Texas Senators Hear Testimony On The Urgent Need For Due Process Rights For Medicaid Providers By TDMR

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Spokesperson for TDMR expresses support for Senate bills that put a reign on Texas Office of Inspector General in placing “credible allegation of fraud” payment holds that bankrupt Medicaid providers without any due process…

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.’

Chuck Young of the Texas Dentists for Medicaid Reform testified Tuesday before the Senate Health and Human Services Committee on Senate Bills 1435 and 1803. Authored by Senator Juan “Chuy” Hinojosa and Senator Joan Huffman respectively, the bills deal with providing Medicaid providers due process rights when under investigation by the Health and Human Services Commission Office of Inspector General (OIG).

Young told the Committee, “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 which 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 preamble to the analysis of SB 1803 by the Senate Research Center concisely states the issues: “Pursuant to the Patient Protection and Affordable Care Act of 2010, federal regulations require state Medicaid agencies to suspend Medicaid payments to a provider when there is a pending investigation of a ‘credible allegation of fraud’ against the provider, unless the state determines there is good cause not to suspend such payments. If a state Medicaid agency makes a determination that a ‘credible allegation of fraud’ exists, the state agency must refer the case to the OIG Medicaid Fraud Control Unit.”

“Concerns have been expressed from physicians, physician's groups, and other medical providers that there is not proper due process when the OIG suspects and accuses a provider of Medicaid fraud or abuse. There are also concerns with transparency and expediency in the investigative process.”

The Senate Research Center analysis of SB 1435 states that the bill “defines ‘credible allegation of fraud’ in compliance with federal government guidelines and clarifies the process for making a determination that a ‘credible allegation of fraud’ exists to justify a hold on Medicaid payments. S.B. 1435 also provides due process procedures for providers who are the subject of a payment hold and/or a recoupment of potential overpayments.” SB 1803 “takes numerous steps to improve due process, transparency, and the expediency of the OIG’s process when a provider is accused of a credible allegation of fraud or Medicaid overpayment.”

In giving support to the measures, Young concluded about the current situation, “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.”

The Committee held over the bills for further study but expressed support in a 5-0 vote on the bills. Senator Jane Nelson, the Committee chair, expressed her appreciation to both Senator Hinojosa and Senator Huffman for their work on the bills.

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