Antoine Dental Center (ADC) and owner Dr. Behzad Nazari, was been placed on an administrative Credible Allegations of Fraud (CAF) 100% payment hold from Medicaid reimbursements/payments in Texas in April 2012.
CAF - Federal law defines a “credible allegation of fraud” as an “allegation, which has been verified by the State, from any source.” 42 CFR § 455.2 states that the source of these allegations may include, but are not limited to, “(1) fraud hotline complaints, (2) claims data mining, (3) patterns identified through provider audits, civil false claims cases, and law enforcement investigations. Allegations are considered credible when they have indicia of reliability and the State Medicaid Agency has reviewed all allegations, facts, and evidence carefully and acts judiciously on a case-by-case basis.
Since Dr. Nazari disagreed with this payment hold he filed a suit against Texas Health and Human Services Commission – Office of Inspector General (HHSC-OIG) —State Office of Administrative Hearings (SOAH) Docket No. 529-13-0997; HHSC-OIG Case number P20111316523848911.
On May 28, 2013 four days of hearings began where evidence from both sides was presented to the judges at the SOAH in Austin.
On August 23, 2013 both sides filed their written Briefs and Closing Arguments. They can be read by clicking the links at the end.
One Brief and Closing made perfect sense, with facts and logic along with visual aids. One sounded like a babbling idiot recounting a fairy tale. Guess which was which.
ADC and Dr. Nazari seem to think that division, and possibly the whole OIG office, is completely unnecessary.
In the ADC Brief and Closing Argument they state:
“How can the OIG support any credible aggregations of impropriety regarding HDL score sheets when the underlying diagnostic material was made available to the State and the State pre-approved the analysis that was reflected on the HDL score sheets? “