Harlingen Family Dentistry is a large dental practice in Harlingen, Tx.  It has 13 dentists and over 130 staff and was started in 1983 by Dr. Juan Villarreal.  HFD had two orthodontists, one board certified, and another dentist who was qualified to treat Medicaid orthodontic patients.  The Texas Tribune listed HFD as the 17th top billing clinic  for Medicaid orthodontics in 2011.  In late 2011, HFD came under a Medicaid payhold by OIG for credible allegations of fraud.  Dr. Villarreal went to the State Office of Administrative Hearings to dispute the allegations of fraud and payhold.

The decision from the SOHA judge, upheld by an HHSC Administrative Court judge, found:

1. No evidence of fraud or misrepresentation;

2. OIG expert witnesses were not credible;

3. The subjective and vague nature of HHSC policy in scoring orthodontic difficulties for Medicaid patients were at fault for the differences of scoring between HFD dentists and OIG experts.

Here is a briefing on HFD and the case as well as a comparison of the scoring of the teeth of individual patients.

The following are court documents:

Hearing Transcripts:

OIG closing argument, June 5, 2012

Decision by State Office of Administrative Hearings Judge Shannon Kilgore, August 15, 2012

Exceptions filed by OIG to decision, September 4, 2012

Proposal for Decision to HHSC Commissioner, September 27, 2012

Decision confirmed by HHSC Administrative Judge Susan Fekety, October 10, 2012

OIG motion for rehearing, October 30, 2012

Final decision denying OIG motion by Judge Fekety, January 7, 2013

Letter to HHSC Commissioner requesting meeting, January 16, 2013