Last Thursday, November 13th, the Texas Sunset Advisory Commission held public hearings about its staff report on the Texas Health and Human Services Commission that was released in October. The Commission heard over nine straight hours of submissions from various individuals and organizations from across the state on the 15 major issues delineated in the report.
The two issues relating to the HHSC Office of the Inspector General received comment and TDMR has put together the following short videos, now on YouTube, relating to that testimony.
Texas Public Policy Foundation
“Treats providers like criminals”
Arlene Wohlgemuth, now executive director of the Texas Public Policy Foundation, authored the original legislation, HB 2292, which created the Health and Human Services Commission 11 years ago.
On OIG, she testified that she was disappointed about the performance of OIG and that it needed to be reorganized. She said that in 2003 the major complaint against OIG was that it “treated providers like criminals” and that that appeared to still be the case today. She also felt that OIG in now having 775 staff had exceeded its original mandate and needed to be scaled back.
“FBI more professional”
Sen. Juan “Chuy” Hinojosa, in response to Ms. Wohlgemuth’s testimony, outlined his concerns with complaints he had received from Medicaid providers and their attorneys as well as from other legislators about the conduct of OIG.
At one point, he said that the FBI was more professional than OIG.
“A messed up organization”
Rep. Richard Peña Raymond, in his comments after Ms. Wohlgemuth’s testimony, called OIG a “messed up” organization. He indicated that Inspector General Doug Wilson had lied during his staff testimony the day before when he told Raymond that he didn’t say something that Raymond knew he had.
Raymond told the committee that he had heard a recording of a conversation taped by a Medicaid provider of an OIG investigator saying she hadn’t found anything wrong in his organization but that she was pressured by her OIG managers to reword her report to find something they could act on.
Pharmacists testify about OIG harm
No right to question overpayment
Craig Martins testified as pharmacy director for Pharmerica Corp of Houston which has 5,500 patients in Texas Medicaid nursing homes around Houston and fills 2,000 prescriptions a day.
He testified that OIG did a performance audit, found no fraud but $12,000 in exceptions. OIG then extrapolated this into a $2.47 million repayment. Through an informal hearing this summer, the repayment was lowered to $700,000 but the company has no opportunity or right under law to discover how this amount was extrapolated. They don’t believe they did anything wrong. Unless a payment plan is agreed to or the amount is paid, the company will go on a vendor payment hold.
No right to question overpayment
Craig Martins testified as pharmacy director for Pharmerica Corp of Houston which has 5,500 patients in Texas Medicaid nursing homes around Houston and fills 2,000 prescriptions a day.
He testified that OIG did a performance audit, found no fraud but $12,000 in exceptions. OIG then extrapolated this into a $2.47 million repayment. Through an informal hearing this summer, the repayment was lowered to $700,000 but the company has no opportunity or right under law to discover how this amount was extrapolated. They don’t believe they did anything wrong. Unless a payment plan is agreed to or the amount is paid, the company will go on a vendor payment hold.
OIG most abusive organization seen in 30 year career
Attorney Jennifer Riggs testified on behalf of TrueCare, an association of some 500 independent pharmacies, and another provider.
She said that in her 30 year history as an administrative law attorney she has never seen the abuse and lack of respect for the Texas Constitution as shown by HHSC-OIG. She explained that providers are presumed guilty and pharmacies in particular have no right to even a hearing on OIG charges.
Medicaid dentists testify about OIG harm
Can’t afford to pay to get hearing
Dr. Paul Dunn, a Medicaid dentist who is being bankrupted by OIG, testified about how he was told by OIG that he hadn’t committed fraud in his Medicaid orthodontic billings but that OIG still wants $2.7 million, paid back. He can’t afford the $40,000-$70,000 payment needed to pay OIG as an advance for a SOAH hearing on the allegations.
Found innocent by SOAH but HHSC overturned it
Dr. Behzad Nazari testified about how he went before the State Office of Administrative Hearings on his 100% “credible allegation of fraud” payment hold for his Medicaid orthodontic billings and was totally exonerated only to have HHSC simply reverse the decision. He spent $500,000 to defend himself and two of his clinic offices are now closed.
Going bankrupt waiting for hearing
Dr. Chad Evans testified that because of an 100% payment hold, he had to immediately layoff 117 staff. Yet, he has been unable to get his overpayment hearing held with OIG. Just this week, OIG has delayed it another four months. He is on the verge of declaring bankruptcy.
Providers can’t get their day in court with OIG
Attorney Jason Ray testified that he represents clients who have been wrongly accused of $250 million of Medicaid fraud and that these providers cannot get their day in court.
HHSC should not be allowed to reverse SOAH decisions
Rep. Richard Peña Raymond expressed his concern over HHSC’s ability to simply overturn a SOAH decision. He says that either Sunset or the legislature has to fix this.
Can’t afford to pay to get hearing
Dr. Paul Dunn, a Medicaid dentist who is being bankrupted by OIG, testified about how he was told by OIG that he hadn’t committed fraud in his Medicaid orthodontic billings but that OIG still wants $2.7 million, paid back. He can’t afford the $40,000-$70,000 payment needed to pay OIG as an advance for a SOAH hearing on the allegations.
Found innocent by SOAH but HHSC overturned it
Dr. Behzad Nazari testified about how he went before the State Office of Administrative Hearings on his 100% “credible allegation of fraud” payment hold for his Medicaid orthodontic billings and was totally exonerated only to have HHSC simply reverse the decision. He spent $500,000 to defend himself and two of his clinic offices are now closed.
Going bankrupt waiting for hearing
Dr. Chad Evans testified that because of an 100% payment hold, he had to immediately layoff 117 staff. Yet, he has been unable to get his overpayment hearing held with OIG. Just this week, OIG has delayed it another four months. He is on the verge of declaring bankruptcy.
Providers can’t get their day in court with OIG
Attorney Jason Ray testified that he represents clients who have been wrongly accused of $250 million of Medicaid fraud and that these providers cannot get their day in court.
HHSC should not be allowed to reverse SOAH decisions
Rep. Richard Peña Raymond expressed his concern over HHSC’s ability to simply overturn a SOAH decision. He says that either Sunset or the legislature has to fix this.