But the reemergence of Dr. Lewis’ case shows physicians who were subjects
of open cases during the agency’s bad old days can’t necessarily just leave the past behind.
AN UNWANTED SEQUEL Dr. Lewis battled OIG from 2005 to 2008 after it initially examined his billing practices in 2004–05 and claimed he might owe the state nearly $440,000. (See
“Guilty ‘Til Proven Innocent,” December 2012 Texas Medicine, pages 16–22, or visit
www.texmed.org/ProvenInnocent.) Dr. Lewis says he thought he had won that battle for good after then-Attor-
ney General Greg Abbott ultimately ordered the state to obey a previous court order stating OIG couldn’t execute payment holds for his Medicaid services. Eventually, Medicaid processed all his unpaid claims. But Dr. Lewis says he heard from OIG again in a 2013 letter, which said the
office thought Dr. Lewis received overpayments for the same time period, 2002– 06, that OIG flagged the first time around. “And they sent us spreadsheets, and they said, ‘Well, we actually have an error in our spreadsheets; we’ll get back to you,’” Dr. Lewis said. Last August, Dr. Lewis’ attorney received another letter from OIG. This one,
he says, once again asserted overpayment stemming from the exact same re- cords, those from 2002–06. The letter offered Dr. Lewis the option of paying to settle the case; Dr. Lewis’ attorney, Ken Stone, asked Texas Medicine not to publish OIG’s settlement offer. If Dr. Lewis chose not to settle, the letter said, OIG would use a federal ex-
trapolation formula to calculate what Dr. Lewis owed. According to Dr. Lewis, OIG claims the court case he previously won “solely
had to do with whether or not the OIG had the authority to put a payment hold on any and all services that I rendered,” which Dr. Lewis’ attorney says is legally correct. Noting doctors have finite limits of time to file claims or to file an appeal for a
denied claim, Dr. Lewis says OIG should have a statute of limitations for pursu- ing suspected overpayments; right now, none exists. “They just want you to say, ‘Oh, you know what, this is such a small amount
of money’ … and [pay it to] be done with it,” Dr. Lewis said of OIG’s settlement offer. “But I’m not that type of person. If there was overbilling inadvertently, then okay, fine, I owe something. But I also would think, why is this still going on dating back to 2002? Really, how long can you beat a dead horse?” Since his dispute with OIG originally began, Dr. Lewis has gotten more in-
volved in efforts to improve the Medicaid system and joined TMA’s Select Com- mittee on Medicaid, CHIP and the Uninsured. “It’s really deflating,” Dr. Lewis said. “For as long as I’ve been in practice, 21
years, I’ve been a Medicaid advocate. And then I went through that horrific court case and didn’t get paid for almost two years on that Medicaid claim. It’s getting harder and harder to be an advocate, and it’s getting harder to convince other physicians to join the program when you have situations like this.” Just receiving a letter from OIG is scary enough for physicians, says San An-
tonio pediatric ophthalmologist James Mims, MD. Last spring, he received an audit letter from OIG requesting records on 17 different patients. Dr. Mims says he sent OIG the requested records in April. More than four months later, he was still waiting for a response.
+ Texas Ofice of Inspector General:
http://oig.hhsc.state.tx.us
“It’s getting harder and harder to be an advocate, and it’s getting harder to convince other
physicians to join the program when you have situations like this.”
November 2015 TEXAS MEDICINE 29
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