Travis County Judge Decides that OIG Must Return Payment Hold Monies Back to HFD

Justice for Medicaid providersHarlingen Family Dentistry has won a tremendous legal victory this week.

Travis County District Court Judge Amy Clark Meachum has granted HFD’s motion for a writ of mandamus to force the Office of Inspector General to return more than $1 million back to the dental practice that OIG had taken under a “credible allegation of fraud” payment hold. HFD brought the motion back in May.

HFD was forced to bring the motion as OIG refused to return the funds after HFD was found not to have committed fraud by administrative laws judges from both the State Office of Administrative Hearings and HHSC itself. That ruling came as a result of a SOAH hearing last April with the decision finalized this past January.

Judge Meacham wrote in a letter to the parties, stating “Petitioner Harlingen Family Dentistry exercised its statutorily-created right to have a prima facie hearing regarding the Medicaid payment hold exercised by Respondents. Texas Human Resources Code section 32.091(c) creates a statutory framework for this hearing to occur: that ‘the department shall discontinue the hold unless the department makes a prima facie showing at the hearing that the evidence relied on by the department in imposing the hold is relevant, credible and material to the issue of fraud or willful misrepresentation.’

“Respondents failed to make a prima facie showing yet they are still withholding the funds. For the Legislature to create this hearing, yet it have no viable effect, would render the statute meaningless – this cannot be the just and reasonable result. Therefore, Petitioner is entitled to recover its improperly sequestered funds and this is proper grounds for mandamus.”

HFD has issued a press release.