Sunday, February 24, 2013

Hole in Texas Dentists for Medicaid Reform Press Release

TDMR-FraudOn February 7, 2013  the newly organized Texas Dentists for Medicaid Reform Fraud issued a press release stating the Texas Office of Inspector General had dropped its case against one of their poster-children, Diane Malone, DDS – co-owner along with husband, Dr. Scott Malone in M & M Orthodontics in San Antonio.

The TDMR stated the Texas HHSC-OIG had filed a motion to drop all claims against Dr. Malone, stating it was a “hopeful sign that Medicaid Fraud enforcement agency is seeing the light on due process and provider rights.”

Disgraced former Texas Representative, Tara Rios-Ybarra, DDS, an executive of the Texas Dentists for Medicaid Reform Fraud was tickled pink, saying, “We are very concerned about Medicaid provider rights. These impact the security with which providers can practice their professions and deliver effective help to Medicaid patients.  Due process is a cornerstone of these rights and we are happy to see at least a harbinger of change from the OG on this issue.”

What they didn’t say in their fancy-dancy press release was HHSC-OIG had "Motioned" for the withdrawal of its nonsuit against Diane Malone, DDS – “Without Prejudice”.  Meaning, OIG can bring this same action  against Diane Malone at anytime in the future.  No “Motion” was made to withdraw the action against M & M Orthodontics. 

The OIG had alleged Dr. Diane Malone and M & M Orthodontics had failed to meet the dental standard of care in treating patients and owed the state 8.2 million of dollars – basically they were delivering “worthless services”.  In addition, the Texas OIG had assessed a $6.6 million dollar fine, according to an April 2012 story by KSAT-TV.  Malone’s panties were in a wad about having to fork over the $14.8 million dollars.  Malone decided to fight the law – so her as well as her company – M & M Orthodontics – appealed. (The “worthless services theory” is something everyone in the Medicaid dental community should get to know well.)


On appeal, the Administrative Law Judge(ALJ) granted only part of Dr. Malone’s and M & M Orthodontics Appeal.  Granted was just the part about the money Diane Malone, DDS owed personally  – $2,109,196.  This is completely separate from her company M & M Orthodontics.

In my opinion, the bigger issue Dr. Diana Malone wanted granted by the ALJ was her personal case to be severed from the case against her company – M & M Orthodontics – that portion of the Appeal was denied by the ALJ.

So, contrary to the TDMR press release, in my opinion, Dr. Malone is far from out of trouble and certainly is not in the clear and neither is M & M Orthodontics.

Of course, I’m no attorney.  Below on the related documents.  You can draw your own conclusion.

Related Documents:

M & M Final Notice from HHSC, January 23, 2012
Diane Malone, DDS Final Notice from HHSC, January 23, 2012
KSAT-TV Story on M & M Orthodontics, April 13, 2012
Diane Malone and M & M Orthodontics Appeal Order, October 5, 2012
HHSC-OIG Motion To Withdraw, February 5, 2013
TDMR Press Release , February 7, 2013