OAG Says TMFPA Relators Don’t Need Knowledge of Provider Wrongdoing

Medicaid providers might be forgiven for thinking that the Texas government has provided legal protections against frivolous or vengeful TMFPA lawsuits. These are cases in which the relator files a TMFPA lawsuit for a disingenuous purpose other than exposing Medicaid fraud, for example, to harass a provider into a settlement.

No protections for providers

Well, if you think there are such protections, you are whistling past the graveyard. There do not appear to be any.

TMFPA relators don’t need first-hand knowledge of alleged wrongdoing

According to a January 2020 court filing by the Office of the Attorney General in the Lafountain case against 71 dental entities, “there is no provision of the TMFPA that requires the qui tam relator to have “independent” “direct” or “first-hand” or “insider” knowledge of any alleged unlawful conduct.”

Specific to this particular case, even though Lafountain has since stated under oath that he has no knowledge or evidence to back up his claims of illegal conduct by the defendants, the OAG stated that “Mr. LaFountain (sic) is not required to have direct or personal knowledge of unlawful acts in order to pursue recovery on behalf of the Medicaid program…”

Civil cases require a preponderance of the evidence, not TMFPA

Wild, isn’t it? In ordinary civil cases, the plaintiff has the burden of proving his case by a preponderance of the evidence. Yet, to have a TMFPA case move forward, no knowledge or evidence is apparently required.

The OAG initially reviewed Lafountain’s claim back in 2016, declined to take it over, but protests its dismissal even though the relator can’t provide any knowledge or evidence of wrongdoing. The OAG has the power to dismiss but so far won’t.

Like a state-sanctioned shakedown

This standard shows that the door is open for brazen, unscrupulous relators and their lawyers to conduct expensive fishing expeditions through discovery to come up with any evidence to back up their disingenuous claims. This forces providers into an incredibly expensive legal defence to uphold their integrity and prove their innocence.  Unfortunately, agreeing to a nuisance settlement with no admission of wrongdoing ends up making more business sense than proving one’s innocence. Such an outcome fans the flames for more such lawsuits and similar outcomes.

Something is wrong here. It seems like a state-sanctioned shakedown, doesn’t it? After all, the State of Texas gets 65 to 75% of any settlement.

No comment from OAG

It is so unbelievable that TDMR sent an email last week to the communications director of the Office of the Attorney General, Ms. Lauren Louvven, asking what protections Medicaid providers have against frivolous TMFPA lawsuits.

Unsurprisingly, there was no response.

Only provider recourse is to go to trial

According to the OAG’s court filing, the only recourse for these defendants, and presumably any defendant in a TMFPA lawsuit, is “in the trial court to challenge the amount of any recovery..”

Here is the OAG’s statement of interest on behalf of the State of Texas in this case.

5-Attorney General filing

17 Responses

  • This is just terrible and very frightening. Any provider at any time can be a victim of this shakedown. Something needs to be done ASAP.

  • Wow…. a couple weeks ago I was reading an Article with the Attorney General complaining against the expensive lawsuit against him, and the Attorney Generals Office is shaking people down. The irony is amazing. This is exactly why my husband and I stopped taking medicaid. Someone needs to fix this system.

  • After reading the case, it seems like this is a blatant attempt to proceed without any substantial evidence.

    How does a person without any first hand knowledge or evidence get so far. How does the justice system allow this?

    This is not justice.

  • I don’t understand how someone will no knowledge can sue one person but Better question is How does one person with no knowledge of anything sue 71 entities, at the same time !!??

    Easy to see why unethical lawyers would jump at a big fishing expedition $$, but it appears the AG is turning their backs on the business owners in order to get their cut.
    Lawsuits like this can destroy both businesses and lives !

    Changes must be made!!!!!!!!

  • This is absolutely unacceptable, how can they allow such injustice go on. Without any substantial evidence those dentists are subject to a shake down, this has to change

  • I thought Texas was good place for business? So this legislation, or the way it’s being interpreted, basically says someone who has never worked at your office, doesn’t know you or anyone in your office, and in this case the guy has never even been inside the offices can accuse you of fraud. Then you have to waste your time and money to prove you’re not?!

    This needs to change or it will destroy dentistry. This is nothing more than a money grab and I can see lawyers doing this as a “hobby” to collect money.

    So you spend years and money defending yourself you’re innocent, or you settle so you don’t have to go through that. It will never stop. I am shocked our AG thinks this is good for business in Texas.

  • If you are a Medicaid dental provider, I would get out now! Or at least until this is fixed. If you are a Medicaid provider, you are vulnerable. I would not ever consider treating the poor in this state because the AOG does not care if there are providers.

    • I would not become a Medicaid dental provider in Texas. You give up you civil rights doing so.

    • This Lafountain is not the only sleaze ball. I hope all current and future employers see this.

      The other bad actor is Cristine Eliis. She works for UT Southwestern and along with her attorneys simply went through and created a list of the top 25 orthodontic Medicaid providers and placed them in a sealed lawsuit. She NEVER worked or saw any patients in these practices. She never had a very successful practice at UT Southwestern and I hope her employers see this.

      • Session is coming up in January 2021, every single dentist needs to be breaking down the doors of their reps and senators to make sure they figure this thing out. This is shameful. This needs to be national news.

  • This is completely outrageous! So anyone walking down the street can accuse any one of us of something and we have to pay a lawyer to defend us?! This is Texas, we are supposed to have liberty, justice and due process! Where is AG Ken Paxton?!?! Docs, we have to unite or ambulance chasing lawyers will continue to do this. We have to make our voice heard to Austin as well. I am going to take action, are you with me?

  • This LaFountain is not the only one doing this and I hope his current and future employers are paying attention to this.

    Another bad actor is Christine Ellis and her attorneys. What did she do? Go through a list of all the top 25 Orthodontic providers along with her leach attorneys and placed them in a sealed lawsuit. She NEVER worked on any of these practices. She just had a poor performing practice at UT Southwestern and was NEVER a Medicaid provider. I hope her employers at UT Southwestern see this and consider the liabilities they could be under.

  • This is really scary for all of us Medicaid providers! What’s to stop this guy and his greedy lawyers from doing this to another 70 random dental or medical practices once they are done here? Nothing at all right now! They’re actually being helped by the OAG in their fishing expedition.

    How does this make any sense? Where is the due process or even the ability to fairly defend oneself against baseless claims? This is apparently the thanks Medicaid providers get from the OAG for serving an underserved community. Very disheartening!

  • This is insane! How is a lawsuit like this allowed to happen, and being backed by the AG?! Truly frightening for all providers to have to worry about any person without any knowledge of provider wrongdoing decide they want to attempt to extort money. This is not ok!

  • People need to LOSE THEIR JOBS OVER THIS . Look up Jack Stick and the OIG. This is far worst, there needs to be accountability.

  • This is unbelievable, someone has to be held responsible for this kind of corruption. It’s hard to accept the fact that AG is allowing this to happen. If this doesn’t show a systematic level of corruption, i don’t know what does.

Leave a Reply

Your email address will not be published. Required fields are marked *