Judge Tells Texas Agency to Give Back More Than $1 Million in Withheld Funds to Medicaid Dentist

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Travis County Judge Orders the Texas Health and Human Services Commission Office of Inspector General to return $1.3 million withheld from Harlingen Family Dentistry based on unfounded “credible allegations of fraud” claims on orthodontic Medicaid billings

Texas citizens deserve better than this from their government. When a citizen wins their case in court, they shouldn’t have to keep fighting to force the state to abide by the court decision.

Travis County District Court Judge Amy Clark Meachum has granted a petition of mandamus to force the Office of Inspector General (OIG) to return more than $1 million to Harlingen Family Dentistry (HFD), a south Texas dental provider (Travis County District Court Cause No. D-1-GN-13-001557). The OIG instituted a payment hold in September 2011 against HFD, claiming that the OIG had a “credible allegation of fraud” against HFD’s orthodontic billings. The payment hold allowed the OIG to withhold funds from HFD, pending a final resolution of the OIG’s claims. From September 2011 through February 2013, the OIG withheld over $1.3 million from HFD.

Court documents show that HFD challenged the OIG’s payment hold, alleging that the OIG could not make a prima facie case for fraud against HFD.(SOAH Docket No. 529-13-3180 Harlingen Family Dentistry vs. Texas Health and Human Services Commission) Earlier this year, administrative law judges from both the State Office of Administrative Hearings and HHSC itself agreed with HFD, stating in their decision that the OIG could not show the basic elements of fraud regarding HFD’s Medicaid orthodontic billings. The OIG did not appeal that decision, and the ruling became final in February.

According to HFD's attorneys, HFD repeatedly asked the OIG to return over $1.3 million that had been sequestered by the OIG and OIG refused. In May, HFD sued HHSC and the OIG seeking return of those funds. Court records show that the OIG argued that Judge Meachum did not have jurisdiction to force the OIG to return the funds, and that the state did not have to return any funds even if the money was taken inappropriately.

“I am very pleased by Judge Meachum’s decision,” stated Dr. Juan Villarreal, HFD’s owner. “However, I think it is unfortunate that more of the Texas taxpayer’s money was wasted, as well as my own, in having to pursue this judgment. There seems to be endless public funds to waste in such legal actions but not much funds to pay Medicaid providers decently. If OIG appeals this decision, they show their true colors for the Texas taxpayer.”

In explaining her decision, 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.”

Attorney Jason Ray of Riggs Aleshire & Ray, P.C. brought the action on behalf of HFD back in late May.

“Obvious we are pleased that justice was done for Harlingen Family Dentistry,” stated Ray. “But it is embarrassing to see a state agency blatantly refuse to follow the law. HFD won their payment hold case, but the OIG decided that instead of appealing the decision, they would just ignore it. Texas citizens deserve better than this from their government. When a citizen wins their case in court, they shouldn’t have to keep fighting to force the state to abide by the court decision.”

The OIG indicated that it would attempt to appeal Judge Meachum’s decision, which is expected to be signed next week.

More documentation on this case is available at TDMR.org.

Harlingen Family Dentistry is based in Harlingen, Tx, and includes 13 dentists along with 130 staff. Started in 1983 by Dr. Juan Villarreal, a former appointee of Governor Perry to the Texas Board of Dental Examiners, HFD's mission has been to provide its clients with the highest quality and most up-to-date dental care at affordable prices. HFD also strives to build strong ties to the community through educational programs, youth sponsorship, and scholarship programs as well as working with our multiple charitable organizations and outreach programs.

HFD's "Willy the Walrus" dental education program has reached over 50,000 youth in the Rio Grande Valley, and stresses the importance of oral hygiene.

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