Vol. 4 Antoine Dental Centers vs. THHSC, OIG -Dr. Nazari

7/28/2019 Vol. 4 Antoine Dental Centers vs. THHSC, OIG -Dr. Nazari

1/167

10fff9b4-1fd2-4ff8-a65e-8fdd

800. 829. 6936 * 512. 472. 0880ken@kenowen. com * www. kenowen. com

Page 1

REPORTER' S RECORD

VOLUME 4 OF 4 VOLUMESOAH DOCKET NO. 529- 13- 0997

HHSC- OI G CASE NO: P20111316523848911

ANTOI NE DENTAL CENTER, (

PETI TI ONER, ((

VS. ( BEFORE THE STATE OFFI CE(

TEXAS HEALTH AND HUMAN (SERVI CES COMMI SSI ON, (OFFI CE OF I NSPECTOR (GENERAL, (

RESPONDENT ( ADMI NI STRATI VE HEARI NGS

***************************

HEARI NG

***************************

On t he 31st of May, 2013, t he f ol l owi ng

pr oceedi ngs came on to be hear d i n the above- ent i t l ed

and numbered cause bef or e t he Honorabl e Howar d Sei t zman

and Cather i ne Egan, Associ ate Law J udges pr esi di ng,

hel d i n Aust i n, Tr avi s Count y, Texas.

Proceedi ngs r epor t ed by Machi ne Shor t hand.


2/167



Page 2

1 A P P E A R A N C E S2

3 ADMI NI STRATI VE LAWJ UDGES:Honor abl e Howar d Sei t zman

4 Honorabl e Cat her i ne Egan

STATE OFFI CE OF ADMI NI STRATI VE HEARI NGS5 300 West 15t h St r eet , Sui t e 504Aust i n, Texas 78701

6

FOR THE PETI TI ONER:7 Mr . J . A. "Tony" Canal es

Mr . Hect or Canal es8 CANALES & SI MONSON, P. C.

2601 Mor gan Avenue9 Cor pus Chr i st i , Texas 78465

Tel ephone: 361. 883. 060110

- and-Mr . Rober t M. Anderson11 ROBERT M. ANDERTON, DDS, J D

1909 Wal nut Pl z12 Car r ol l t on, Texas 75006

Tel ephone: 972. 416. 525113 - and-

Mr . Phi l i p H. Hi l der14 Mr . Wi l l i am B. Gr aham

Mr . J ames G. Ryt t i ng15 HI LDER & ASSOCI ATES, P. C.

819 Lovet t e Bl vd.16 Houst on, Texas 77006

Tel ephone: 713. 655. 911117 - and-

Mr . Thomas Wat ki ns18 BROWN McCARROLL

111 Congr ess Avenue, Sui t e 140019 Aust i n, Texas 78701

Tel ephone: 512. 703. 575220

FOR THE RESPONDENT:21 Mr . Dan Har grove

WATERS & KRAUSE, L. L. P.22 600 Navar r o, Sui t e 500

San Ant oni o, Texas 7820523 Tel ephone: 210. 349. 0515

- and-24

25


3/167



Page 3

1 Ms. Cai t l yn Si l hanWATERS & KRAUS, L. L. P.

2 3219 McKi nney AvenueDal l as, Texas 75204

3 Tel ephone: 214. 357. 6244- and-

4 Mr . J ames R. Mor i ar t yMORI ARTY LEYENDECKER, P. C.

5 4203 Mont r ose, Sui t e 150Houst on, Texas 77006

6 Tel ephone: 713. 528. 0700- and-

7 Mr . Ket an KharodKHAROD LAW FI RM, P. C.

8

PO Box 151677Aust i n, Texas 787159 Tel ephone: 512. 293. 1556

- and-10 Mr . Raymond C. Wi nt er

Ms. Mar gar et M. Moore11 ATTORNEY GENERAL OF TEXAS

Ci vi l Medi cai d Fr aud Di vi si on12 PO Box 12548

Aust i n, Texas 78711- 2548

13 Tel ephone: 512. 936. 170914 HEALTH AND HUMAN SERVI CES COMMI SSI ON - OFFI CE OFI NSPECTOR GENERAL:

15 Mr . Enr i que Var el aMr . J ohn R. Medl ock

16 11101 Met r i c Bl vd. , Bui l di ng IAust i n, Texas 78708

17 Tel ephone: 512. 491. 200018

19

2021

22

23

24

25


4/167



Page 4

1 Vol ume 4

2 May 31st , 2013 Page

3 RESPONDENT' S WI TNESSES Di r ect Cr oss

4

Behzad Nazar i 8, 137 705 Respondent Rest s. . . . . . . . . . . . . . . . . . . . . . . . . . . . 150

6 Mot i ons by Pet i t i oner . . . . . . . . . . . . . . . . . . . . . . . 160

7 Adj our nment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166

8 Cour t Repor t er ' s Cer t i f i cat e. . . . . . . . . . . . . . . . 167

9 EXHI BI T I NDEX

10 RESPONDENT' S

NO. DESCRI PTI ON OFFERED ADMI TTED11

86 Dr . Or ni sh deposi t i on 5 712

87 CD- ROM document s 155 15713

89 Spr eadsheet 153 15514

OFFER OF PROOF15

RESPONDENT' S16 NO. DESCRI PTI ON

17 88 Li nda Al t enhof f r ebut t al 150t est i mony

18

19

20

21

22

23

24

25


5/167



Page 5

1 P R O C E E D I N G S

2 J UDGE EGAN: We' r e r econveni ng i n SOAH

3 Docket Number 529- 13- 0997. I t i s 9: 05 a. m. on May

4 31st , 2013.5 And, Mr . Mor i ar t y, ar e you r eady t o cal l

6 your f i r st wi t ness - -

7 MR. MORI ARTY: I am, J udge.

8 J UDGE EGAN: - - f or t he morni ng not t he

9 f i r st one i n t hi s case.

10 MR. MORI ARTY: Good mor ni ng. Bef or e I do11 t hat , I ' ve mar ked Dr . Or ni sh' s deposi t i on as

12 Respondent ' s 86; and I of f er Respondent ' s 86 i nt o

13 evi dence.

14 J UDGE EGAN: Any obj ect i on?

15 MR. HECTOR CANALES: Yes. We - - yes, your

16 Honor . We obj ect t o hi m of f er i ng Doct or - - Dr .17 Or ni sh' s deposi t i on?

18 MR. MORI ARTY: Ri ght .

19 MR. HECTOR CANALES: The ent i r e

20 deposi t i on?

21 MR. MORI ARTY: Thei r exper t ' s deposi t i on

22

we' r e of f er i ng i t i nt o evi dence.23 MR. TONY CANALES: Can I - - can I answer ,

24 J udge?

25 J UDGE EGAN: No.


6/167



Page 6

1 J UDGE SEI TZMAN: I t ' s up t o her . I ' m a

2 f i gur ehead t hi s mor ni ng.

3 MR. HECTOR CANALES: Your Honor , t hat

4 deposi t i on was not mar ked as a - - as an exhi bi t i n

5 t hei r case - - i n t hei r case i n chi ef and t her e' s - - I

6 coul d see usi ng t he deposi t i on t o i mpeach a wi t ness, i f

7 he answer s di f f er ent l y. That woul d be of f er ed f or t hat

8 pur pose. But i n t hi s case, t hat woul d be i mpr oper and

9 i t wasn' t par t of t hei r - - t hei r exhi bi t l i s t .

10 J UDGE EGAN: Response? Was i t par t of11 your exhi bi t l i st?

12 MR. MORI ARTY: We had no i dea t hat

13 Dr . Or ni sh - - who we wer e t ol d up unt i l 9: 00 or 10: 00

14 o' cl ock l ast ni ght was goi ng t o be her e t o t est i f y and

15 we wer e l ooki ng f or war d t o havi ng t he oppor t uni t y f or

16 hi m t o shar e hi s vi ew of t he wor l d wi t h t hi s Cour t ; but17 he appar ent l y had per sonal busi ness, pr essi ng per sonal

18 busi ness t hat caused hi m t o abandon t he f i el d of

19 bat t l e.

20 So, we now of f er hi s ent i r e deposi t i on

21 i nt o evi dence t o hel p t hi s Cour t under st and what

22

happened her e.23 J UDGE EGAN: Okay. I ' m goi ng t o al l ow i n

24 Respondent ' s Exhi bi t 86.

25 MR. MORI ARTY: And I ' l l now cal l Doct or - -


7/167



Page 7

1 J UDGE EGAN: So, i t i s admi t t ed. I ' m

2 sorry.

3 MR. MORI ARTY: Thank you, J udge.

4 Cal l Dr . Nazar i t o t he st and.

5 MR. HECTOR CANALES: Whi l e Dr . Nazar i i s

6 appr oachi ng, your Honor , i f I coul d, j ust a

7 housekeepi ng, cl ear up P82?

8 J UDGE EGAN: Yes.

9 MR. HECTOR CANALES: I t was br ought t o our

10 at t ent i on t hat pet i t i oner ' s of f er ed t wo exhi bi t number s11 under - - i dent i f i ed as P82. We have changed one of

12 t hose t o P82A. So, P82A i s t he Texas Heal t h & Human

13 Ser vi ces Commi ssi on, Apr i l 4t h, 2012, not i ce of payment

14 hol d l et t er . And I have made t hat cor r ect i on wi t h t he

15 of f i ci al cour t copy - -

16 J UDGE EGAN: Al l r i ght .17 MR. HECTOR CANALES: - - as wel l .

18 J UDGE EGAN: I bel i eve I handed you my

19 copy. So, i f I coul d have i t back.

20 MR. HECTOR CANALES: Yes. I ' m sor r y.

21 J UDGE EGAN: And j ust f or t he r ecor d,

22

t her e i s anot her dupl i cat i on and t hat ' s 81. I don' t23 have t hose exhi bi t s up her e. So, dur i ng a br eak i f we

24 coul d get t hat - -

25 MR. HECTOR CANALES: We' l l wor k on t hat ,


8/167



Page 8

1 your Honor .

2 J UDGE EGAN: Thank you. Al l r i ght . Go

3 ahead and proceed.

4 Woul d you swear t he wi t ness i n, pl ease?

5 BEHZAD NAZARI ,

6 havi ng been f i r st dul y swor n, t est i f i ed as f ol l ows:

7 DI RECT EXAMI NATI ON

8 BY MR. MORI ARTY:

9 Q. Good mor ni ng.

10 A. Good mor ni ng, si r .11 Q. Woul d you i nt r oduce your sel f t o t he J udges,

12 pl ease?

13 A. I ' m Behzad Nazar i , B- E- H- Z- A- D f i r st name,

14 Nazar i , N- A- Z- A- R- I .

15 MR. MORI ARTY: St acey, coul d I have

16 64- 42- 004?17 J UDGE SEI TZMAN: I s t hat 62?

18 MR. MORI ARTY: That ' s Pet i t i oner ' s

19 64- 42- 004.

20 J UDGE SEI TZMAN: Thank you.

21 Q. ( BY MR. MORI ARTY) Dr . Nazar i , we have a

22

document t hat ' s been t aken f r om your f i l es t hat ' s been23 of f er ed i nt o evi dence. Have you had t he oppor t uni t y t o

24 l ook at t hi s f i l e?

25 A. I bel i eve so.


9/167



Page 9

1 Q. What we see on t hat f i l e i s one of your dent al

2 assi st ant s has f i l l ed out t he di agnosi s on a bl ank HLD

3 f or m bef or e any pat i ent was exami ned. What I ' d l i ke

4 you t o do i s I ' d l i ke you t o l ook at t he J udges and I ' d

5 l i ke you t o t el l t he J udges why your dent al assi st ant s

6 ar e f i l l i ng out di agnose - - di agnosi s f or ms wi t hout a

7 pat i ent .

8 MR. HECTOR CANALES: Obj ect i on. 601,

9 l acks f oundat i on.

10 J UDGE EGAN: Over r ul ed.11 A. I f you can compare t he pr evi ous HLD score

12 sheet s wi t h Dr . Kanaan' s handwr i t i ng, t hi s i s

13 Dr . Kanaan' s handwr i t i ng. We have never l et any

14 assi st ant s t o f i l l any HLD scor e sheet wi t h a - - you

15 di ct at e t o t hem - - you mi ght see t hat , you know, I ' m

16 si t t i ng t her e. I have gl oves on. Pat i ent i s i n t he17 chai r and t hen we ar e exami ni ng t hem and t hey mi ght

18 f i l l t he number s f or us l i ke over j et , over bi t e or

19 what ever i t needs t o be cal l ed and we mi ght see some of

20 t hose.

21 I have never and ever , ever l et any

22

person, ot her t han me or Dr . Kanaan or even t he general23 pr act i ce any ot her doct or t o do di agnosi s or compl et e

24 i ni t i al i ndex. Never done t hat .

25 Q. Whi ch quest i on was i t t hat you were answer i ng?


10/167



Page 10

1 A. That why di d I l et - -

2 MR. HECTOR CANALES: Obj ect i on.

3 Ar gument at i ve.

4 J UDGE EGAN: Sust ai ned.5 A. Why di d I l et t he dent al assi st ant t o f i l l

6 t hi s.

7 MR. HECTOR CANALES: Dr . Nazar i .

8 J UDGE EGAN: I t ' s sust ai ned.

9 MR. HECTOR CANALES: I t ' s sust ai ned, whi ch

10 means you don' t have t o answer .11 THE WI TNESS: I ' m sor r y. Yeah. Thi s i s

12 al l new t o me. I ' m sor r y.

13 Q. ( BY MR. MORI ARTY) I f I underst and your

14 t est i mony under oat h, you' ve j ust swor n under oat h

15 bef or e t hi s panel t hat you have never l et a dent al

16 assi st ant f i l l out one of t hese f or ms; i s t hat t r ue?17 A. Under my super vi si on when I di ct at e t o t hem,

18 t hey f i l l i t ; ot her wi se, as f ar as bei ng a doct or and

19 exami ni ng or compl et i ng an i ndex, no, si r , I ' ve never

20 done t hat .

21 Q. You' ve r out i nel y al l owed dent al assi st ant s i n

22

your pr act i ce t o do t hi ngs t hat ar e onl y done by23 dent i sts; i sn' t t hat t r ue?

24 A. Never .

25 Q. Never ?


11/167



Page 11

1 A. No, si r .

2 Q. Okay. So, why don' t you expl ai n t o t hi s Cour t

3 what i t was t hat you were t aken bef ore the Texas St at e

4 Boar d of Dent al Exami ner s f or i n 2008. Do you r emember

5 that?

6 A. Yes, I do.

7 Q. And what happened i n t hat case?

8 A. I t was an agr eed boar d set t l ement and I di d

9 not admi t I l et t hem - - you know, l et any dent al

10 assi st ant do anyt hi ng t hat , you know, beyond t hei r11 descr i pt i ve dut y.

12 Q. My quest i on, si r , i s t hi s: What wer e you

13 accused of doi ng, what mi sconduct were you accused of

14 doi ng bef or e t he dent al boar d?

15 A. I f I r emember cor r ect l y, t her e was a l ack of

16 bl ood pr essure on t he char t and al so t hey had t ol d me17 t hat t he changi ng t he el ast i cs and t hen t he wi r es and

18 t he - - t her e wer e accusat i ons of t he - - you know, by

19 t he pat i ent t hat , you know, t hey put al l t he br acket s

20 and al l t he br aces, whi ch was not cor r ect , whi ch was

21 not f ounded.

22

Q. My quest i on, si r , i s t hi s: You wer e accused23 of al l owi ng dent al assi st ant s t o do dent al wor k,

24 or t hodont i cs wor k on your pat i ent s and t hat was t he

25 accusat i on bef or e the St at e Boar d of Dent al Exami ner s;


12/167



Page 12

1 i sn' t t hat t r ue?

2 A. I t was - - I don' t know what t hat accusat i on.

3 But t here was a compl ai nt agai nst me by one of t he

4 pat i ent s; but as f ar as, you know, what I was accused5 of , I don' t know. I di d not see t he act ual compl ai nt

6 f or m f r om t he St at e Boar d. I don' t r emember . I f you

7 have i t , I can see i t .

8 Q. What t hi s f or m i ndi cat es - - and I want t he - -

9 you t o expl ai n t o t he Cour t because t hey need t o know

10 t hi s.11 Ar e you t el l i ng t hi s Cour t t hat Dr . Kanaan

12 f i l l ed out t hat ent i r e f or m?

13 A. That l ooks t o be hi s handwr i t i ng. Cl ass I

14 mol ar , cr owdi ng, open bi t e, ext r act upper r i ght f our ,

15 TPA. I bel i eve t hat ' s hi s handwr i t i ng. But he - -

16 Q. And he di d i t wi t hout any pat i ent i dent i f yi ng17 i nf or mat i on on t he f or m?

18 MR. HECTOR CANALES: Obj ect i on. For m.

19 Specul at i on.

20 A. I don' t know what Dr . Kanaan di d. I cannot

21 specul at e on t hat .

22

J UDGE EGAN: Hol d on. You need t o l et23 me - -

24 THE WI TNESS: I ' m sor r y.

25 J UDGE EGAN: Over r ul ed.


13/167



Page 13

1 But you need t o l et me make a rul i ng

2 bef ore you pr oceed.


4 J UDGE EGAN: I know you' r e ner vous. So,

5 j ust sl ow down a l i t t l e bi t and pause bef or e you answer

6 a quest i on so t hat i f somebody has an obj ect i on, I can

7 r ul e on i t .

8 THE WI TNESS: Yes, ma' am. Yes, ma' am.

9 J UDGE EGAN: Go ahead.

10 A. Okay. I don' t know i f Dr . Kanaan - - what11 Dr . Kanaan di d on t hat day. I do not know. But t her e

12 ar e ot her i dent i f i cat i on. We have t he X r ays i n f r ont

13 on t he chai r s and we have t he char t on t he chai r . We

14 don' t j ust l ook at a bl ank pi ece of paper , you know, do

15 HLDs on par ent s.

16 J UDGE EGAN: Okay. You have X r ays on t he17 char t or t he chai r ? I t wasn' t cl ear .

18 THE WI TNESS: On t he chai r , t hat ' s what I

19 mean. We have a - - ever yt hi ng i s di gi t al i zed and t hen,

20 you know, you have t he scr een. So, you have t he X r ays

21 t here and t hen, you know, you have - - most of t he t i me

22

you have t he pi ct ur es of t he pat i ent s. And t hen when23 we do t he exami nat i on, t her e mi ght be a bl ank f or m i n

24 f r ont of us t hat when we f i l l i t but you have t he

25 act ual paper char t i n f r ont of us so we can - - we know


14/167



Page 14

1 t hat t her e ar e - - t hi s paper bel ong t o t hi s pat i ent .

2 We don' t j ust get a pi ece of paper and then r andoml y,

3 you know, exami ne pat i ent s or compl et e the HLD i ndex

4 scor e. We don' t do t hat .

5 J UDGE EGAN: Go ahead.

6 Q. ( BY MR. MORI ARTY) You don' t ?

7 A. No, si r .

8 Q. Wel l , what was t he condi t i on of t hi s f or m

9 bef or e Dr . Kanaan put paper - - put handwr i t i ng on i t ?

10 Thi s paper r i ght t here t hat ' s i n f r ont of you, 64- 42 - -11 A. What was t he condi t i on? I don' t know, si r .

12 Q. Si r - -

13 J UDGE EGAN: You need t o wai t .

14 Q. ( BY MR. MORI ARTY) - - pl ease al l ow me t o

15 f i ni sh my - -

16 J UDGE EGAN: I ' l l i nst r uct t he wi t ness,17 pl ease.

18 J ust wai t unt i l he f i ni shes aski ng t he

19 quest i on.

20 THE WI TNESS: Yes, ma' am.

21 J UDGE EGAN: That ' s why I say pause bef ore

22

you begi n answer i ng.23 THE WI TNESS: Yes, ma' am.

24 Q. ( BY MR. MORI ARTY) I f I under st and your cl ai m

25 her e t oday, you never f i l l out bl ank pi eces of paper - -


15/167



Page 15

1 Dr . Kanaan does not f i l l out - - j ust f i l l out bl ank

2 pi eces of paper wi t hout pat i ent i dent i f i cat i on. I s

3 t hat what you' r e sayi ng?

4 A. No, I di d not say t hat , si r .

5 Q. What ar e you sayi ng?

6 A. What I ' m sayi ng i s t hat when we have al l t he

7 r ecor ds r el at ed t o t he pat i ent i n f r ont of us, t he

8 paper char t or t he X r ays so we know t hat - - who t he

9 pat i ent i s and t hen we f i l l out t he HLD i ndex f or m. I f

10 t hei r name i s mi ssi ng, l at er on i t ' s goi ng t o be11 compl et ed by t he dent al ass i st ant s or , you know, by

12 a - - one of our , you know, bi l l i ng per sons, i t i s i n

13 t he pat i ent ' s f i l e.

14 Q. How - - how woul d you know whi ch pat i ent t hi s

15 di agnosi s goes t o?

16 A. Because i t bel ongs t o t hat char t , whi ch i s i n17 f r ont of us. We don' t have t en pat i ent s on t he same

18 chai r . You have one pat i ent , one chai r , one char t at a

19 t i me.

20 Q. So, Dr . Kanaan f i l l s out t he di agnosi s on a

21 bl ank sheet of paper bef or e t he name of t he pat i ent i s

22

even f i l l ed i n? That ' s what you' r e cl ai mi ng?23 A. I don' t know.

24 Q. You don' t know?

25 A. I don' t know. I t mi ght have happened. I


16/167



Page 16

1 don' t know but I don' t see anyt hi ng wr ong wi t h i t .

2 Q. I have. . .

3 No doubt .

4 MR. HECTOR CANALES: Obj ect i on. Si debar .5 J UDGE SEI TZMAN: That ' s exact l y what we

6 wer e t al ki ng about , Mr . Mor i ar t y. We don' t need t hat .

7 MR. MORI ARTY: I apol ogi ze. I know bet t er

8 t han t hat .

9 Q. ( BY MR. MORI ARTY) Al l r i ght . Now, when you

10 t est i f i ed bef or e t he l egi sl at ur e, you t est i f i ed on11 behal f of t he Texas Dent i st s f or Medi cai d Ref or m?

12 A. Yes, s i r .

13 Q. Who asked you t o do t hat ?

14 A. I di d.

15 Q. You asked your sel f t o do t hat ?

16 A. That was my vol unt eer i ng, yes, si r .17 Q. And di d you meet wi t h anybody bef or e you

18 t est i f i ed?

19 A. Di d I meet wi t h anybody bef or e I - - yeah,

20 t he - - my col l eague dent i st s.

21 Q. Whi ch ones?

22

THE WI TNESS: Do I have t o say t he names?23 J UDGE EGAN: Yes.

24 THE WI TNESS: I do? Okay.

25 MR. HECTOR CANALES: Wel l , your Honor , I


17/167



Page 17

1 obj ect t o t he r el evancy - -

2 THE WI TNESS: I mean, i f I have t o.

3 MR. HECTOR CANALES: - - of hi s t est i mony

4 bef or e t he quest i on.

5 J UDGE EGAN: What i s t he r el evancy of t hi s

6 quest i on?

7 MR. MORI ARTY: I ' l l pr ove i t up, J udge.

8 Q. ( BY MR. MORI ARTY) When you t est i f i ed bef ore

9 t he l egi sl at ur e, you swor e under oat h bef or e the

10 l egi sl at ur e t hat you had never had any paper wor k11 vi ol at i ons i n your ent i r e car eer as a Medi cai d dent i st ,

12 i sn' t t hat t r ue, or wor ds t o t hat ef f ect?

13 A. I sai d I have never paper wor k vi ol at i on?

14 Q. Yes, s i r .

15 A. I don' t bel i eve I sai d t hose wor ds.

16 Q. Di d you i nt end t o communi cat e t o t he17 l egi sl at ur e t hat your r ecor d keepi ng i s essent i al l y

18 f l awl ess?

19 A. I di d not i nt end t o do t hat . No, si r .

20 Q. I n f act , your r ecor d keepi ng has subst ant i al

21 def ect s i n i t , doesn' t i t ?

22

A. Pr obabl y.23 MR. MORI ARTY: Let ' s l ook at Pet i t i oner ' s

24 Exhi bi t 25.

25 Q. ( BY MR. MORI ARTY) Now, you know we have


18/167



Page 18

1 asser t ed t hat you have - - you' r e mi ss i ng a number of

2 HLD scor e sheet s i n t he pat i ent f i l es. You' r e awar e of

3 t hat , ar en' t you?

4 A. I bel i eve ever yt hi ng has been i n t he char t

5 when we t ur ned i t i n.

6 Q. That doesn' t answer my quest i on, si r .

7 My quest i on, si r , i s: You' r e awar e t hat

8 t he St at e of Texas says t hat you have got f i l es t hat

9 ar e i ncompl et e. Speci f i cal l y t her e ar e f i ve f i l es t hat

10 ar e mi ssi ng HLD scor e sheet s. You' r e awar e t hat we' ve11 made t hat asser t i on, ar en' t you?

12 A. Yes, s i r .

13 Q. And t hat asser t i on i s t r ue, i sn' t i t ?

14 A. I don' t bel i eve so.

15 Q. Do you deny t hat asser t i on?

16 A. I - - pr obabl y yes because I t ur ned i n what ever17 we had.

18 Q. I don' t have any doubt , si r , t hat you " t ur ned

19 i n what ever I had. "

20 My quest i on i s: Those r ecords were not

21 compl et e; i sn' t t hat t r ue?

22

A. I need t o l ook at t he r ecor ds.23 Q. We wi l l l ook at t he r ecor ds. We' r e goi ng t o

24 l ook at your f i l e.

25 Now, t hi s i s act ual l y f r om your l awyer ' s


19/167



Page 19

1 f i l e. That ' s - - see t hat P down t her e at t he bot t om,

2 P00417?

3 A. Yes, s i r .

4 Q. That means t hat copy of your pat i ent r ecor d5 came f r om your l awyer ' s f i l es.

6 A. Okay. Yes, si r .

7 Q. Al l r i ght . Now, t hat page 001, t hat ' s not an

8 HLD f or m, i s i t ?

9 A. Thi s one, no, si r .

10 Q. Page 2, t hat ' s not an HLD f or m?11 A. No, si r .

12 Q. Page 3?

13 A. No, si r .

14 Q. Page 4?

15 A. No, si r .

16 Q. Page 5?17 A. No, si r .

18 Q. Page 6?

19 A. No, si r .

20 Q. Page 7?

21 A. No, si r .

22

Q. 8?23 A. No, si r .

24 Q. 9?

25 A. No, si r .


20/167



Page 20

1 Q. 10?

2 A. No.

3 Q. 11?

4 A. No.

5 Q. 12?

6 A. No. No.

7 Q. 13?

8 A. No, si r .

9 Q. That ' s i t . That ' s al l t her e i s .

10 J UDGE EGAN: Mr . Mor i ar t y, whi ch pat i ent11 number i s t hi s? I ' ve got t he - -

12 MR. MORI ARTY: Pat i ent - - i t ' s 25,

13 Pet i t i oner ' s - - i t ' s Pat i ent 25.

14 Q. ( BY MR. MORI ARTY) Ther e i s no HLD scor e sheet

15 i n t hat f i l e, i s t here?

16 A. I don' t see i t , no, s i r .17 Q. That ' s a r ecor ds vi ol at i on, i sn' t i t ?

18 A. I f I don' t have i t , I don' t know. Pr obabl y i t

19 i s.

20 Q. Do you admi t now t hat you l ack t he pr oper f i l e

21 f or Pat i ent Number 25?

22

A. I do not admi t t o t hat because you don' t have23 i t , i t doesn' t mean i t di d not exi st .

24 Q. Si r , t he r ul e i s t hat you' r e obl i gat ed t o keep

25 your pat i ent f i l es i n pr oper or der so t hat when we, t he


21/167



Page 21

1 St ate of Texas, show up t o exami ne your pat i ent r ecor ds

2 we can t ake t hat pat i ent r ecor d, make our copi es of

3 t hat r ecor d and we - - we l i ve and you l i ve wi t h

4 what ever ' s i n t hat f i l e at t he t i me we show up t o get

5 i t ; i sn' t t hat r i ght ?

6 A. I bel i eve so, yes, s i r .

7 Q. And i f i t ' s not i n t he f i l e, t he r ul e i n

8 medi ci ne i s i t di dn' t happen; i sn' t t hat t r ue?

9 MR. HECTOR CANALES: Obj ect i on, your

10 Honor .11 A. I - -

12 J UDGE EGAN: What ' s your obj ect i on - -

13 obj ect i on.

14 MR. HECTOR CANALES: I t ' s - - i t ' s ar gu- - -

15 i t ' s argument at i ve, your Honor .

16 J UDGE EGAN: Over r ul ed.17 A. Can you r epeat t he quest i on agai n? The r ul e

18 i s?

19 Q. ( BY MR. MORI ARTY) Si r , you' r e obl i gat ed t o

20 keep t he HLD scor e sheet , t he mol ds, t he X r ays, t he

21 CEF, t he consent f or ms, you' r e obl i gat ed t o keep al l of

22

t hat i nf or mat i on i n t he f i l e, ar en' t you?23 A. Yes.

24 Q. And i f you f ai l t o do so, you ar e not ent i t l ed

25 t o t ur n i n cl ai ms f or t hat f i l e t o Medi cai d; i sn' t t hat


22/167



Page 22

1 true?

2 A. At t he t i me t hat we compl et ed t he HLD, t he

3 X r ays, t he phot ogr aphs and we send to Texas Medi cai d

4 t hey wi l l not pr ocess any - - any pr e- aut hor i zat i on

5 wi t hout pr oper document at i on. So, i f i t i s mi ssi ng and

6 we di d not t ur n f i ve HLDs t hat day, i t does not mean

7 t hat t hey never exi st ed. I t di d exi st ed; ot her wi se,

8 t he pr e- aut h- - - pr e- aut hor i zat i on wi l l never be

9 pr ocessed.

10 Q. Here' s my quest i on, si r : When we show up t o11 get your pat i ent f i l es, we' r e ent i t l ed t o r el y on

12 what ever ' s i n t he f i l e t hat day. Tr ue?

13 A. That day, I don' t know t hat day i s t r ue. That

14 moment . I t mi ght t ake us a f ew days t o gat her al l t he

15 i nf or mat i on.

16 Q. You' r e not cl ai mi ng t hat you l acked t i me t o17 get your f i l es t oget her when we came up t o get t he

18 f i l es, ar e you?

19 A. We - - i t t ook us somet i me t o get i t .

20 Q. Di d you have adequat e t i me t o gat her up al l

21 t he pr oper document s so t hat we coul d get al l t he

22

pr oper f i l es?23 A. I bel i eve so.

24 Q. Al l r i ght . And you acknowl edge t hat t hi s f i l e

25 di d not have an HLD f or m and, t hus, di d not - -


23/167



Page 23

1 A. I n t hat t i me - - i f you don' t have i t , yes, I

2 agr ee wi t h i t .

3 MR. MORI ARTY: Your Honor , I di dn' t f i ni sh

4 my quest i on.

5 A. Sor r y.

6 J UDGE EGAN: Agai n, l i st en t o t he

7 quest i on. He' s aski ng you whether or not when t hey

8 came up t o pi ck up t he f i l e was t he HLD scor e sheet i n

9 the f i l e.

10 THE WI TNESS: Okay.11 A. As you say, i t does not exi st - - i t does not

12 exi st i n t hat t i me, yes, s i r .

13 Q. ( BY MR. MORI ARTY) Al l r i ght . And wi l l you

14 concede t hat f or Pat i ent 44, Pat i ent 48, Pat i ent 51 and

15 Pat i ent 53, al l t hose f i l es ar e al so mi ssi ng HLD scor e

16 f or ms, ar en' t t hey?17 A. At t he t i me t hat t hey pi cked up t he char t s,

18 yes, s i r .

19 Q. Al l r i ght . Now - -

20 J UDGE EGAN: Wi l l you gi ve me t hose

21 numbers agai n? I got 44, 48.

22

MR. MORI ARTY: 25, 44, 48, 51 and 53.23 J UDGE EGAN: Thank you.

24 Q. ( BY MR. MORI ARTY) Now, when we ar e eval uat i ng

25 your conduct based on what we f i nd i n your char t , al l


24/167



Page 24

1 we' ve got t o go on i s what you pr ovi de t o us; i sn' t

2 that true?

3 MR. HECTOR CANALES: Obj ect i on. Requi r es

4 specul at i on.

5 The quest i on i s aski ng f or Dr . Nazar i t o

6 ent er t he mi nd of OI G of what t hey have and don' t have.


8 A. I don' t know t he answer , si r .

9 Q. ( BY MR. MORI ARTY) Wel l , you' r e not cl ai mi ng

10 t hat we' r e t r eat i ng you unf ai r l y when we go t hr ough11 your f i l es and we f i nd a l ack of pr oper document at i on?

12 A. I ' m not cl ai mi ng anyt hi ng, si r .

13 Q. Okay.

14 MR. MORI ARTY: Now, l et ' s go t o P64- 25.

15 Q. ( BY MR. MORI ARTY) Now, t hi s i s t he HLD score

16 sheet f or Pat i ent Number 25, cor r ect ?17 A. Yes, s i r .

18 Q. Now, l et ' s go t o t he upper l ef t - hand cor ner of

19 t hat document . Do you know what t hat i s?

20 A. No, si r .

21 Q. Let me r epr esent t o you t hat t hat i s a mar k

22

t hat i ndi cat es t hat t hat i s t he document t hat - - as i t23 was Bat e st amped by t he Texas Heal t h Medi cai d

24 Par t ner shi p. That i ndi cat es t hat HLD f or m di d not come

25 f r om your r ecor ds, di d i t ?


25/167



Page 25

1 MR. HECTOR CANALES: Obj ect i ng t o

2 t est i mony by counsel .

3 A. I bel i eve so - -

4 MR. HECTOR CANALES: Excuse me.

5 J UDGE EGAN: Do you have a quest i on i n

6 t her e?

7 MR. MORI ARTY: Yes, si r ( si c) .

8 Q. ( BY MR. MORI ARTY) Thi s f orm, t hi s document

9 P64- 025 di d not come f r om your f i l es, di d i t ?

10 MR. HECTOR CANALES: Obj ect i on - -11 obj ect i on, your Honor . Lacks f oundat i on. Based on - -

12 t he quest i on i s based on t he number t hat Dr . Nazar i ' s

13 al r eady t est i f i ed he doesn' t know.

14 J UDGE EGAN: He can answer whet her or not

15 i t came f r om hi s f i l e.

16 Go ahead. Over r ul ed.17 MR. HECTOR CANALES: Then I woul d r equest

18 t he ent i r e pi ct ur e - - t he ent i r e sheet be shown t o hi m.

19 J UDGE SEI TZMAN: Wel l , gi ve us - - gi ve us

20 a second.

21 J UDGE EGAN: Al l r i ght . Go ahead.

22

Pr oceed.23 MR. MORI ARTY: Thank you.

24 Q. ( BY MR. MORI ARTY) I get ol d and somet i mes I

25 f or get s tuf f . So, i f I ' ve asked t hi s bef ore, I ' m j ust


26/167



Page 26

1 t r yi ng t o have a cl ean r ecor d. Thi s document P - -

2 MR. MORI ARTY: What ' s t he Bat es number

3 down on t he bot t om, St acey?

4 MR. KHAROD: P64- 25- 0002.

5 Q. ( BY MR. MORI ARTY) P64- 25- 0002 di dn' t come

6 f r om your r ecor ds, di d i t ?

7 A. I f t hat paper has t hat st amp on i t , no, si r .

8 Q. Okay. So, we' r e now i n agr eement t hat you' r e

9 mi ssi ng f i ve HLD scor e sheet s, cor r ect ?

10 A. Yes, s i r .11 Q. Now, l et ' s go t o t he quest i on of mol ds. Doi ng

12 a dent al mol d i s i mpor t ant f or t he pur pose of pr oper l y

13 eval uat i ng t he medi cal condi t i on of a chi l d; i sn' t t hat

14 true?

15 A. Yes, s i r .

16 MR. MORI ARTY: Okay. May I appr oach17 counsel , your Honor ?

18 J UDGE EGAN: Yes.

19 MR. MORI ARTY: And may I approach t he

20 wi t ness?

21 J UDGE EGAN: Yes.

22

J UDGE EGAN: Gi ve counsel an oppor t uni t y23 t o l ook.

24 MR. MORI ARTY: Sure.

25 J UDGE EGAN: I mean, you can put t hat i n


27/167



Page 27

1 f r ont of t he wi t ness but l et counsel l ook at i t .


3 MR. MORI ARTY: For t he r ecor d, I ' m not

4 goi ng t o of f er t hi s i nt o evi dence. I ' m goi ng t o seek5 t est i mony f r om i t .

6 J UDGE EGAN: Do you have a copy f or t he

7 J udges?

8 MR. MORI ARTY: I do.

9 J UDGE EGAN: Al l r i ght . Proceed.

10 Q. ( BY MR. MORI ARTY) Dr . Nazar i , do you r emember11 when t he f ol ks f r om OI G showed up at your of f i ce, what

12 was t hat , November of 2011?

13 A. Yes, s i r .

14 Q. Now, do you r ecal l t he t est i mony of J ack St i ck

15 yest er day?

16 A. Yes.17 Q. You wer e pr esent dur i ng t he ent i r et y of hi s

18 t est i mony?

19 A. Yes, s i r .

20 Q. And you hear d Mr . St i ck gi ve t he numbers f or

21 how many pat i ent s you guys had dur i ng t he t i me per i od

22

bef ore OI G showed up seeki ng your r ecor ds and t he dr op23 of f i n t he number of pat i ent s?

24 A. Yes, s i r .

25 Q. Can you expl ai n t hat t o t he Cour t ?


28/167



Page 28

1 A. Expl ai n why t her e was a dr op of f ?

2 Q. Yes, s i r .

3 A. Okay. On - - November when t hey came i n and

4 t hen next mont h i s December . Okay? December we

5 usual l y cl ose bet ween, l i ke - - bef or e t he Chr i st mas

6 hol i days and New Year , we ar e cl osed. So, i t ' s al ways

7 a sl ow t i me. Not many pat i ent seek dent al t r eat ment .

8 Bet ween J anuary 1st and March 1st t here

9 was a suspensi on of al l t he or t hodont i c - - you know,

10 new or t hodont i c accept ance was compl et el y suspended.11 I t i s a bul l et i n up t her e t hat we can' t - - you know, i f

12 you guys al l ow me, I can show you bul l et i n showi ng f r om

13 J anuar y ' t i l - - J anuar y 1st , 2012, and Mar ch or - - or

14 Febr uar y 29t h t hat bul l et i n sai d they have suspended

15 al l of t he pr e- aut hor i zat i ons f or t he new cases.

16 So, i t wasn' t onl y me. Nobody i n t he17 st at e of Texas was sendi ng any - - any cases t o t he - -

18 t o any - - TMHP because t hat ' s t he t i me t hat when we al l

19 f ound out t hat t her e i s a pr obl em goi ng on wi t h t he

20 TMHP as f ar as, you know, pre- aut hor i zat i on process.

21 Then i n mont h of Mar ch t hey st ar t ed goi ng t hr ough al l

22

t he t r ansi t i ons and - - t o t he new t hr ee dent al23 compani es. MCUs t hey cal l t hem, MCA, Del t a Dent al and

24 al so Dent al Quest . Then - -

25 J UDGE EGAN: Dent al what ?


29/167



Page 29

1 THE WI TNESS: Dent al Quest .

2 A. Then t here was a conf usi on whet her t hese

3 pat i ent s ar e goi ng t o be assi gned t o t he same pr ovi der

4 or not because i t went t o t he - - f r om t he5 f ee- f or - servi ce i nt o an HMO pl an, dent al DMO pl an. I

6 don' t know what ever t hey want t o cal l i t . Then we

7 don' t know who t hese pat i ent s ar e goi ng t o be t he

8 pr ovi der s and t hen we' r e t r yi ng t o go t hr ough al l t he

9 appl i cat i ons. We needed t o know i f we' r e goi ng t o be

10 appr oved or not .11 And i mmedi at el y somet i me i n Mar ch one of

12 t he compani es cal l ed MCNA, send me a l et t er t hat - -

13 yes, si r .

14 J UDGE EGAN: He' s answer i ng your quest i on.

15 MR. MORI ARTY: I asked t hrough Mar ch.

16 J UDGE EGAN: Okay.17 MR. MORI ARTY: Now he' s goi ng on t hrough

18 Mar ch. I ' l l l et hi m - -

19 J UDGE EGAN: He' s i n March r i ght now i s

20 what I under st and.

21 MR. MORI ARTY: I ' l l l et hi m keep goi ng.

22

Q. ( BY MR. MORI ARTY) Keep t al ki ng.23 J UDGE EGAN: Wel l - -

24 A. No. I ' m j ust t el l i ng you - - you asked me why

25 i t dr opped. I ' m j ust gi vi ng you si mpl e expl anat i on.


30/167



Page 30

1 J UDGE EGAN: You can go ahead and f i ni sh

2 t hrough March.


4 A. Then i n March - - somet i me i n March one of t he

5 dent al DMO company send me a l et t er t hat t hey have

6 di squal i f i ed me because of t he same reason we j ust

7 ment i oned, st at e boar d agr eed set t l ement . They don' t

8 want me t o t r eat t hei r or t hodont i c pat i ent s. So, we

9 wer e j ust - - i t was t he conf usi on and I coul d not t ake

10 t he r esponsi bi l i t y t o br i ng any mor e pat i ent s on boar d11 and not bei ng abl e t o t r eat t hem. We di d not know

12 what ' s goi ng on.

13 Dr . Al t enhof f di d t hi s t o us. We wer e

14 t al ki ng t o her and we wer e goi ng t hr ough e- mai l s,

15 cal l i ng. They changed - - t hey changed t he di r ect or i n

16 t he Texas Medi cai d. Dr . J ohn Rober t s came i n. We were17 t al ki ng t o t hem. We were t al ki ng t o DA. I t was mass

18 conf usi on. J ust because we di d not accept any cases

19 does not mean t hat , you know, I was t r yi ng t o hi de

20 somet hi ng.

21 J UDGE EGAN: Okay. Thank you.

22

Go ahead.23 Q. ( BY MR. MORI ARTY) So, you' r e sayi ng t he f act

24 t hat your - - your number of new pat i ent s submi t t ed - -

25 t he f act t hat t hat j ust f el l of f t he char t s f or t he


31/167



Page 31

1 mont h of December i s because i t was Chr i st mast i me?

2 A. That ' s one of t he r easons, yes, si r .

3 Q. Okay. And t hen J anuary, Febr uary and March

4 was - - you coul dn' t si gn up any cases?5 A. J anuar y and Febr uar y - - J anuar y and Febr uar y

6 was compl et e suspensi on. We have t he bul l et i ns.

7 Q. Okay. Now, l et me ask you t hi s: About - - f or

8 t he year - - l et ' s say t he year 2010, about how many

9 new - -

10 J UDGE SEI TZMAN: I ' m sor r y. I di dn' t get11 t he year . The door cl osed.

12 What was t he year you were t al ki ng?

13 MR. MORI ARTY: 2010.

14 Q. ( BY MR. MORI ARTY) For t he year 2010 about how

15 many new or t hodont i cs pat i ent s woul d you have come i n

16 t he door per week, per year , per mont h?17 A. Comi ng t hr ough t he door ?

18 Q. Yes, si r . How many new pat i ent s?

19 A. Many. I don' t know. But , you know, how many

20 we have sent t o Medi cai d i s di f f er ent - - I mean, not

21 Medi cai d. TMHP. Probabl y around - - we wer e aver agi ng

22

about - - about a t housand pat i ent s, 1200 a year23 pr obabl y.

24 Q. 1200?

25 A. Yeah. That we wer e submi t t i ng t o - - we wer e


32/167



Page 32

1 submi t t i ng t o TMHP.

2 Q. My quest i on, si r , i s: For what ever number you

3 wer e submi t t i ng t o TMHP, how many came t o you f or

4 or t hodont i c ser vi ces?

5 A. How many came t o me f or or t hodont i c ser vi ces?

6 I don' t know, si r .

7 Q. Wel l - -

8 A. I can' t gi ve you an exact number .

9 J UDGE EGAN: Can you gi ve - - do you have

10 an appr oxi mat i on?11 THE WI TNESS: They came di r ect l y seeki ng

12 or t hodont i cs on t hei r own? Pr obabl y 50 per cent of t hem

13 about 5- 600 pat i ent s.

14 J UDGE SEI TZMAN: Mr . Mor i ar t y, as I

15 under st ood your quest i on t o Dr . Nazar i i s: How many

16 new pat i ent s, be t hey Medi cai d or nonMedi cai d, wer e17 comi ng i n i n t hat t i me per i od t hat you' ve i nqui r ed

18 about .

19 MR. MORI ARTY: That ' s - -

20 J UDGE SEI TZMAN: I s t hat your quest i on?

21 MR. MORI ARTY: Yes, si r .

22

J UDGE SEI TZMAN: Dr . Nazar i , do you23 have - - nobody' s goi ng t o hol d you t o an exact number .

24 But do you have an est i mat e of t he number of new

25 pat i ent s t hat came i n i n t hat t i me per i od?


33/167



Page 33

1 THE WI TNESS: Okay. Can I be mor e cl ear?

2 I mean, bot h pr i vat e pay and t hen Medi cai d pat i ent s

3 comi ng i n and we act ual l y st ar t ed t he t r eat ment or t hey

4 j ust came i n f or exami nat i on and t hen t hey j ust went

5 away? I need - -

6 J UDGE SEI TZMAN: I ' l l l et doct or - - I ' l l

7 l et Mr . Mor i ar t y cl ar i f y hi s quest i on.

8 MR. MORI ARTY: Thank you, J udge.

9 Q. ( BY MR. MORI ARTY) Wer e you doi ng pr i vat e- pay

10 and Medi cai d - -11 A. Yes, s i r .

12 Q. - - cl i ent s at t hat t i me?

13 A. Yes, s i r .

14 Q. What percent age of Medi cai d? Whi ch percent age

15 pr i vat e pay?

16 MR. HECTOR CANALES: Obj ect t o t he17 r el evancy of t hi s, your Honor .


19 A. Probabl y about 30- 40 per cent pr i vat e pay and

20 70 to 60 percent Medi cai d.

21 Q. ( BY MR. MORI ARTY) So, t he 70 or t he 60

22

percent t hat was Medi cai d, about how many per spect i ve23 new pat i ent s woul d you have come i n i n a year ?

24 MR. HECTOR CANALES: Ar e we st i l l - - i f I

25 can ask f or some cl ar i f i cat i on. What year or - -


34/167



Page 34

1 MR. MORI ARTY: I ' l l - - I ' l l cl ar i f y.

2 Q. ( BY MR. MORI ARTY) For t he year 2010 - - and

3 nobody' s goi ng t o mar r y you t o t hese number s. I ' m

4 l ooki ng f or your best r ecol l ect i on.

5 A. Okay.

6 Q. Okay? For t he year 2010 about how many

7 per spect i ve Medi cai d or t hodont i cs pat i ent s came t o your

8 cl i ni cs?

9 A. Meani ng t hat we di d not st ar t t r eat ment , t hey

10 j ust came i n f or exami nat i ons?11 J UDGE EGAN: Yes.

12 Q. ( BY MR. MORI ARTY) For - -

13 A. J ust came i n f or exami nat i on. I j ust want t o

14 cl ar i f y t hat .


16 J UDGE EGAN: The ent i r e body.17 A. Pr obabl y we woul d get - - j ust Medi cai d

18 popul at i on pr obabl y we woul d get about 2, 000, 2500.

19 J UDGE EGAN: Per mont h? Per year ?

20 THE WI TNESS: No. Per year .

21 J UDGE EGAN: Okay.

22

THE WI TNESS: Bet ween t he t wo - - t wo23 of f i ces, I bel i eve, yeah, t wo of f i ces dur i ng t hat t i me.

24 J UDGE EGAN: Thank you.

25 Q. ( BY MR. MORI ARTY) Gi ve me your r ange of - -


35/167



Page 35

1 woul d i t be no l ess t han 2, 000, no mor e t han 3, 000?

2 MR. HECTOR CANALES: I ' m goi ng t o obj ect

3 at t hi s poi nt i n t i me, your Honor . J ust one

4 ant i ci pat i on of what t hi s guessi ng t est i mony' s goi ng t o

5 be used f or t hat Mr . - - i t ' s goi ng t o be some sor t of

6 cal cul at i on t hat ' s l at er goi ng t o be t ur ned i n and i t ' s

7 j ust i mpr oper . These ar e al l guesses and I don' t

8 bel i eve i t ' s pr oper t est i mony.

9 J UDGE EGAN: Wel l , i t ' s an est i mat i on.

10 And he' s al r eady t est i f i ed as t o what t he est i mat i on11 was.

12 MR. MORI ARTY: Okay.

13 MR. HECTOR CANALES: And t hat ' s my

14 obj ect i on, your Honor , i s t o havi ng hi m t est i f y as t o

15 est i mat i ons. I don' t t hi nk t hat i s pr oper especi al l y

16 when I t hi nk t he pl an i s t o use t hese est i mat i ons t o17 use quest i ons i n t he f ut ur e.

18 J UDGE EGAN: When t hey get t o t her e, you

19 can r ai se your obj ect i on.

20 MR. HECTOR CANALES: Okay. Thank you,

21 your Honor .

22

Q. ( BY MR. MORI ARTY) Wel l , you wer e here when23 J ack St i ck t est i f i ed t hat f or t he t hree year s bef or e - -

24 t hr ee year s i n quest i on - -

25 A. Uh- huh.


36/167


37/167



Page 37

1 t he quest i on we asked ear l i er i s what i s t he t ot al pool

2 f r om whi ch a segment was dr awn f r om.

3 MR. HECTOR CANALES: And I ' m not t r yi ng t o

4 di sr upt t hat , your Honor . Under st and. I j ust want t o

5 make sur e t hat we' r e deal i ng wi t h t he r i ght t i me

6 per i ods and t hat i t ' s cl ear t o t he wi t ness because I

7 t hi nk we mi ght be j umbl i ng mul t i pl e year s. And I

8 under st and t he Cour t want s t hat i nf or mat i on.

9 J UDGE SEI TZMAN: And I under st and t hat

10 you' r e t r yi ng t o get compar at i ve t i me per i ods.11 MR. HECTOR CANALES: That ' s r i ght .

12 Q. ( BY MR. MORI ARTY) Li st en caref ul l y,

13 Dr . Nazar i .

14 A. I - - yes, si r .

15 Q. For t he t i me per i od bef ore t he St ate showed up

16 f or a r ecor d sear ch - -17 A. Yes, s i r .

18 Q. - - 2009- 2010, what per cent age of t he pot ent i al

19 Medi cai d or t hodont i cs pat i ent s t hat act ual l y came t o

20 your cl i ni cs seeki ng or t hodont i c ser vi ces di d you

21 scr een so t hi s many di dn' t - - you sought t o gi ve

22

ser vi ces f or and t hi s many di d not ? And I ' m j ust23 l ooki ng f or a r at i o or a per cent age or a sense of

24 magni t ude.

25 A. Yes, si r , I under st and t hat . Pr obabl y


38/167



Page 38

1 about - - we submi t t ed pr obabl y - - I ' m j ust guessi ng - -

2 about 70 percent .

3 Q. 70 per cent of t he pat i ent ?

4 A. 70 - - yes, si r .5 MR. HECTOR CANALES: Mi ght I j ust have a

6 r unni ng obj ect i on t o t hi s ent i r e l i ne of est i mat i ng

7 quest i ons, your Honor ?

8 J UDGE EGAN: Yes.

9 MR. HECTOR CANALES: Thank you.

10 Q. ( BY MR. MORI ARTY) Your best swor n t est i mony11 bef or e t hi s panel i s t hat 70 per cent of t he Medi cai d

12 or t hodont i cs pat i ent s t hat came t o your door you

13 submi t t ed t o Medi cai d f or payment - -

14 A. I bel i eve - -

15 Q. - - f or - -

16 A. I bel i eve so, s i r .17 Q. Okay. And can we f ai r l y sur mi se f r om t hese 63

18 cases t hat i n vi r t ual l y al l of t hose cases you

19 submi t t ed cl ai ms f or t hose 70 per cent of peopl e based

20 on ect opi c er upt i on?

21 J UDGE EGAN: I f you don' t know you can say

22

you don' t know.23 A. I don' t know. I don' t know.

24 Q. ( BY MR. MORI ARTY) Okay. Al l r i ght .

25 Let ' s go t o - - l et ' s go t o t hat document I


39/167



Page 39

1 put i n f r ont of you, t he r ecor ds af f i davi t .

2 A. I di dn' t say.

3 Q. Now, how di d you f i nd out t hat t he St at e was

4 out at your of f i ce seeki ng medi cal r ecor ds?

5 A. I was cal l ed by t he of f i ce manager .

6 Q. And t hat of f i ce manager woul d be Mr . Tar dy?

7 A. Yes, s i r .

8 Q. Wi l l i am Tar dy?

9 A. Yes, s i r .

10 Q. He' s t he gent l eman who act ual l y si gned t hi s11 af f i davi t , t hi s r ecor ds af f i davi t t hat ' s i n f r ont of

12 you, cor r ect ?

13 A. Yes, s i r .

14 Q. And he was your of f i ce manager and t he per son

15 who was r esponsi bl e f or gat her i ng up t hese medi cal

16 r ecor ds?17 A. Yes, s i r .

18 Q. And you want ed hi m t o gi ve al l of t he medi cal

19 r ecor ds t hat wer e i n your possessi on t o t he aut hor i t i es

20 as t hey r equest ed, cor r ect ?

21 A. Yes, s i r .

22

Q. Okay. Now, I ' m not goi ng t o of f er t hi s23 document i nt o evi dence because i t ' s got t he act ual

24 names of t he pat i ent s on i t ; but what I woul d l i ke t o

25 have you do i s go t o t he second page and you see a


40/167



Page 40

1 cl i ent PCN t hat ' s down at t he bot t om t hat says - -

2 MR. MORI ARTY: May I approach t he wi t ness,

3 J udge?

4 J UDGE EGAN: Yes, you can.5 Q. ( BY MR. MORI ARTY) I can si mpl i f y t hi s,

6 Dr . Nazar i . For t hi s pat i ent - - you see on t he f or m?

7 A. Yes, s i r .

8 Q. That pat i ent , whi ch we show as Pat i ent Number

9 43, your of f i ce di d not pr ovi de a dent al mol d, di d i t ?

10 A. No, s i r .11 Q. And f or Pat i ent 13, your of f i ce di d not

12 pr ovi de a dent al mol d, di d i t ?

13 A. No, s i r .

14 J UDGE EGAN: I f you want t o go wi t h hi m

15 and st and t o see, you' r e wel come t o. I t ' s up t o you.

16 MR. HECTOR CANALES: I wi l l , your Honor .17 J UDGE EGAN: Okay. We' r e at Pat i ent 13

18 di d not have a dent al mol d.

19 MR. MORI ARTY: Yes, ma' am.

20 Q. ( BY MR. MORI ARTY) That ' s t r ue. Pat i ent 13

21 di d not have a dent al mol d?

22

A. That ' s what t hi s mar ki ng her e.23 Q. Wel l , t he r ecor ds af f i davi t t hat was si gned by

24 Wi l l i am Tar dy, your of f i ce manager , conf i r ms t hat t hat

25 pat i ent di d not - - you di d not submi t a mol d f or t hat


41/167



Page 41

1 pat i ent , di d you?

2 A. No, si r .

3 Q. Okay. Now, t her e' s one t hat - - t her e' s no

4 mol d f or t he pat i ent under neat h t hat but l et me

5 r epr esent t o you t hat pat i ent i s not one of t hese 63.

6 A. Okay.

7 Q. Okay?

8 A. Yes, s i r .

9 Q. So, go t o t he next page and we' ve got anot her

10 mi ssi ng mol d f or t hi s chi l d but t hat chi l d i s not one11 of t hese 63 t hat ' s i n quest i on her e.

12 A. Yes, s i r .

13 Q. Okay. And t he next chi l d i s Pat i ent Number 32

14 and t her e' s a mi ssi ng mol d i n t hat case, cor r ect ?

15 A. Yes, s i r .

16 Q. And Pat i ent Number 2, mi ssi ng mol d?17 A. Yes, s i r .

18 Q. Pat i ent Number 1, mi ssi ng mol d?

19 A. Yes, s i r .

20 Q. Pat i ent Number 4, mi ssi ng mol d?

21 A. Yes, s i r .

22

Q. Thr ee mor e pat i ent s mi ssi ng mol d, but t hey' r e23 not i n t he 63. So, t hey don' t mat t er f or t hi s hear i ng.

24 A. Okay. Yes, si r .

25 J UDGE SEI TZMAN: Excuse me. Si nce you' r e


42/167



Page 42

1 not over t her e, you' r e t al ki ng about t he t hr ee t hat ar e

2 gr ouped t oget her bef or e t he ver y l ast one on t hat page?


4 Q. ( BY MR. MORI ARTY) And t hen none of t hose

5 t hr ee ar e par t of t he 63 i n quest i on?

6 A. Yes, s i r .

7 Q. And t hen one underneat h t hat ' s Pat i ent Number

8 48, mi ss i ng mol d?

9 A. Yes, s i r .

10 Q. Okay. And l ast page, Pat i ent Number 45,11 mi ssi ng mol d?

12 A. Yes, s i r .

13 Q. Okay. Now, you agr ee t hat - -

14 A. You want me t o keep t hi s or you - -

15 Q. I t hi nk t hat ' s al l I ' ve got , t hank you, on

16 t hi s one.17 Now, you agr ee - -

18 J UDGE EGAN: Hol d on j ust a second. J ust

19 want ed t o make sur e I got al l of t hem.

20 MR. MORI ARTY: 1, 4, 13.

21 J UDGE SEI TZMAN: J udge Sei t zman gave t hem

22

t o me. I know what ' s mi ss i ng.23 Q. ( BY MR. MORI ARTY) Okay. So - - and t hose

24 mol ds ar e requi r ed t o be kept by Texas St ate Boar d

25 r ul es and by t he r ul es t hat you - -


43/167



Page 43

1 A. Yes, s i r .

2 Q. Okay. And you di dn' t - - you di dn' t have t hem?

3 A. No, s i r .

4 Q. Okay. They' r e al l - - you acknowl edge t hose5 ar e al l pr ogr am vi ol at i ons, ar en' t t hey?

6 A. I can - - I don' t know. I don' t know about

7 pr ogr am vi ol at i ons ent i t l ed t o. I t mi ght be.

8 Q. Wel l , you under - - - I ' m sor r y. Go ahead and

9 f i ni sh.

10 A. Yeah. I t mi ght be, yes.11 Q. Okay. You under st and you' r e obl i gat ed t o know

12 t he Medi cai d r ul es and you' r e obl i gat ed t o f ol l ow t hem

13 and i f you don' t know what t hey ar e, you under st and

14 you' r e obl i gat ed t o f i nd out what t hey ar e?

15 A. Yes, s i r .

16 Q. You' r e obl i gat ed t o r ead t hi s manual and17 f ol l ow i t , ar en' t you?

18 A. Yes, s i r .

19 Q. And i f you f ai l t o do so, we have t he r i ght t o

20 not pay you, don' t we?

21 A. I don' t know t hat . I don' t know i f you' r e

22

obl i gat ed t o do t hat or not .23 Q. Okay.

24 A. That ' s not my deci si on.

25 Q. Al l r i ght . Now, we can go t o t hese f i l es i f


44/167



Page 44

1 you want t o and I ' l l be happy t o. We' ve got t he f i l es

2 here.

3 But f or Pat i ent Number 22 and Pat i ent

4 Number 48, t hose r ecor ds, t he recor ds we got f r om you5 do not show pr e- t r eat ment X r ays, do t hey?

6 A. I don' t r emember , si r .

7 MR. MORI ARTY: Al l r i ght . Let ' s go t o

8 P22.

9 Q. ( BY MR. MORI ARTY) Now, what I ' m goi ng t o do

10 i s I ' m goi ng t o j ust r api dl y go t hr ough page by page;11 and i f you see pr e- t r eat ment X r ays i n t her e, I want

12 you t o t el l me where we ar e.

13 A. Yes, s i r .

14 Q. And we' l l st ar t wi t h 220001, 02, 03.

15 A. I ' m sor r y. Can you go back?

16 Q. Go back.17 A. That ' s - - t hat up t her e - - no, not t hi s one.

18 The one up t op.

19 J UDGE EGAN: The above one.

20 A. I - - t hat shoul d be pr e- t r eat ment

21 cephal omet r i cs.

22

J UDGE EGAN: I can' t - -23 Q. ( BY MR. MORI ARTY) That ' s one of t he X r ays

24 you' r e obl i gat ed.

25 A. Yes. No. I ' m sayi ng one of t hem i s up t her e.


45/167



Page 45

1 Q. But you' r e obl i gat ed t o have mor e t han t hat ?

2 A. I under stand, s i r . I ' m j ust t r yi ng t o poi nt

3 out t o you t hat - -

4 Q. And t hi s X r ay, t hi s panor ami c vi ew, t hat ' s

5 dur i ng t r eat ment , i sn' t i t ?

6 A. Yes, s i r .

7 Q. So, you l ack t he pr e- t r eat ment X r ays i n t hi s

8 f i l e?

9 A. Can we - - can we go down?

10 Q. Yes, s i r .11 03, l et ' s l ook at t he dat e on t hat . I s

12 t hi s post t r eat ment ?

13 A. I bel i eve so.

14 Q. Okay. So, t hi s doesn' t qual i f y.

15 Next - - next X - - next , 05. Thi s i s

16 dur i ng t r eat ment ?17 A. You - - I don' t bel i eve you have i t .

18 Q. Okay. So, we - - we' r e i n agr eement t her e' s no

19 pr e- t r eat ment X r ay f or Pat i ent 22, cor r ect ?

20 A. Yes, s i r .

21 Q. Do you agr ee t hat t her e' s no pr e- t r eat ment

22

X r ay f or Pat i ent 48?23 A. At t he t i me t hat you pi cked up - - at t he t i me

24 t hat you pi cked up t he r ecords probabl y we di d not t ur n

25 i t i n. But t hat does not mean t hat i t never exi st ed.


46/167



Page 46

1 Q. Si r , I can' t possi bl y eval uat e your conduct

2 wi t h anyt hi ng ot her t han t he evi dence you tur n over

3 when we show up, r i ght ?

4 MR. HECTOR CANALES: Obj ect i on. I t ' s

5 ar gument at i ve. Si debar .

6 A. I don' t know, si r .


8 J UDGE EGAN: I t ' s been answer ed.

9 Go ahead.

10 Q. ( BY MR. MORI ARTY) You don' t have a11 pr e- t r eat ment X r ay f or Pat i ent 48, do you?

12 A. No, si r .

13 Q. Okay. Now, do you want t o go t hr ough t he si x

14 no t r eat ment car d f i l es par t i cul ar l y 02, 04, 05, 06,

15 07, 08?

16 A. I ' m sor r y. I don' t under st and your quest i on.17 J UDGE EGAN: Run t hose number s by - -

18 A. I di dn' t underst and what you mean.

19 Q. ( BY MR. MORI ARTY) Pat i ent 2, 4, 5, 6, 7, and

20 8, what ' s t he - - what ' s t he t r eat ment car d?

21 A. What does t hat mean? What ar e you aski ng?

22

Q. You' r e aski ng what - - you' r e aski ng me what a23 t r eat ment car d i s?

24 A. Yeah. What do you mean t her e i s no t r eat ment

25 car d? I need t o know who t he pat i ent s ar e bef or e I can


47/167



Page 47

1 answer .

2 Q. Al l r i ght . Let ' s l ook at Pat i ent Number 2.

3 J UDGE EGAN: J ust f or my cl ar i f i cat i on,

4 Mr . Mor i ar t y, when you say " t r eat ment car d, " ar e you

5 r ef er r i ng t o what a l ayper son t ypi cal l y r ef er s t o as

6 t he cl i ni cal r ecor d wher e t he doct or makes not at i ons?

7 MR. MORI ARTY: Yes, ma' am.

8 J UDGE EGAN: Okay.

9 MR. HECTOR CANALES: Your Honor , and we

10 woul d obj ect t o t hat . I don' t bel i eve t hat ' s one of11 t he ar eas t hat i s l i st ed i n t he compl ai nt f or a pr ogr am

12 vi ol at i on. I coul d be wr ong but I don' t r ecal l t hat .

13 J UDGE EGAN: Gi ve me a second.

14 MR. MORI ARTY: J udge, t hi s woul d be a dat e

15 of ser vi ce i ssue.

16 J UDGE SEI TZMAN: I ' m sor r y. I di dn' t hear17 what you sai d.

18 MR. MORI ARTY: I t ' s a dat e of servi ce

19 i ssue.

20 J UDGE EGAN: The pl eadi ng f r om my

21 r ecol l ect i on, because I act ual l y br oke t he pl eadi ng

22

down, i s t hat f ai l ed t o keep r ecor ds f or t he t i me23 r equi r ed and ot her document s or model s r equi r ed by

24 f eder al or st at e l aw or r egul at i ons or cont r act t o be

25 mai nt ai ned - - t hat t hey' r e cont r act ed t o be mai nt ai ned.


48/167



Page 48

1 So, t hat i s Al l egat i on 1. Let ' s t ake a

2 l ook at i t .

3 J UDGE SEI TZMAN: I s t hi s - - i s t hi s t he

4 one about t he dat es of ser vi ce and f ai l ed t o make t he5 act ual dat es?


7 J UDGE SEI TZMAN: Okay.


9 Thi s i s wher e you' r e - - i t ' s her e.

10 MR. HECTOR CANALES: These ar e on11 pat i ent s - - t he f i r st ei ght pat i ent s 2 t hr ough 8 or - -

12 MR. MORI ARTY: No, i t ' s - - I ' m sor r y.

13 Pl ease excuse me.

14 Pat i ent 2, 4, 5, 6, 7, 8.

15 MR. HECTOR CANALES: And t he cont ent i on i s

16 t hat t hese t r eat - - t hese - - t her e' s no r ecor ds of17 t r eat ment on t hese - - on t hose?

18 J UDGE EGAN: The servi ce dat es.

19 MR. MORI ARTY: I t ' s a dat e of servi ce

20 i ssue.

21 MR. HECTOR CANALES: Okay. Al l r i ght .

22

J UDGE SEI TZMAN: I ' m sor r y. I s 6 i n t her e23 because I di dn' t get - -


25 J UDGE SEI TZMAN: I got 4, 5, 6, 7, 8.


49/167



Page 49

1 MS. SI LHAN: 6 i s.

2 Q. ( BY MR. MORI ARTY) Okay. Let ' s go t o Pat i ent

3 2, Page 1. Ther e' s no dat e of ser vi ce on t hi s f or m, i s

4 t her e?

5 A. No dat e of ser vi ce, yes, si r .

6 Q. Page 2, i s t her e a dat e of ser vi ce her e?

7 A. I don' t see one.

8 Q. Page 3?

9 A. Ther e ar e di f f er ent dat es t her e.

10 Q. I ' m sor r y?11 A. Ther e wer e di f f er ent dat es t her e and t hat ' s

12 t he dat e shi pped r i ght t her e 4/ 1/ 09. Thi s i s t he

13 l abor at or y sl i p t hat we sent f or t he st udy model s

14 4/ 1/ 09.

15 Q. I ' m sor r y. Excuse me. I di dn' t mean t o cut

16 you of f . Go ahead.17 A. No. That ' s t he dat e t hey' r e goi ng t o be

18 shi pped, st udy model s 4/ 1/ 09 t o t he Genesi s Or t hodont i c

19 Labor at or y.

20 Q. Al l r i ght . But t hat ' s one of t he ser vi ces but

21 t hat ' s onl y one of t he ser vi ces t hat you bi l l ed t he

22

St at e f or on t hi s chi l d, cor r ect ?23 A. I under st and your quest i on, yes, si r .

24 Q. Okay. Page 4, no dat e of ser vi ce t her e?

25 A. Wel l , you have er ase t her e. I mean, t her e' s


50/167



Page 50

1 t he dat e r i ght t her e under Ant oi ne Dent al . Ther e

2 shoul d be a dat e. The comput er aut omat i cal l y put s t he

3 dat e on t here.

4 Q. Doct or , I ' m l ooki ng f or t he dat es wher e you

5 al l egedl y t r eat ed t hi s chi l d.

6 A. Wel l , I ' m sor r y, si r . You ar e showi ng me t he

7 wr ong document s. You need t o go t o t he pr ogr ess not es.

8 Q. We' r e goi ng - - we' r e goi ng t o get t her e. I

9 j ust - - I want t o el i mi nat e - -

10 A. That ' s t he r eason t her e' s a dat e t her e.11 Yes, t her e i s a dat e t her e.

12 Q. Al l r i ght . Let ' s go t o pr ogr ess not es. Next .

13 Okay. We' ve gone t hrough t he r ecor d and

14 we have no document s i n t hat f i l e t o show when you

15 pr ovi ded t r eat ment f or t hat chi l d. Tr ue?

16 A. Based on t hese document s t hat you have, yes,17 si r .

18 Q. Okay. So, we don' t have a compl et e and a

19 t hor ough medi cal r ecor d f or t hat chi l d j ust i f yi ng t he

20 t r eat ment t hat you r ender ed f or t hat chi l d, cor r ect ?

21 A. Based on what you have, yes, si r .

22

Q. Okay. Do you want t o concede t he same t hi ng23 i s t r ue f or 4, 5, 6, 7 and 8 or do you want t o go

24 t hr ough t hem?

25 A. I f you don' t mi nd.


51/167



Page 51

1 MR. MORI ARTY: Al l r i ght . Let ' s go t o 4.

2 J UDGE EGAN: And f or t he r ecor d, we' r e

3 goi ng t hr ough each page i n t he f i l e of t hese pat i ent s?

4 Q. ( BY MR. MORI ARTY) Al l r i ght . We' ve gone5 t hr ough - - f or Pat i ent 4 we' ve gone t hr ough

6 Pet i t i oner ' s 04 t hr ough 0007. Do you concede t hat

7 t her e' s no dat e of t r eat ment r ecor d f or Pat i ent 4?

8 A. Based on what I see on t he scr een, no, si r .

9 Q. Wel l , but what you see on t he scr een' s your

10 f i l e t hat we got f r om you, r i ght ?11 A. I bel i eve so.

12 Q. And you agr eed t hat i t ' s l acki ng dat es of

13 t r eat ment , cor r ect ?

14 A. Yes, s i r .

15 Q. Okay. Pat i ent - - we' r e at 5. Let ' s go

16 t hr ough 5. Same t hi ng, no - - no dat e of t r eat ment ,17 r i ght ?

18 A. No, s i r .

19 Q. Okay. Goi ng t o go t o 6?

20 A. Pl ease.

21 Q. Okay.

22

MR. MORI ARTY: Let ' s go t hr ough i t , St ace.23 Q. ( BY MR. MORI ARTY) Okay. We got t he same

24 pr obl em on 6, r i ght ?

25 A. I t seems l i ke i t , yes, si r , based on what you


52/167



Page 52

1 have.

2 Q. Al l r i ght . We' ve got no pr oof of when you

3 t r eat ed t hat chi l d, cor r ect ?

4 A. I t doesn' t l ook l i ke i t on t hi s - - on t hi s

5 scr een, no.

6 Q. Wel l , I want t he r ecor d t o be cl ear . Your

7 f i l es t hat we got t hat I ' ve showed you don' t have t he

8 dat e of ser vi ce of t hat chi l d t hat you bi l l ed t he St at e

9 f or , t rue?

10 A. Yes, s i r .11 Q. And you' r e obl i gat ed t o pr ovi de t hat

12 i nf or mat i on t o t he St at e and i t ' s got t o be t r ue and

13 accur at e and cor r ect , r i ght ?

14 A. Yes, s i r .

15 Q. Okay. And you di dn' t do t hat , di d you?

16 A. No, si r .17 Q. Okay.

18 MR. MORI ARTY: Let ' s go t o 7, Pat i ent 7.

19 Q. ( BY MR. MORI ARTY) Okay. We' ve gone t hrough

20 al l t he r ecords on Pat i ent Number 7. You have no

21 pr ogr ess not es showi ng dat e of ser vi ce on t hat f i l e

22

ei t her , do you?23 A. No, si r .

24 Q. You want t o go t hr ough 8?

25 A. Pl ease.


53/167



Page 53

1 Q. Okay. We' ve gone t hr ough al l of t he - - al l of

2 your pat i ent f i l e f or t he f i l e you' ve pr ovi ded t he

3 St at e f or Pat i ent Number 8 and t her e' s no pr ogr ess

4 not es i n t hat f i l e, cor r ect ?

5 A. Yes, s i r .

6 Q. Okay. So, do you now concede t hat f or Pat i ent

7 2, 4, 5, 6, 7, and 8 t hose f i l es ar e not f ul l , compl et e

8 and accur at e as you ar e requi r ed t o keep, cor r ect ?

9 A. Yes, s i r .

10 Q. Okay. Now, l et ' s - - we' ve got t hr ee chi l dr en11 t hat you t r eat ed t hat wer e under 12, Pat i ent 15,

12 Pat i ent 56 and Pat i ent 60. You know t hat you t r eat ed

13 and bi l l ed f or t hr ee chi l dr en under 12, cor r ect ?

14 A. I - - can we go t hr ough t hem, pl ease?

15 Q. Sur e.

16 J UDGE EGAN: Pat i ent 15?17 MR. MORI ARTY: 15, 56 and 60.

18 Q. ( BY MR. MORI ARTY) Now, I t hi nk - - and I want

19 you t o bear wi t h me on t hi s - - t hese r ecor ds ar e

20 r edact ed, whi ch means we' ve t aken al l of t he pat i ent

21 i dent i f yi ng i nf or mat i on of f of t he r ecor ds. Now, we

22

have t he or i gi nal r ecor ds her e i n t he cour t r oom, your23 or i gi nal r ecor ds, whi ch you' r e happy t o go t hr ough, i f

24 you want t o. But l et me t el l you t hat t hese r ecor ds

25 t hat we' ve got up t her e ar e r edact ed.


54/167



Page 54

1 Do you admi t t hat you submi t t ed bi l l s t o

2 t he St at e of Texas f or t hr ee chi l dr en who wer e under

3 t he age of 12 who you were not al l owed t o t r eat f or

4 f ul l or t hodont i c ser vi ces? Do you concede t hat ?

5 A. No, si r .

6 Q. Al l r i ght .

7 A. Need t o l ook at t he r ecor ds.

8 Q. Then what I ask you t o do i s whi l e we' r e at a

9 br eak, you go t hr ough t hose - - f i nd t hose t hr ee f i l es

10 and you ver i f y that what I ' m asser t i ng t o t he Cour t i s11 t r ue t hat you got t hr ee chi l dr en, Pat i ent 15, Pat i ent

12 55 and Pat i ent 60. And t hose t hr ee f i l es, your

13 or i gi nal f i l es, wi l l show t hose - - t hose t hr ee wer e

14 under age 12.

15 A. Okay, si r .

16 Q. Now, you act ual l y have t he r i ght t o r equest an17 exempt i on t o THMP t o t r eat a chi l d under 12. Ther e are

18 some chi l dr en under 12 t hat ar e appr opr i at e f or

19 t r eat ment ; i sn' t t hat t r ue?

20 A. Yes, s i r .

21 Q. And al l you have t o do i s ask f or an

22

exempt i on - - exempt i on f or t hat chi l d, cor r ect ?23 A. Yes, s i r .

24 Q. And you di dn' t ask f or t hat , di d you?

25 A. I need t o l ook at t he r ecor ds, si r . I don' t


55/167



Page 55

1 know.

2 Q. Par don me?

3 A. I need t o l ook at t he r ecor ds. I don' t

4 r emember i f I di d or not .

5 Q. Al l r i ght . Now, l et ' s go t o Pat i ent 23. What

6 i s an ext r act i on r equest ?

7 A. You mean i n her e?

8 Q. I want - - I want you t o t el l me - - t el l t he

9 j udges what an ext r act i on r equest i s.

10 A. I f we do i t wi t hi n t he of f i ce, i f we do i t i n11 t he of f i ce, we wr i t e on t he - - i n t he not es. These ar e

12 t he t r eat ment car d t hat you were aski ng me or we cal l

13 i t pr ogr ess not es. We wr i t e i t i n her e. I f we have t o

14 send i t t o a speci al t y out of t he of f i ce, t hen we have

15 a r ef er r al not e t hat , you know, i t has t he Ant oi ne

16 Dent al Cent er l ogo and t hen our phone number and17 ever yt hi ng. And t hen we gi ve i t t o - - you know, we

18 send i t t o t he or al sur geon. We r ef er t o or al sur geon.

19 J UDGE EGAN: I can barel y see t hat . So,

20 can you hi ghl i ght wher e t he wor d - - t he wor ds ar e - -

21 Q. ( BY MR. MORI ARTY) There' s not hi ng on t hi s - -

22

t hi s f or m, i n f act , t her e' s not hi ng i n t hi s f i l e, t o23 i ndi cate you may - - you had a pr oper ext r act i on

24 r equest , cor r ect ?

25 A. I cannot see, si r . You t al ki ng about - -


56/167



Page 56

1 J UDGE EGAN: She' s goi ng t o enl arge - -

2 l ooks l i ke she' s t r yi ng t o enl ar ge i t .

3 A. I t ' s r i ght i n her e. Br aces on f i ve t o f i ve,

4 need t o ext r act upper - -5 J UDGE SEI TZMAN: Okay. Hang on. Hang on,

6 Doct or .


8 J UDGE SEI TZMAN: Pul l t he mi cr ophone t o

9 your l ef t wher e your wat er bot t l e i s. From t her e you

10 can t al k.11 A. Okay. Ri ght her e i t says br aces on f i ve t o

12 f i ve means t he upper t eet h and l ower t eet h st ar t i ng

13 f r om t he mol ar s need t o ext r act upper f our s and expose

14 upper f i ves.

15 Q. ( BY MR. MORI ARTY) Ar e you r equi r ed t o have an

16 ext r act i on r equest as par t of t he f i l e?17 A. Wi t hi n t he of f i ce, I don' t t hi nk so. I don' t

18 know. I don' t t hi nk so.

19 Q. Okay. I ' m t r yi ng - - I need some cl ar i t y on

20 t hat quest i on.

21 Ar e you or are you not r equi r ed t o have

22

wi t hi n your f i l e a pr oper ext r act i on r equest ? Yes or23 no.

24 A. No, s i r .

25 Q. Okay. I ' m goi ng t o ask at t he br eak t o l ook


57/167



Page 57

1 at 15, 56 and 60.

2 Now, l et ' s swi t ch t o anot her coupl e of

3 ar eas.

4 J UDGE EGAN: Hol d on j ust a second. Di d

5 you - -

6 J UDGE SEI TZMAN: I j ust want t o be cl ear

7 at t hi s poi nt i n t he r ecor d. When we' r e t al ki ng about

8 "ext r act i on r equest , " we' r e t al ki ng about ext r act i on of

9 a t oot h?

10 MR. MORI ARTY: Yes, si r .11 J UDGE SEI TZMAN: And t hat ' s what you

12 under st ood, Dr . Nazar i , t al ki ng about ext r act i on - -

13 THE WI TNESS: Yes, si r .

14 J UDGE SEI TZMAN: - - of a t oot h?

15 THE WI TNESS: Yes, si r .

16 Q. ( BY MR. MORI ARTY) You' r e not an or t hodont i st ?17 A. No, si r .

18 Q. When di d you deci de t o get i nt o t he

19 or t hodont i cs busi ness?

20 A. I gr aduat ed i n 1998 and i n 1999 or 2000 I

21 st ar t ed t aki ng some cont i nui ng - - cont i nui ng educat i on

22

cour ses.23 Q. My quest i on, si r , i s: When di d you deci de t o

24 get i nt o t he Medi cai d or t hodont i cs busi ness?

25 A. Oh, Medi cai d or t hodont i cs I t hi nk i t was


58/167



Page 58

1 around l at e 2002- 2003.

2 Q. And why di d you deci de t o do so?

3 A. I nt o Medi cai d?

4 Q. Yes.5 A. Medi cai d or - -

6 Q. Yes.

7 A. - - i n gener al ?

8 I don' t know. I j ust l i ke doi ng or t ho- - -

9 or t hodont i cs.

10 Q. Now, you r epr esent ed t o t he Cour t a l i t t l e bi t11 ear l i er t hat about 30 per cent of your pr act i ce i n t he

12 past , say 2010 or 2011, was pr i vat e pay.

13 A. Uh- huh.

14 Q. And 60 or 70 per cent of your pr act i ce was

15 Medi cai d; i s t hat cor r ect ?

16 A. I bel i eve so.17 Q. And you were si gni ng up and submi t t i ng

18 somet hi ng over a t housand a year Medi cai d pat i ent s,

19 correct?

20 A. I n t he past f ew year s t hat you ment i oned, yes,

21 si r .

22

Q. Al l r i ght . And you' r e doi ng pur el y23 pr i vat e- pay pat i ent s t oday?

24 A. Yes, si r . Wel l , no. No. I t ake i t back. I

25 st i l l see my Medi cai d pat i ent s. We have - - you know,


59/167



Page 59

1 I ' m not get t i ng pai d because t hey have nowher e t o go.

2 Q. Okay.

3 A. I st i l l see t hose pat i ent s.

4 Q. And f or your pr i vat e- pay or t hodont i cs5 pat i ent s, how many new pr i vat e- pay or t hodont i cs

6 pat i ent s have you si gned up i n t he l ast 60 days?

7 A. I n t he l ast 60 days? Pr obabl y about hundr ed,

8 120 bet ween t he t wo of f i ces.

9 Q. Maybe t wo a day?

10 A. Wel l , i f you' r e goi ng t o di vi de i t by 30 days11 a mont h, whi ch, you know, we ar e cl osed on Sundays

12 and - - however you want t o aver age i t , I ' l l t ake i t .

13 Q. Al l r i ght . Do you know what an ect opi c

14 er upt i on i s?

15 A. Yes, s i r .

16 Q. Now, do you agr ee wi t h t he pr oposi t i on t hat17 what ever an ect opi c er upt i on i s t he - - 70 per cent of

18 t he pat i ent s t hat had i t t hat came t o you - - Medi cai d

19 pat i ent s came t o you, what ever condi t i on t hey had, i t

20 cer t ai nl y wasn' t unusual , was i t ?

21 A. Wasn' t unusual ?

22

Q. Yes, si r .23 A. I n what t er m? What do you mean by unusual ?

24 Unusual bei ng i r r egul ar and bei ng abnor mal , yes, t hey

25 were unusual .


60/167



Page 60

1 Q. What does unusual mean t o you?

2 A. Whi ch i s not - - somet hi ng t hat i s abnor mal ,

3 whi ch i s not supposed t o be t her e, not r egul ar .

4 J UDGE EGAN: Okay. I ' m get t i ng l ost i n

5 t hi s. So, can you j ust speak a l i t t l e sl ower and ask

6 your quest i on and bot h - - bot h of you wai t unt i l t he

7 ot her f i ni shes?

8 Q. ( BY MR. MORI ARTY) The usual condi t i on of t he

9 Medi cai d pat i ent s t hat pr esent ed t hemsel ves i n your

10 of f i ce, t he usual condi t i on was what ever i t i s you now11 cal l ect opi c er upt i ons; i sn' t t hat t r ue?

12 A. I t ' s not what I cal l ect opi c er upt i on. I t ' s

13 what I was t aught whi ch i s what I l ear ned f r om t he

14 manual and f r om t he NHI C how t o eval uat e ect opi c

15 er upt i on.

16 Q. My poi nt , si r , i s t hi s: Ther e wasn' t anyt hi ng17 unusual - - about what ever condi t i on t hat was, i t wasn' t

18 unusual . I n f act , i t exi st ed i n ever y si ngl e one of

19 t hese 63 pat i ent s, cor r ect ?

20 A. I t was unusual , si r .

21 MR. MORI ARTY: May we t ake a l i t t l e shor t

22

br eak? I t hi nk I ' m about done.23 J UDGE EGAN: Why don' t you pul l t hose

24 f i l es whi l e we t ake a br eak and l et hi m l ook t hr ough

25 t hem.


61/167



Page 61

1 MR. MORI ARTY: Yes, ma' am. That ' l l be

2 good.

3 J UDGE EGAN: And we' l l t ake a 10- mi nut e

4 br eak. We' l l be back at a quar t er af t er 10: 00.5 ( Of f t he r ecor d)

6 J UDGE EGAN: We' r e conveni ng i n SOAH

7 Docket Number 529- 13- 0997 and i t i s 10: 23 a. m.

8 And you may pr oceed.

9 MR. MORI ARTY: Thank you, your Honor .

10 Q. ( BY MR. MORI ARTY) Now, Dr . Nazar i , dur i ng11 t he br eak have you had t he oppor t uni t y t o r evi ew your

12 pat i ent f i l es?

13 A. Yes, si r , I di d.

14 Q. And have I cor r ect l y asser t ed t o t he Cour t

15 t hat on Pat i ent 15, Pat i ent 56 and Pat i ent 60, al l

16 t hr ee of t hose chi l dr en wer e under 12 when you t r eat ed17 t hem?

18 A. Yes, s i r .

19 Q. And you di d not r equest an exempt i on f r om t he

20 St at e f or t r eat i ng t hose chi l dr en, di d you?

21 A. On - -

22

J UDGE EGAN: You need t o move t he mi c23 cl oser or - -

24 MR. MORI ARTY: Wel l , somebody moved i t .

25 Sorry.


62/167



Page 62

1 Q. ( BY MR. MORI ARTY) You di d not - - you di d not

2 compl y wi t h Medi cai d r ul es when you submi t t ed t hose

3 cases, di d you?

4 A. I - - I di sagree. The f i r s t - - f i r s t pat i ent ,

5 Pat i ent Number 15, ** **** *****.

6 J UDGE EGAN: Don' t use names. Pl ease

7 r edact .

8 THE WI TNESS: I ' m sor r y. I ' m sor r y.

9 J UDGE EGAN: We j ust r ef er t o t hem as

10 Pat i ent Number 15.11 J UDGE SEI TZMAN: Excuse me.

12 And, St ephani e, wi l l you st r i ke t hat f r om

13 t he r ecor d?

14 Thank you.

15 A. Pat i ent Number 15, can we put her pi ct ur es on

16 t he scr een, pl ease.17 Q. ( BY MR. MORI ARTY) Si r , my quest i on i s: Was

18 she under 12 when you t r eat ed her ?

19 A. He was under 12.

20 Q. He was under 12?

21 A. He was born J anuar y 1, 2008. The r ul es

22

al l owed us t o do t hi s and t hi s i s t he same case even23 Dr . Tadl ock appr ove f or br aces; and i f Dr . Tadl ock i s

24 t he di r ect or and t he di r ect or of busi ness t el l s me t hi s

25 pat i ent needs braces and I send t he request and he


63/167



Page 63

1 appr oves i t , I don' t see what I di d wr ong.

2 Q. Al l r i ght . So, i f I under st and what you' r e

3 sayi ng, what you' r e t el l i ng t he Cour t i s even t hough

4 t he Medi cai d r ul es f or bi d you t o t r eat a chi l d under 12

5 wi t hout r equest i ng an exempt i on f r om t hat r ul e, t he

6 f act t hat t hey pai d i t pr oves t o you i t was val i d?

7 MR. HECTOR CANALES: Obj ect i on. Mi sst at es

8 hi s t est i mony.

9 J UDGE EGAN: I bel i eve i t does mi sst at e

10 hi s t est i mony, but i t ' s cross.11 That ' s not what you sai d, you' r e f r ee t o

12 say, "That ' s not what I sai d. "

13 A. Yeah. That ' s not what I sai d, si r .

14 I sai d I asked f or - - I submi t t ed al l t he

15 document s. I submi t t ed t he HLD. I submi t t ed t he

16 r equest f or m. I s

Documents

Vol. 4 Antoine Dental Centers vs. THHSC, OIG -Dr. Nazari