January 2015 Archives

Recently, the Texas Health and Human Services Commission-Office of Inspector General ("HHSC-OIG") suffered a substantial blow to its overall strategy for imposing payment suspensions. In an unequivocal opinion, the Third Circuit Court of Appeals concluded that the specific rules utilized by HHSC-OIG for imposing payment suspensions, in the absence of a finding of a credible allegation of fraud, exceed statutory authority and are thus invalid. See, Harlingen Family Dentistry, P.C.; and Trueblood Dental Associates, P.A., vs. Texas Health and Human Services Commission and Office of the Inspector General. Specifically, the Third Circuit Court in Harlingen sided with providers who argued that particular rules found in the Texas Administrative Code, which permitted imposing a payment suspension as long as there was a finding of a "program violation," were inconsistent with the intent of the original law relating to payment suspensions.