“Ho” Down in Texas – James W. Orr, DDS Testifies for Antoine Dental Center

Background
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 Fraud Reform (TDMR). 

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.