Legal Case Highlights Danger of Expensive, Opportunistic TMFPA Lawsuits

A legal case against 71 Medicaid dental entities and dentists brought by a single, former dental employee who never worked in any of their offices highlights the tremendous potential for abuse that apparently can happen under the current provisions of the Texas Medicaid Fraud Prevention Act (TMFPA).

Good purpose of TMFPA subverted

It seems the good purpose of the TMFPA to catch and punish fraudsters by rewarding courageous and honest whistleblowers is being subverted by allowing TMFPA lawsuits to continue that contain disingenuous allegations of Medicaid fraud, of which the so-called whistleblower has no personal knowledge or evidence. Doesn’t make sense, does it?

Seemingly, the game is really to force a lucrative settlement to enrich the relator and his contingency-fee based legal team by making any legal defense so onerous that the provider has to cry uncle and pay up before they go bankrupt or just to get out of the stupidity.

Expensive defense required

In this particular case, two of the defendants have already settled for undisclosed amounts. Another defendant fought a demand to provide some 35,000 patient records so the relator and his legal team could conduct a fishing expedition to find some evidence to back the relator’s allegations since he doesn’t have any. Defending against such actions becomes financially onerous.

Under the TMFPA, the Office of the Attorney General has the option to take over a whistleblower lawsuit, allow it to be prosecuted by the relator and his attorneys or have it dismissed. The OAG in this case allowed the lawsuit to continue.

The case in question, State of Texas EX REL Joshua Lafountain v. Kashani ET AL, was filed in 2016, four years after the relator held an employment position in any dental practice in Texas.

Not credible actors

According to a recent deposition, the relator, Joshua Lafountain, had worked at Bear Creek Dentistry in the Dallas area as an office manager for six years until 2012 when he was terminated. He had no formal dental training and claims in his lawsuit that he was an “area manager” for Bear Creek when he was fired. But, he admitted under oath that this elevated title is what he called himself. The company never did.

He has also admitted under oath that he used office computers while he was working to illegally gamble online and even borrowed money from Bear Creek staff to cover his debts. A real top-notch, credible individual.

Lafountain has filed numerous other whistleblower complaints including three against Bear Creek for Medicaid fraud which have gone nowhere. He was unemployed at the time of his deposition in April after having quit driving for a ride-sharing service.

No evidence or personal knowledge

More importantly, he stated under oath that he has never visited, worked at, talked with any of the staff, or has any personal knowledge of patient billing practices at the numerous locations, and by the dentists, he is claiming to have committed Medicaid fraud.

In his deposition, he seemed to have a hard time remembering dates, people he met with, their names and when he worked where. But he “knows” for certain that the dentists he has accused of Medicaid fraud in his complaint are doing so because they at one time worked for Bear Creek before they started their own practices!

Medicaid providers should be protected

One has to ask why this harassment of Medicaid providers is being allowed by our legislators. Are not healthcare providers valuable commodities in Texas? Do they not deserve respect and protection of the law rather than have the law used to make them into victims of blatant opportunism?

The finalized lawsuit is available below.