Dr. Paul Dunn, a small town general dentist who practices orthodontics out of Levelland, has had a case outstanding with the Health and Human Services Commission Office of Inspector General since 2011. He has been under severe financial strain since that time from a 51% “credible allegation of fraud” payment hold although he was told by OIG that he had not committed any fraud.
Overpayment rose from $1.2 to $2.5 million including $500,000 interest despite no fraud
Since that time, the amount of OIG’s claimed overpayment has jumped from $1.2 million to now $2.5 million, $500,000 of which is interest assessed by OIG.
Based on four cases
This apparently is based on just four cases the agency questioned in its investigation and extrapolated to a multi-million dollar amount. Dunn says they have it wrong on those cases.
Spent life savings to stay afloat
Dunn, with a one-man practice, has spent his life savings, maxed his credit to keep things going, hoping at the end of the day, he would be able to get to an impartial court to get his case heard. He used to take in Medicaid patients from a 200 mile radius and be asked by HHSC to take over the patient load of retiring dentists in the area. Not now.
Today, OIG wants $40,000 in court costs to go before a judge at the State Office of Administrative Hearings (SOAH) and his lawyer dropped him in January because Dunn could no longer afford to pay him.
No lawyer or money for defense
He was thinking to represent himself before an HHSC Appeals Court hearing, the alternative to SOAH, in June. It wouldn’t cost him anything but that court has a history of simply doing whatever the agency wants – finding dentists guilty, even after they have been found innocent by judges from SOAH. So he knows he would only waste his time by going.
Dunn has talked about bankruptcy for a long while but it is not his preferred road out. So he has tried to keep afloat even though the IRS is now after him too because he must pay tax on the 51% monies that he has never received.
Told to file for bankruptcy fast to save OIG time and money
But when he mentioned bankruptcy as an option to an OIG lawyer handling his case a few weeks ago on the phone he was startled by the response. The OIG lawyer told him that if Dunn was going to do it, he should do it soon to save everyone (meaning OIG) time and money.
Yes, Paul Dunn should be considerate of OIG – his career is ending in an unseemly debacle after helping thousands of young, poor Texans have healthy teeth and he’ll never be able to set the record and his reputation straight.
Attempt to get OIG to listen failed
TDMR since the beginning of March has been seeking to help Dunn by trying to get a conversation going for him with OIG. It was thought with the scathing report of the Sunset Commission last October about the ineptness of OIG and forthcoming legislation to heel in the agency and the removal of several of its top characters, Inspector General Doug Wilson and his former deputy Jack Stick, there might be a sea change at the agency.
No. Whatever political wind is blowing, it isn’t reaching the ground floor at OIG.
Oh, there was interest initially from one of the new men in OIG. He asked Dunn for his financials to see if OIG might reduce the payment hold or possibly give him back some of his money that the state is holding so Dunn could get to SOAH or get a lawyer. However, in an email, he wrote that other providers are available in Dunn’s area for Medicaid patients (so Dunn wasn’t important), that the payment hold was “only” 51% (he could probably get along on 51% of his pay) and that the amount of money the state is holding isn’t enough to give back (yes, the state should just keep it).
In other words, too bad for Paul Dunn.
Despite political whirlwind and public condemnation, no change at OIG
Dunn’s case is indicative. It shows meaningful change hasn’t happened at OIG despite all the good intentions of the Sunset Commission, its staff and legislators who really want to see things done right in Medicaid.
Paul Dunn is a trooper and he is probably being punished for it. He is one of the few dentists who came forward to testify about his OIG case in the 2012 legislative session before the House Human Services Committee. It was on behalf of a bill for due process rights for Medicaid providers.
Punished for speaking about his case before legislators?
In that hearing, he had to face his accuser Jack Stick who was there to defend OIG – it was Stick who told Dunn an informal settlement conference in 2012 that he hadn’t committed fraud but they were going to withhold his monies anyway and demand repayment. It was the first time Stick had to publicly defend OIG’s tactics of extrapolation and payment holds and he didn’t look too good under that scrutiny. The emperor had no clothes and it started to show.
Culture of contempt for due process must change at OIG
So what can be done about the culture of contempt for due process rights at OIG?
Well, our honeymoon waiting for change at the agency is over. There isn’t evidence of it.
If there was any real change, Paul Dunn would have been dealt with differently over the last few months.