last year that ADC should be paid until the investigation is complete. HHSC and the OIG then appealed that decision, which resulted in Gilpin’s final ruling last week…