Who can forget the reports by WFAA’s Bryon Harris, which spurred investigations in to orthodontic Medicaid Fraud by the State of Texas?In the fall of 2011 and continuing today, The Texas Health and Human Services Commission (HHSC) Inspector General put Credible Allegation of Fraud (CAF) payment holds on a covey of dental clinics; some general dentistry and some orthodontic clinics.
Deciding not to take this sitting down, a few of these highly suspect dentists decided to take it to court; appealing to the State Office of Administrative Hearings (SOAH).
Dr. Juan Villarreal, owner of Harlingen Family Dentistry, a Scientologist and a former member of Texas State Board of Dental Examiners (TSBDE) appealed the HHSC decision for his CAF payment hold. In a ruling by the SOAH in October of 2012, Villarreal/Harlingen Family Dental’s payment hold was reduced from 40% to down to 4%. The ruling for Harlingen was further upheld by an HHSC Administrative judge in January of this year (2013). Villarreal also heads up Texas Dentists for Medicaid
The judge’s ruling in the Villarreal case, by the most part, was based on the testimony of one Dr. James W. Orr. This favorable ruling no doubt was the impetus to others, like Antoine Dental Centers and M & M Orthodontics in appealing their CAF payment holds.
One last thing, before we move on — WHAT is the HDL scoring index? Well, it is much like scoring some jurisdiction do to determine if one gets bail or not. A point for this, a point for that and if it totals up to be high enough, bam! You’re outta there. For orthodontics (braces and other appliances) children over age 12 AND have lost all their baby teeth can received services if their HDL score is 26 or higher. Like anything else there are exceptions, but this is the simple explanation.
Antoine Dental Center-Dr. Behzad Nazari
First up, for this series, is Dr. Behzad Nazari and Antoine Dental Center (ADC) vs. Texas Health and Human Services (THHSC) (SOAH docket no. 529-0997). ADC was represented by Jose A. (Tony) Canales and Oscar X. Garcia. Robert (Bob) M. Anderton. Many of these clinic suspected of fraud have hired dentist/attorney, Dr. Robert (Bob) Anderton, former American Dental Association president.
Dr. Behzad Nazari/Antoine Dental Center has been under a 100% (that is HUGE) CAF pay hold since March 28, 2012 totaling over $550,000. On March 29, 2012 the Texas Attorney General’s Medicaid Control Fraud Unit (MCFU) opened an investigation into ADC.
The state had taken 63 files random files from Antoine for a review and 100% of the Medicaid patients qualified for braces. Nearly all the files were incomplete. Some missing dates of treatment, many missing HDL score sheets and/or molds. Even though Dr. Nazari denies any guilt, he was sanctioned by the TSBDE for poor record keeping a few years ago, apparently nothing has improved in his offices. Also, Nazari recently testified before the state Committee on Public Health.
The ADC vs. THHSC appeals hearing began Tuesday May 28, 2013 and ended Friday May 30, 2013. Before it was over on Friday, Dr. Irwin K. Ornish, the lone “expert witness” left standing tucked tail and ran home or sent home, who knows.
James W. Orr, DDS ex-Expert Witness
Right now let’s look at “Expert Witness” Dr. James W. Orr’s testimony in part one of “Ho” Down in Texas. Dr. Orr worked for National Heritage Insurance Company from 19950-2003 and was in charge of approving or denying all Medicaid orthodontic cases presented for payment; their claims agent. National Heritage was a contractor administrating the Medicaid dental program in Texas for many years, ending in 2003.
In recently years, Dr. James W. Orr has been the “hottest chick” on the proverbial “corner”; in high demand by the dentists who have found themselves under fraud investigation in Texas. He once worked for the people of Texas as an “expert witness” in the first fraud case against Dr. Richard Malouf.
He claims to be everything from Dental Director of Texas Medicaid to an “Occlusionist”. A what, you ask? An o c c l u s I o n I s t. No, not an illusionist. However I think illusionist fit much better. (I’ll explain later)
Last week, Dr. Orr’s value as an “expert anything” plummeted I suspect. Moriarty and Hargrove — for the State of Texas — filed a Motion to Exclude Dr. Orr’s testimony from the record completely. (see here)
James Orr, DDS and Bob Anderton, remember, that attorney representing many of these hoodlums, including Nazari are best buds and colleagues. (Ornish too) Orr and Anderton actually teach a course called “Have You Been Sued Yet"?” at UT Health Sciences Center, San Antonio, that includes a session in “what to do if you are”. (I’m guessing they suggest dentist should call Orr and Anderton, first thing). Below was taken from the course page at UTHSCSA website June 2, 2013, where Orr, along with Anderton claim Orr was the Director of the Texas Medicaid Program. (“I am the Queen of Sheba” rings in my head)
Taking the stand, I doubt Dr. Orr was too concerned being as an “expert witness” in the case of ADC vs. THHSC. In the most part, ADC was challenging the same allegations as HDF had in 2011; false claims, up coding, billing for nonreimbursable services, and failure to comply with Medicaid rules. Dr. Orr drove it home — so to speak —for Dr. Villerreal/Harlingen Family Dental. It probably seemed like another day, another snow job to him. Orr knew the new attorneys for the state had only gotten the case 3 weeks ago. His confidence had to be high; he had been testifying on this subject for many years. Heck, according to him, besides teaching it, he also all but wrote the book on HDL scoring and Medicaid orthodontic services for Texas. Plus, get this, he was the Dental Director for Texas Medicaid. Or was he?
Below is the list of attributes Orr testified to under oath that he “is” when he “is not”:
- A specialist in occlusion (no such specialty exists, this is a violation of the Dental Practice Act)
- Dental Director for the State of Texas Medicaid 1995-2004 (he worked for a private company – National Heritage Insurance Company(NHIC) )
- Medicaid Policy maker (NEVER worked as a government employee in a policy making role.)
- An Occlusionist (no such thing exists)
- Completed a two year residency program in occlusion (never happened)
- Occlusion Professor – teaching student “where and why he wants teeth” (he may teach it, but that doesn’t mean he had any qualification to do so)
- Teaches Orthodontics (he’s not even an orthodontist)
- At NHIC he accepted or denied ALL claims personally. (impossible!)
When Orr worked for the State in the Malouf case, he found HDL scores of 30 or above that he deemed should have been scored zero. Yet, now being paid by Antoine and presented a case with nearly the same case scenario he told the court the high HDL score was spot on. This happened time after time during the hearing. Amazing!
Orr had a very hard time at the hearing explaining what the HDL index was for. He said, on this day, he wasn’t an expert in it, but he could read the manual.
Orr actually tried to sell to the judges this one patient had some 11 millimeters of space between their front teeth. A dime is approximately a millimeter in thickness. The judges were asked to put these 11 dimes (or whatever the number) in between the teeth of the mold exhibit. The judge said he only needed 2!!
Orr told the judges that many parts of the HDL scoring is “completely subjective”. Saying a person, that person’s training and attitude along with mental functions and emotional intellect will come up with different scores. About the only thing he did list was financial stability or is the wife’s Mercedes payment due!
When asked questions by the State Orr didn’t know much. When Canales asked him an open ended question he could ramble until ones eyes glazed over.
Orr said he would need at least an hour with each patient file to make any determination at all on the scoring. Yes, an hour on EACH before he could say if the HDL score matched the patient. Now, being he also swore under oath he “personally approved or disapproved every single orthodontic Medicaid case” while at years NHIC, I think that means he might still be working for them!
In 2002 they had nearly 13,000 cases for review. What is real confusing is, he also swore he was so busy making Medicaid policy and recruiting dentists, etc. he usually spent only and hour a day working the approval process and he swears he needs an hour to check one. Now, this doesn’t make sense to me; not one lick. That is 1 per day he could “personally approve or disapprove”. Do the math.
Dr. Orr is not an orthodontist and has not worked in HDL scoring in 10 years; yet here he is, rushing to take the stand and testify for all these fraudsters. Why would he want to be an “expert witness” in any of this? Why? Are Anderton and Orr making the round presenting and testifying in these cases to cover their own behinds?
Other witnesses in the case — Nazari and Ornish — state Dr. Orr taught them how to “utilize” — their word, not mine — the HDL scoring system inside a conference room at Robert (Bob) Anderton’s office! So, was this when he worked for HNIC? After? or Both? Why Anderton’s office? What lengths did Orr go to in recruiting dentist to join in the orthodontic treatment of children on Medicaid in Texas?
Also, for God’s sake, DO NOT ask him what “ectopic eruption” means. NEVER EVER ask him this! EVER! He basically said, it means what I say it means, when ever I say it and that may change from sentence to sentence, case to case, or possibly within the same sentence. Other witnesses said only about 4% of the population suffered from “ectopic erupted teeth” But I guess if you are on Medicaid and live in Texas, are between 12-20 then you have them, whether you can tell it or not.
During lunch Orr was to look over 3 or 4 of these files. During this time, Dr. Nazari and Dr. Kanaan came up to him and Canales and talked for several minutes. When asked what they were talking about while he was suppose to be reviewing these files in question, Orr says testified, “They were telling me what I should say” “Telling me what I should do”. Orr says he and Canales tried to “shoo them away”!
Yes, it was a real “Ho Down” in Austin last week. “Orr” Down indeed!
Look for Part 2 coming soon.
Related Documents and Links:
Motion to Limit or Exclude Opinions or Testimony of James W. Orr, DDS (includes CV and excerpts from testimony as well as other items of interest.)
Dr. Behzad Nazari testimony to the Committee on Human Services