Seven years ago, Charles Turner Lewis, MD, thought it was over. Dr. Lewis’ battle with the Texas Health and Human Services Commission (HHSC)
Office of Inspector General (OIG) over his Medicaid billing had cost the Kaufman pediatrician three years and thousands of dollars. But in 2008, it appeared he’d come out on top over an agency that has earned a reputation for making life harrowing for Medicaid-participating doctors for more than a decade. But now — even as sweeping changes at OIG bring hope the agency will become more efficient, transparent, and reasonable — Dr. Lewis finds himself fighting a new version of the same battle. Last August, he once again heard from OIG, alleging billing overpayment on the exact same records that were at issue during the first audit — records from 2002 to 2006.
“So now once again, here I am. It’s 2015 … and I’m now having to go back through spreadsheets that they have provided and look through charts that I have electronically,” Dr. Lewis said. “But probably over two-thirds of the claims are on paper charts that they took off with, and I have not had access to for the last 10 years. I have no way to prove that they have maintained my records at all because they have been out of my sight for 10 years. And I think it’s just totally, unbelievably unrealistic to continue to come after somebody for something that is 10 years old.” OIG, whose charge is to prevent, detect, and investigate fraud, waste, and
abuse in Medicaid and other aspects of the health and human services system, is in the midst of a complete rebuild following a sharply critical Sunset Advisory Commission report last fall and the resignation of previous Inspector General Doug Wilson and other officials a couple of months later. All this occurred after a questionable no-bid contract drew the attention of investigators and the Texas State Auditor’s Office (SAO). To read the SAO report on the agency, visit www
.sao.state.tx.us/reports/main/15-031.pdf. See the full Sunset Advisory Commis- sion report at tma.tips/SunsetHHSCReport. Much of what’s new about OIG provides hope for medicine’s future relation-
ship with the agency, such as the stated focus of new Inspector General Stuart Bowen Jr. and a new law that tightens the definition of “fraud” and situations in which OIG can place a payment hold during an investigation. Mr. Bowen says the vast majority of doctors who participate in Medicaid do
so lawfully and helpfully, and “I’m only after those who don’t.” “Going forward, we believe that we’ve got an OIG we can trust and believe in
and discuss things with, and we think we’ve got a set of guidelines for the OIG that we can live with that will allow us to get these cases settled in a timely fash- ion,” said John Holcomb, MD, chair of the Texas Medical Association’s Select Committee on Medicaid, CHIP and the Uninsured.
28 TEXAS MEDICINE November 2015
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68