OIG Settlement Successfully Negotiated

OIG Settlement Successfully Negotiated
TDMR has learned that Jason Ray, attorney at the Austin law firm of Riggs, Aleshire & Ray, P.C., recently negotiated a full settlement of an OIG complaint and payment hold against a dentist in the Dallas area.

The dentist, who operates multiple offices in Dallas, was placed under a payment hold pursuant to a Credible Allegation of Fraud received by the OIG. Specifically, the OIG claimed that the dentist had solicited Medicaid patients through the use of gift cards, and had also violated solicitation laws by providing transportation to Medicaid patients who could not otherwise attend their dental appointments. All of the dentist’s locations had been placed on a 100% Medicaid payment hold for several months while the OIG’s investigation continued, despite there being only allegations levied against one of the dentist’s clinics.

“Payment holds based on a credible allegation of fraud can be devastating to a Medicaid provider,” Mr. Ray explained, “and this dentist certainly was beginning to question whether his business could continue in the face of such an immediate, and harsh, sanction.” After negotiations with the OIG staff failed to produce results, the dentist contacted TDMR, who provided information about the work being done to help dental Medicaid providers facing investigations before the OIG. Ultimately the dentist retained legal counsel seeking help.

“The OIG was surprisingly responsive to my communications,” stated Mr. Ray. “We were able to negotiate a reasonable fine, a release of the payment hold, and the return of 70% of the funds that had accumulated from the payment hold,” he said.

In fact, the Deputy Inspector for the OIG, Jack Stick, followed up to assure that there were no problems after the parties had agreed in principle to the terms. Mr. Ray explained, “Jack indicated that an 8 month delay in handling a straightforward allegation was not consistent with the way he wanted to do business. That bodes well for dentists who have legitimate concerns about how things might have been handled in the past. I give credit to the TDMR for raising public awareness about the OIG’s backlog of investigations and how providers have needlessly suffered under heavy CAF (credible allegation of fraud) holds.”

Mr. Ray indicated that the dentist had executed the agreement and that the OIG had indicated that it would become effective within two weeks.

This is good news for all Medicaid providers!