December 2, 2014 — A Texas appeals court has invalidated several rules related to payment holds imposed during Medicaid fraud investigations, saying they violate due process rights.
The Third Court of Appeals invalidated rules that authorized the Texas Office of Inspector General (OIG) to impose payment holds on Medicaid funds when a provider is being investigated for fraud, according to the November 25 ruling. The decision sides with plaintiffs Harlingen Family Dentistry and Trueblood Dental Associates and also reverses a trial court’s ruling on the matter.
The Texas Health and Human Services Commission (HHSC) and the OIG have withheld more than $1.5 million in Medicaid payments from Harlingen Family Dentistry, said attorney Jason Ray, who represented Harlingen in the appeals case.
“This couldn’t be a bigger win for Harlingen Family Dentistry,” Ray told DrBicuspid.com. “Harlingen should receive all of the money that the state has withheld, and the state should stop withholding any money from Harlingen going forward.”
“This couldn’t be a bigger win for Harlingen Family Dentistry.”
— Jason Ray, attorney representing Harlingen Family Dentistry
On October 30, a state appeals court ordered the state to repay $1.3 million it has been withholding from Harlingen Family Dentistry, which it had accused of Medicaid fraud, continuing a winning streak for accused dentists and orthodontists as officials have settled cases for pennies on the dollar.