We’re not exactly sure what happened, but Raymond C. Winter, who headed up the Civil Medicaid Fraud division of the Office of the Attorney General of Texas for the last 15 years, is no longer there.
According to his LinkedIn profile, Mr. Winter left the OAG and his reign as the CMF division’s head ended in November last year. However, there are rumors that he was still in the office until earlier this year.
Speculation on the reason for leaving
We’re not sure the cause of his leaving. He wasn’t close to retirement age.
Could the AG be embarrassed that Winter’s 2019 Medicaid fraud settlement arrangements with Xerox/Conduent was the subject of recent insurance fraud litigation in Delaware and that the Civil Medicaid division might have helped perpetrate the alleged fraud? The judge in that case made disparaging comments about Winter’s deposition when she overturned the jury verdict against Conduent not too long ago.
Highly unlikely.
Did Winter leave because he was upset that Texas HHS has forgiven Conduent and given them a new multi-million dollar Medicaid contract, the company they fired in 2014, and Winter’s division sued for rubber stamping hundreds of millions of dollars in Medicaid orthodontic services from 2004 to 2011, the settlement of which in 2019 was the largest in Texas history?
Probably not.
Could it possibly be that there was a twinge of conscience about using the Texas Medicaid Fraud Prevention Act to support spurious whistleblowers like Joshua Lafountain extracting large nuisance settlements from Medicaid dental providers so the state could get its cut? After all, last Legislative session the House Committee on Judiciary & Civil Jurisprudence passed a bill to fix the TMFPA, which mysteriously didn’t make it to a vote.
OMG, definitely not!
Did Winter get on the wrong side of Attorney General Ken Paxton? Yes, a good chance of that but we don’t know.
Relentless quest against dentists despite court rulings in their favor
TDMR’s concern has always been on basic rights for Medicaid dentists, such as due process, being innocent until proven guilty, getting your day in court before a jury of your peers and the punishment matching the crime.
Before Xerox/Conduent became a target for the orthodontic mess back in 2012, HHSC OIG and the Civil Medicaid Fraud unit of the OAG went after individual Medicaid dentists.
In payment hold hearings before the State Office of Administrative Hearings, the dentists all won. In the Antoine Dental case, Winter’s division hired qui tam lawyers Jim Moriarty and Waters & Kraus to prosecute their case, costing taxpayers $250,000. The three SOAH judges still found in favor of Antoine.
Lack of evidence of fraud, no deterrent
Did these court defeats perhaps signal to Winter and his division that they were barking up a wrong tree? No, that didn’t happen. In the Antoine case, they tried to connive a reversal with Kyle Janek, then Executive Commissioner of HHSC, and when that failed, they went to the appeal courts losing all the way. They cost taxpayers and the dental providers involved dearly.
In early 2015, HHSC OIG was reformed after Janek, former Chief of Staff Jack Stick and former IG Doug Wilson were replaced. OIG started settling with dentists to end the Medicaid fraud charade.
Never got day in court
However, the cases of several dentists were passed over to the OAG so they could go to Travis County District Court to get their day in court. The late Dr. Juan D. Villarreal, TDMR’s founder, was one of these.
Never got their day in court and, for Dr. Villarreal, it definitely was not from a lack of trying. In the end, settlements were forced and one 80-year-old defendant was forced into bankruptcy.
So Mr. Winter’s resignation, firing, retirement is unlamented. We hope his replacement has a better sense of justice.
No harm no foul. That seems to be the attitude. And if there is a foul, do what you want anyways with no consequences. Reminds me of the Jack Sick, Douglas Wilson and other messes. It often appears that those tasked with fighting fraud have as much of a stink on them as the criminals they ‘chase.”