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Austin attorney Mark Chouteau addressed physicians on avoiding and defending themselves against Medicaid fraud and abuse at the TMA Fall Conference Dawn Duster. He educated attendees on new rules the Texas Health and Human Services Commission Office of Inspector General adopted in October and explained the investigation process used by the agency in Medicaid fraud investigations.
After Dr. Lewis and his lawyer met with TMA attorneys and other staff, a TMA reimbursement specialist reviewed 10 of the Medicaid claims the state had denied and found them to be valid. In 2008, Attorney General Greg Ab-
bott ordered OIG to obey Judge Kilgore’s ruling. The case settled that year, Med- icaid processed Dr. Lewis’ unpaid claims, and he didn’t have to pay the state a dime.
Still, the incident was costly. Dr. Lew- is spent about $65,000 on legal fees, drained his retirement and personal sav- ings accounts, took out a second mort- gage on his home, and sold many of his possessions to keep his office open. He’s never been able to retrieve 200 patient charts OIG confiscated from his office as part of the agency’s investigation. “TMA and my attorney have tried to get my charts back to no avail,” Dr. Lewis said. “When we ask OIG for the charts, they tell us either they don’t have them or the investigation is still open.
22 TEXAS MEDICINE December 2012
I’m missing charts for some of my pa- tients, who are rightfully upset. Plus, the medical board requires me to maintain patient records, but I don’t have access to the ones OIG still has.” Despite his ongoing quest to recover
his records and his past struggles with OIG, Dr. Lewis continues to see Medic- aid patients. “Eighteen years ago, I decided to bring a high-quality pediatric practice to Kaufman, a rural area. I feel like it would be a detriment to the community to let OIG win, to close my practice to Medicaid patients. I have a real connec- tion to the community, which has been so supportive. The parents here really appreciate the fact that they have quality care for Medicaid children,” he said. n
Crystal Conde is an associate editor of Texas Medicine. You can reach her by telephone at (800) 880-1300, ext. 1385, or (512) 370-1385; by fax at (512) 370-1629; or by email at
crystal.conde@
texmed.org.
JIM LINCOLN
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