#Settlement #Texas Medicaid #Whistleblowers

Recent Ruling in Texas Medicaid Fraud Case

A Texas District Court has recently mandated a significant ruling in the case involving Medicaid fraud, which has been in the pipeline for over a decade. The ruling, delivered by Judge Maya Guerra Gamble, directs the State of Texas to allocate approximately $37.1 million to three whistleblowers, acknowledging their extensive efforts in exposing fraudulent activities within the state’s Medicaid program run by Xerox State Healthcare, LLC.

Background of the Case

The whistleblowers—Alexandra Alvarez, Joshua LaFountain, and Dr. Christine Ellis, D.D.S.—filed their lawsuit in early 2012 against Xerox, claiming violations of the Texas Medicaid Fraud Prevention Act (TMFPA). Under TMFPA, whistleblowers who successfully unearth fraud are entitled to a share of any financial recovery resulting from their disclosures. After the state intervened in 2013 and separately filed a TMFPA lawsuit in 2014, a settlement was finally reached in 2019, which unfortunately included the refusal to compensate the whistleblowers as prescribed by the law.

Before legal actions were taken, Dr. Ellis, a Dallas-based orthodontist, had been tirelessly working to bring attention to the fraud she witnessed in the Medicaid system. Her testimony before a U.S. congressional committee and persistent reports to the state highlighted serious concerns about improper approval of orthodontic services, often without verification of medical necessity.

Investigation and Allegations

The state’s own investigation confirmed Dr. Ellis's suspicions, revealing that unqualified staff employed by Xerox had inappropriately given the green light for several orthodontic services, resulting in taxpayers funding unnecessary treatments for many children in Texas.

This outcome not only questioned the integrity of Xerox’s operational standards but raised alarms regarding how corporate practices impacted state policies and, furthermore, public trust.

The Court's Decision

The court's recent decision to award the whistleblowers underscores the critical role they played in safeguarding taxpayer interests. Ms. Caitlyn Silhan, their attorney, emphasized their disappointment with the State's prior attempts to evade payment, but welcomed the court’s ruling as a validation of their fight against fraud.

Attorney James