TDMR Testifies in Favor of SB 1803, Due Process Rights for Medicaid Providers

Senate Bill 1803 is another Medicaid provider due process bill like House Bill 1536 heard last week in the House Human Services Committee

Yesterday, Chuck Young, TDMR spokesperson, testified at the public hearing of SB 1803, an act relating to the Office of the Inspector General. The bill is authored by Sen. Joan Huffman and is based on a meeting of interested parties several weeks ago that was requested by Sen. Jane Nelson. The bill outlines a number of due process initiatives for Medicaid providers in dealing with the Office of the Inspector General HHSC. The text of the bill is here.

The following is Chuck’s testimony:

Good morning Senators, and thank you for hearing my testimony. My name is Chuck Young; I’m the spokesperson for Texas Dentists for Medicaid Reform. I’m here to speak in favor of bills SB 1435 and SB 1803, with some reservations.

We’re in favor of just about anything at this point that brings some checks and balances to OIG’s processes — especially their determination of “credible allegations of fraud.” A payment hold is a catastrophe to a majority-medicaid practice, that can lead to bankruptcy in a matter of weeks. But the situation is badly compounded when an agency pursues its mandate so aggressively as to threaten to crash the whole Texas Medicaid provider network.

The long testimony a week ago on HB 1536 was quite instructive in this regard, and I encourage all present to take the time to watch it. I won’t comment on Mr. Stick’s testimony, which ran over an hour, except to state that it was soundly refuted. Leading the way in this refutation was the testimony of Mr. Fread Houston, former Director of Sanctions at OIG.

In his explosive testimony Mr. Houston related that:

• OIG has used experts with little to no Medicaid experience
• OIG has edited expert’s testimony to remove statements supportive of providers
• OIG has retroactively applied a “new Medicaid policy… regarding ectopic eruptions”, enabling 100% payment holds on practices despite “no evidence of actual fraud.”

Mr. Houston’s testimony contained many other points; I’ve attached the complete written version for the edification of this committee. Given his revelations, it’s no wonder that Tony Canales — the first attorney to fight a CAF hold all the way through the administrative law process — declared OIG, in this same hearing, to be an agency “running amok.”

But nothing brought home the injustice of the current situation for me personally like the testimony of Dr. Paul Dunn. Dr. Dunn has been providing dental care to patients in rural West Texas for almost 40 years. He was put on a CAF hold that summarily crushed his practice in a matter of a couple of months — but the horror of Dr. Dunn’s situation is that OIG, and specifically Mr. Stick, admitted to him that he was not apparently guilty of fraud.

I ask the Senators to take a moment to ponder a “credible allegation of fraud” by an agency that admits there is no apparent fraud. Add to this that Dr. Dunn was then told he could be back in business for $1.5 million, a sum he couldn’t raise if he sold everything he owned. And there’s an extra dose of irony — Dr. Dunn, like every provider terrified of OIG retribution should he speak out, was in fact punished by Mr. Stick right there in the committee room, as the 66 year old Doctor got to hear his payment hold increased to $2.3 million in front of the entire hearing.

Senators, we’re against fraud. But in the pursuit of this agenda, the State hasn’t just thrown out the baby with the bathwater — it’s thrown out the baby, the towel, the tub, the rug, and the baby’s whole family. Until some trust is restored to this situation, we cannot see how any medical professional in their right mind would participate in the Texas Medicaid system.

Thank you for your time.