Medicaid providers including representatives from Texas Dentists for Medicaid Reform got to tell their side of the story, joined by attorneys and other professionals to provide testimony at the first public hearing on HB-1536, a bill that aims to provide Medicaid providers real due process.
Austin, Tx (PRWeb): Yesterday at the Texas Capitol, the House Committee on Human Services heard public testimony on House Bill 1536, an act relating to a Medicaid provider’s right to an administrative hearing on an action taken by the office of inspector general for the Health and Human Services Commission to recover overpayments under the Medicaid program. The bill is co-authored by Rep. Bobby Guerra of District 41 and has received bipartisan support of 15 other Reps.
The legislation will provide for the State Office of Administrative Hearings to hear OIG overpayment hearings against Medicaid providers accused of fraud or overbilling the program. Currently, such hearings are held in the HHSC appeals division. The point of the bill is that HHSC-OIG is investigator, prosecutor and judge with a vested interest in finding against the provider. No other state agency has such power. The bill also provides, if the SOAH judges rules against a provider, for a judicial appeal for a trial de novo in Travis County Court if the amount in question is more than $50,000.
Testimony on the bill went on for four hours and the bill received support from the Texas Academy of General Dentistry, the Texas Hospital Association and Texas Medical Association.
TDMR has placed a number of the written submissions on their website given to the Committee by various dentists and lawyers in support of the Bill and the excesses of the current enforcement regime.
“We are advertising these submissions on our website because legislators and the public-at-large are unaware of the what is going on beyond the façade of loud and persistent allegations of Medicaid fraud in Texas,” comments Chuck Young, newly named Director of Communication for TDMR. Young founded Texans for Accountable Government. “A number of these individuals have not spoken publicly before because of their fear of possible further legal entanglements and retribution.”
Dr. Tara Rios DDS, former House Rep and TDMR Board member, wrote, “I was indicted by the United States Attorney General’s Office and the Attorney General of Texas on serious anti-kickback violations in 2010, all charges were subsequently dismissed in Federal Court by a United States District Judge. During this incident, I saw first-hand the overzealous and overreaching actions of the Attorney General of Texas Office and the United States Office of Attorney General. Prior to the indictment, a Texas MFCU (Medicaid Fraud Control Unit) agent called to inquiry about a visit, I attempted to set up a meeting to answer questions they may have. When the Texas state agents learned I would have my attorney present, I was informed by state agents they would cancel appointment if my attorney was present during this meeting. The meeting was cancelled by the MFCU agents. This is one example of the gaming of a system to create fear and mistrust by all parties.”
Dr. Paul Dunn DDS from Levelland, wrote, “On January 2, 2013, I received a registered letter from HHSC stating they had found three examples of possible fraud out of the 70 patients and were placing a hold on all Medicaid funds. My practice is 90% Medicaid and that basically shut down all cash flow to my practice…[In a meeting] Mr. Stick [OIG Deputy Inspector General for Enforcement] told me that he didn’t see any evidence of fraud. But he then indicated that OIG wanted 40% of my income back from the time that I had been working with the Medicaid program. Mr. Stick told me that if I wrote a check to OIG for 1.2 million then this might all go away. If I sold everything I own with my life insurance thrown in, I couldn’t raise 1.2 million.”
“I have personally experienced the wrath and manipulating tactics the OIG uses to intimidate Medicaid providers. I’ve been through 2 different audits. The first for Orthodontics and when the judge ruled in our favor that same week the OIG returned and demanded additional files because they were opening up a second case. The OIG demanded all the documentation to be prepared in a 3 day period. When we asked for more time they would not grants us an extension and suggested we close the practice so that the documents could be produced by the due date and time,” wrote Marisol Alanis, office manager of Harlingen Family Dentistry which took OIG to the State Office of Administrative Hearings. The administrative judges in the case found no evidence of fraud or misrepresentation on the part of the practice.
“Sunlight is the bane of authoritarianism and we are bringing the sunlight to this unconscionable situation for dental Medicaid providers. They deserve fair treatment and due process to separate the guilty from the innocent. Punish the guilty, absolutely. Not the innocent,” concluded Young.