Dr. Tyrone C. Malloy M.D.

SARAH HOLMES:  Then it says, Please do not respond to this message.

DR. MALLOY:  Okay, keep going.

SARAH HOLMES:  Um, Sincerely, IBN, last initial

M, ACS, and it has a, um, identification #11027492.

DR. MALLOY:  Okay.  Then keep going.  You’ll – you’re – the body of the [indistinct; pages shuffling].

SARAH HOLMES:  Um - -

DR. MALLOY:  Maybe the area that you – that what you sent to her.

SARAH HOLMES:  Oh.

DR. MALLOY:  Oh, no, not [indistinct] the – the – the email that you – what you requested.

SARAH HOLMES:  Okay.  Um, comments.  We realize that Medicaid does not reimburse for elective terminations of a pregnancy.  I’m contacting you to make sure that our pol – office protocol is in compliance with GHP regulations for Medicaid patients.  Patients who are a member of the GHP Medicaid Program frequently call us – call us either to determine whether they are pregnant and how far along and/or because they may wish to terminate the pregnancy.  We immediately inform the patient that a voluntary pregnancy termination is not covered by Medicaid.  If the patient would like an office visit to confirm the pregnancy, the visit and the diagnostic tests are covered by Medicaid.  However, if the patient then decides to terminate the pregnancy and is medically eligible, she may do so but is personally responsible for all charges in related to the – to the abortion procedure.  Attached is a copy of our waiver form.  We would like to know if our form is acceptable in its current format.

And at the bottom, we have highlighted:  Patient understands that Medicaid does not pay for elective termination and this will have to be paid by her.  Patients may undergo additional counseling and terminate her pregnancy at this facility or at a facility of her choice.

DR. MALLOY:  Okay.  Do me a favor, okay, because I kind of had you go backwards.  Just, again, for the Court, read what her response was.

SARAH HOLMES:  Her response was:  Thank you for contacting the CIC.  We have received your inquiry.  The provider’s office is in compliance with Medicaid’s policies and the form is acceptable.

DR. MALLOY:  Okay.  With Medicaid policies?  Is that what’s written in there?

SARAH HOLMES:  Yes, it is.

DR. MALLOY:  Okay.  Um, Ms. – Ms. Holmes, any – anybody is – everybody right now – well, we – we – we’re all in an economic recession of some sort and I – I guess you know how much this has affected me.  About how much money has Medicaid withheld because of – withheld because of withholding my number, approximately?

SARAH HOLMES:  Uh, well over – I believe I would say approximately over 50,000.

DR. MALLOY:  So $50,000 they are – they held from me because they said I was doing something fraudulent or misrepresentation?

SARAH HOLMES:  Correct.

DR. MALLOY:  Yet, we have somebody from Medicaid who responded to you – and earlier somebody, and it’s a different person – responded to Dr. Callaway almost the same exact question saying that we were in compliance.

SARAH HOLMES:  Correct.

DR. MALLOY:  Um, and I, as you know, have I ever had any problems with taking care of Medicaid patients?

SARAH HOLMES:  No, you have not.

DR. MALLOY:  When doctors were not taking care of

Medicaid patients, I’ve taken care of Medicaid patients?

SARAH HOLMES: Yes, you have.

DR. MALLOY:  I’ve never closed the door on a

Medicaid patient?

SARAH HOLMES:  No, you have not.

DR. MALLOY:  Matter of fact, I’m probably one of the oldest gynecologists in the city of Atlanta.

SARAH HOLMES:  That is correct.

DR. MALLOY:  That’s actively practicing, still taking care of Medicaid patients.

SARAH HOLMES:  That is correct.

DR. MALLOY:  Okay.  So you know the frustration I had when I’ve never been subjected to anything negative about Medicaid to have this audit and to be standing here in this courtroom right now?

SARAH HOLMES:  Yes, I do.

DR. MALLOY:  Okay.  Because I have done nothing but comply with Medicaid policies for 29 years.

SARAH HOLMES:  That is correct. 

DR. MALLOY:  No further questions.

JUDGE TEATE:  Cross-examination?

TARA DICKERSON:  Just a couple of questions.  You never provided any medical records that were reviewed to this particular party, did you?

SARAH HOLMES:  I wasn’t asked to.

TARA DICKERSON:  But I’m saying you took the initiative to contact them, correct?

SARAH HOLMES:  Yes, I did.

TARA DICKERSON:  And you never provided them with

any medical records that were actually [indistinct], correct?

SARAH HOLMES:  No, I did not.

TARA DICKERSON:  No other questions.

JUDGE TEATE:  Anything else, sir?

DR. MALLOY:  [Indistinct]

JUDGE TEATE:  All right.  Thank you for coming.

SARAH HOLMES:  Thank you.

JUDGE TEATE:  Is she free to leave, sir?

DR. MALLOY:  Yes, she is.

JUDGE TEATE:  Dr. Malloy, I think you indicated she was your last witness - -

DR. MALLOY:  Yes.

JUDGE TEATE:  - - other than yourself.  Do you wish to give testimony directly?

DR. MALLOY:  Yes.  Yes.

JUDGE TEATE:  All right, go ahead, sir.

DR. MALLOY:  Do I - -

JUDGE TEATE:  You can – yeah.  As long as she can see you, you can remain there - -

DR. MALLOY:  Uh, okay.

JUDGE TEATE:  - - if that’s more comfortable.  All right.

DR. MALLOY:  Okay. 

JUDGE TEATE:  You’ve already been sworn, so - -

DR. MALLOY:  Okay.  Um, what – what I think, first of all, I – I truly think that – that there was some misinterpretation on the part of how these regulations were, um, evaluated.  If you actually look at the – the 904 provision that you made mention of, and I’m sorry I don’t, um, 904.2 – Physician Services, and it states:  In accordance with federal regulations and a recent Congressionally-enacted revision of the Hyde Amendment, and it goes on to basically say that the only time the federal government, um, would reimburse, uh, if the fetus were carried to term, if the mother was a victim or rape, incest or the life of the mother was in danger.  But this Amendment wanted to make sure that there could be a situation where a patient needed to undergo an abortion as mentioned in those three areas.  But they, to cover themselves and to make sure it was done properly, they have a form, the DMA-311 Form, that had to be submitted with a claim for abortions.

Now, they are specific when they’re talking about life endangerment, rape, incest, someone is going to have an abortion.  If you submit the claim, we will pay for the abortion and your procedures associated with that abortion.  Those two areas – those two areas, okay – are together.  They weren’t saying in that – in that 904.2 that you need to file this form for abortion-related procedures, meaning lab, ultrasound, if there’s endangerment, rape, incest.  They’re saying if you are filing for an abortion, then you must submit this claim and it will be covered for those areas.  That’s what DAM(sic)-311 was saying.  And what this 904.2 says, and it says in the second paragraph:  A Certificate of Necessity for Abortion certifying the above situation must be properly executed and attached to the claim form when submitted to the Division.  Form DAM(sic)-311 applies to surgical, non-surgical – and then it starts talking about whether it’s Mifepristone [indistinct].  And they talk about related services with that abortion.

What we have been doing at Old National – and you heard other facilities around the state of Georgia – for over 20 years, without anyone ever saying that we were doing something that was fraudulent, has been patient coming in.  They have no idea sometimes if, as mentioned over here, I’m sure some of them have an inkling that they are pregnant.  Yes, they do.  But they don’t know how far along they are.  They may find out that they are so far along that they are going to go on and keep the pregnancy.  They don’t know if they’re gonna have more than one, any twins, triplets.  They’re coming in to find out if they’re pregnant, how far along they’re pregnant, if there’s anything else going on and, with that, they then make the decision what they’re going to do.

Now they have made up in their mind – granted, a lot of them have made up in their mind – that, you know, if I’m pregnant, I’m gonna probably terminate this pregnancy unless I change my mind.  But if nothing else, if I don’t let the office know 24 hours in advance, if I just walk in there and make an appointment and find out, Hey, I’m coming in ‘cause I think I may be pregnant, and they – I find out that I’m pregnant, now I gotta make another trip back if I decide to terminate the pregnancy.  So I think for the sake of it not being a burden on them and making it we’re the only GYN practice in that area, I’ve been in that community for almost 20 years, everybody knows and they know my office.  You see my staff is not – I don’t have the kind of staff that turns over every month or two months.  My staff has been with for 20 years plus.  They come in there knowing, I need to say I’m going to have an abortion because, if I don’t say that, okay, and I find out that I am a certain number of weeks, I can’t have the abortion.  I’m gonna have to come back again.  So, yes, they put on that information sheet:  Coming in to terminate the pregnancy.  But you saw on one of the patients where she put that on the sheet and didn’t terminate the pregnancy.  And it wasn’t because she was too far.  It wasn’t because she wasn’t far enough.  She was seven weeks.  She was seven weeks, but, yet, she put on the information sheet to terminate the pregnancy.  But when she got in there, she changed her mind and she decided to maintain the pregnancy.

So not everybody who comes to that office, no matter what they put on that sheet, okay, decides to terminate the pregnancy.  But if they do decide to terminate the pregnancy, that is a right that they have.  They’re not asking Medicaid to pay for that.  They’re not – they, not one patient has ever said – well, I can’t say never, but it’s just [indistinct] spoken to [indistinct] maybe some patients over the phone.  But not one patient has ever said to me, Doc Malloy, why doesn’t Medicaid pay for abortion?  And the reason that they don’t is because when they call on the phone, we let them know right from the beginning:  If you have Medicaid, Medicaid is not going to pay for your abortion.  Now if you want to come in and find out how far along you are, if you are indeed pregnant, how many weeks you may be, okay, fine.  You can come in because you are a Medicaid recipient and you re eligible, according to your guidelines, to go to a doctor’s office to have those procedures done.  As I showed on the – the Chapter 900, under Family Planning Services, it specifically states Part II – and this is the Policies and Procedures for Physician Services – Chapter 900 – Scope of Services:  Family planning services are provided to eligible Medicaid members who wish to prevent pregnancies, plan the number of pregnancies, plan the spacing between pregnancies, or obtain confirmation of pregnancy.  This is covered. For me to say to the patient, because you’re going to have an abortion, okay, or if you decide to have an abortion, guess what?  I have to charge you for the ultrasound and the lab.  And they’ll tell me, Whoa!  Dr. Malloy, it says – it specifically says – that I can come in and get covered to find the confirmation of pregnancy. 

I’ve been sitting or standing right here in this courtroom defending that I’d done something fraudulent because I charge the patient money when they are eligible for Medicaid coverage.  I did [indistinct] just the opposite.  Someone turned this around – or could turn this around – and say:  Why did you collect money from that patient?  She was eligible.  It says it right here.  Okay?  Part II [indistinct] that she can get confirmation of pregnancy.  You shouldn’t have charged her for that ultrasound.  She was able to come to your office to get an ultrasound.  So it’s – it’s almost like I would win – lose – either way.  Okay?  So the fact that we have done this, no one has ever said it was not correct, offices all around the city and state have been doing this, we’ve got two reps from Medicaid that said:  You are in compliance.  Okay?  No one has ever sent me anything in writing stipulating as – as has been said earlier – about some time delay between those – the – the sonogram and – and lab and when they have a procedure. 

Somebody earlier said today that if it had been done another day, it would’ve been okay.  Someone else said if it had been done another day, it still wouldn’t have been covered.  You see?  I mean, even this confusion even amongst the witnesses that have said that I’ve done something fraudulent.  Okay?  And I think the confusion isn’t because I think you guys are out to get me.  I, um, I believe I am not standing here feeling as though I’m a victim.  I am standing here because I really think that the way this was interpreted was interpreted incorrectly, okay?  And whether it was spurred on by something, I don’t know.  I’m – I’m not gonna – I don’t know.  I don’t know why, all of a sudden, in January of this year, this happened.  I – I can’t – I can’t get into that.  The only thing I know is that I have never intentionally tried to misrepresent my actions, my responsibilities as a Medicaid provider.

Um, the – one of the – I think one of the reasons why we did – and – and I’ll be – to be honest with you, we are the ones that started this Pregnancy Verification Form years ago.  Years ago.  Okay?  There was no Pregnancy Verification Forms in doctors’ offices.  Okay?  When I started doing abortions and realized that Medicaid did not pay for them, okay, I put this form together.  Okay?  I can’t even stand here and say other doctors’ offices even have this form, but I did because I was trying to do everything that I could to not do anything fraudulent and to let the patient know up front that Medicaid did not pay for an abortion.  And that’s why we have it in bold, highlighted:  Medicaid does not pay for elective termination.  Okay?  Every patient sees this before they go any further, okay, in our office.

I know that it’s been the testimony, okay, showing the pattern, the pattern, the pattern.  Well, yes, there’s going to be a pattern of – matter of fact, I would hope that you wouldn’t see a whole lot of variation, that you would see that when a patient comes in to a doctor’s office and you’re trying to evaluate whether or not they’re pregnant, there’s only certain things that you do.  It’s the same thing that you do.  You do a pregnancy test.  You do an ultrasound.  You do a hematocrit to see if they’re anemic.  Okay?  You may do a urina(sic) – those, yes, it’s going to be the same pattern because it is the standard of care, and working up a patient who has delayed menses, amenorrhea or not sure of how far along she is in pregnancy. 

Okay?  Even – even under obstetrical services that’s covered – obstetrical services that’s covered by Medicaid, okay, it even states, okay, that the very first visit – the very first visit – is to be treated as an initial visit.  It’s not even supposed to be part of the continuing prenatal care.  That first visit is supposed to be a visit to confirm the pregnancy.  It states right there this is what they’re allowed to do.  Okay?  Doesn’t make any comment about whether they decide to have an abortion in that first visit.  It doesn’t say anything in the policy about that.  It says obstetrical visit is – the initial obstetrical service – here it is right here:  903.18 – Obstetrical Services.  Initial visit and prenatal profile.  The Division provides reimbursement for the initial visit to determine pregnancy and the initial laboratory services separately from any other obstetrical care.  Any other.  Because I think – I think – that Medicaid realized that, you know, we don’t know what might happen after this first visit.  Okay?  And if they attach it all together, okay, then it would be a mess because you have had doctors who have filed prenatal care – prenatal care – and then turned around and said, Oh, the pregnancy was terminated.  So even Medicaid, I think – and now I can’t – I didn’t put this together, but they made that a separate visit.  Okay?  Reimbursement for the initial visit to determine preg(sic).  And that’s obstetrical services.  And I wasn’t even arguing obstetrical services; I’ve been commenting to the family, um, uh, to the, um, family planning – excuse me.  Yeah, Scope of Services – Family Planning, where, again, Medicaid says they’ll cover for confirmation of pregnancy.  Okay?

Now, I understand we’re using that term abortion-related.  Well, any time you do any surgical procedure, okay, you can say anything that was done before then was related.  For instance, Medicaid does not pay for plastic surgery.  It doesn’t.  Okay?  So what is being stated here is if someone comes into a doctor’s office and sees a general surgeon and has some issues going on – maybe wants to have some sort of cosmetic surgery – and that patient goes on and has that cosmetic surgery, so what you’d be – you would be basically saying, that office visit?  That office visit that that patient had would not be covered by Medicaid, okay, because Medicaid – even though that person didn’t do any plastic surgery, Medicaid would not cover because they don’t cover plastic surgery, so procedures related to it would not be covered.

The issue that I was speaking to Ms. Benson about earlier, about patients who my group – I have a seven-man OB group.  We covered the emergency room at DeKalb Medical Center.  Okay?  We were the only group in Atlanta that actually covered [tapping] emergency room 24/7 which, as you can imagine, we saw more Medicaid patients than anybody else.  We were the largest OB group in the state of Georgia delivering over 150 babies a month.  There’s seven of us.  Okay?  We stay in-house 24 hours.  So I know what happens in emergency rooms.  I know that a patient can come to the emergency room.  Unfortunately, some people use emergency rooms as clinics.  I think it’s unfortunate.  They don’t always go there for emergencies.  Um, they go to emergency rooms for vaginitis, urinary tract infection – none of those are emergencies – but they go.  Okay?  And so it’s not uncommon for a patient to go to the emergency room with a missed period, no period, abnormal period, finds out that they’re pregnant, and will ask the physician who sees them:  I want to terminate the pregnancy.  Where can I go?  The physicians in most emergency rooms have a list of clinics and private doctors’ offices that will do abortions, gives the patient that information, patient may or may not terminate the pregnancy, and that emergency room will make – will file Medicaid for that reimbursement.

I would think that nobody, no hospital, wants to be [indistinct] doing something wrong.  If they felt that what they were doing was wrong, then, believe me, they would say, now, I can’t – I can’t talk about abortion.  Then, you know, um, because [indistinct] I’ve got to – I can’t file this claim.  It doesn’t make practical sense, okay, the way this is being interpreted in the real world.  It doesn’t.  And I think that’s why for 20-something years nobody has said anything because everybody felt that it was okay.  Why this year?  I have no clue.  Okay?  All I’m saying is that I have not done anything out of what is incompliance.  I think that this has been misinterpreted.  When you look at abortion-related procedures, okay, any procedure that is determining [indistinct] pregnancy, whether or not they’re pregnancy can be related to abortion, can be related to maintaining the pregnancy.  So I don’t feel as though because there is a [indistinct] of that, that that would be considered out of the ordinary. 

There was one other thing.  I noticed that in – - I think in one of the letters, it talks about bundling and unbundling.  Okay?  You cannot, okay, in Medicaid, okay, you don’t bundle.  Okay?  It’s this – there was something that was stated about I think in – in (and I can’t find it) about my bundling or trying to unbundle, okay?  You could only do that if they are together, okay, in the regular insurance.  I think this is why with the OB provision why they separate the initial visit from everything else.  Um, I - -

TARA DICKERSON:  It’s in your letter that you wrote - -

DR. MALLOY:  Oh.

TARA DICKERSON:  - - dated May, the 1st, where you used the term on the second page.

DR. MALLOY:  [Indistinct] can’t – my hand - -

TARA DICKERSON:  Exhibit R-E, your letter.

DR. MALLOY:  Okay. 

TARA DICKERSON:  Second page.  Third paragraph.

DR. MALLOY:  Okay, yeah.  Okay.  Okay.  Well, I base – I’m going to repeat myself on that.  I – I kind of, um, uh, [stuttering] stated that.  Um, so I – in – in – in – in – in – in – in – in closing, ‘cause there’s not a whole lot more I think I – I can say other than start to repeat myself, um, the – the reason why we – we got, at least we thought, information, um, from the field reps and I think the field reps – in fact, we had two different field reps representing different counties, who said exactly the same thing – I think would support that they weren’t – it wasn’t an opinion.  It wasn’t I think false information.  Uh, I – I feel that when a provider – they must realize that when we call, we’re calling for guidance.  That’s why we’re calling; we’re calling for guidance.  And they realize that we’re going to act on their response.  Um, that’s all we can act on, you know?  We act on their response.  And I think, in this instance, we had support that I hadn’t done anything wrong.  I hadn’t done anything that I had not been doing nor any other doctor in this city who provides first trimester abortions in their private practice.  And – and, with that, I feel that it was unjustified to withhold my Medicaid number, to have me incur the deficit of over $50,000 to try to maintain my practice at a time when, as we all know, the economy the pits.

Um, I – I – I just – I almost feel [indistinct] after 29 years of what I felt was providing good OB/GYN care to Medicaid patients, which I’ve never turned down one, for this to happen to me, it – it – it hurt.  It hurt, but I’m – I’m glad that the system has allowed me to at least ex – express my – my concerns.

JUDGE TEATE:  Cross – cross-examination?

TARA DICKERSON:  No cross, Your Honor.

JUDGE TEATE: All right.  Sir, do you wish to make that your closing?  It really had the tone of a closing argument in a lot of ways.

DR. MALLOY:  No, I - -

JUDGE TEATE:  Okay.  Did you wish to make a closing or just stand on the record, Ms. Dickerson?

TARA DICKERSON:  No, I’m gonna make a closing.

JUDGE TEATE:  Okay.

TARA DICKERSON:  Your Honor, first of all, I just want to make, uh, Dr. Malloy aware that, as far as I know, this case came about simply as a Utilization Review.  I’m not aware of any employee or former employee of yours or anybody associated with your office – I didn’t even know who Dr. Malloy was until this case came across my desk – so I do want you to know that. 

As it relates to this case and what we’re talking about here, as you know, the Hyde Amendment and – has been, you know, amended some, really, uh, took force here back in October of 2005.  So you keep speaking of all this time of 29-30 years of experience, but what we’re talking about is a particular time frame with regard to when this, uh, issue really came about for the State of Georgia and with regard to what we did in the Policy and Procedures Manual to implement that. 

As we see it based upon the records – and that’s what we’re looking at here; we’re looking at medical records – what came across was an abundance of records where repeatedly the purpose for the visit with regard to the Medicaid members that came into the office was to have an abortion.  They, in fact, did have that abortion.  And with regard to the issues that we are speaking of, these are instances where the members came into the office, they had the tests.  And we all agree that these are services related to an abortion but could also be service related to – to basic obstetrical care.  I do want to put that out.  But then they went forward and, at that very same time, had an abortion.  This is unlike the situation that you have repeated in which I go to the emergency room, I have a pregnancy test.  First of all, I’d be surprised if Medicaid would pay for a pregnancy test from the emergency room since that is not an emergency room event.  But if, in fact, they do, then if somebody else refers me out to somebody to have an abortion, then that’s a separate time frame event and everything, a different location, somebody totally different would be billing for their services.  It wouldn’t be the same people, I would think, unless they were garnering businesses – business – for themselves who were working at the hospital.  Then that would be another issue.

But, nevertheless, what we’re talking about here is what an interpretation of this is.  And I think what this has shown us is that, on the one hand, you can provide all of the obstetrical care and services that you want.  We even had a couple of cases where someone came in, they had obstetrical care, they want to keep their baby, you can be their doctor, provide whatever, and, if they’re on Medicaid, Medicaid can bill – you can bill accordingly under Medicaid.  But what we’re looking at specifically is – and this is what creates a pattern, and I think this is where we just simply differ with regard to what is the Hyde Amendment stating.  And if you go to the Policy and Procedures and if you look specifically with regard to § 904.2 and abortions, and it really talks about a Certification of Necessity for an Abortion.  Everyone in this case that we’re talking about that’s Medicaid-related did, in fact, have the abortion.  We want to make that clear.  We’re talking about the bills associated with those patients who did, in fact, have an abortion and they also had these associated services, such as the lab tests or ultrasound studies, that type of thing – any expenditures for abortion – and that’s what this section talks about if you look at the revisions from October of 2005 with regard to what will not be paid.

As it relates to what we came up with, it was a pattern, a practice, and repeatedly that is what we saw from the records submitted.  And I think it has to be noted that, yes, you were audited and we, you know, we don’t have staff to go and audit everybody every day.  And with the volume of records that it takes to do an audit, it does take time for that audit to come to fruition with regard to the results.  In this case, we saw repeatedly on the same date that someone came into your office, they stated the purpose of their visit, and that purpose was for bill(sic).  And what it appeared to us with regard to the willful [stuttering] willful misrepresentation was that, yes, you were trying to provide a service to Medicaid members and that what you were doing was just splitting that cost.  As simple as that.  The Medicaid member would pay out of pocket through whatever means they had for the actual abortion procedure, and then with regard to the cost which – with regard to the tests and the lab results and everything that was ran – they cost on average $403 for those services that was then billed to Medicaid for these services.  And over time, we’re talking about from January – October 2008 to January 1, 2010 – a total of 72 records, so, um, you know, that’s over that time period.  And that was the pattern we saw as it relates to Medicaid members.  And I do want to focus on that.  We’re simply here talking about DCH policy as it relates to Medicaid members.

And I also want to stress to the Court with regard to interpretation – and I guess at the end of the day, it does come down to interpretation – and that’s why I wanted the Court to be aware of what Part I Policy and Procedure indicates is that when you agree to participate in Medicaid, you do say that you are going to give deference to what our interpretation of that policy is.  And we don’t think that this un – this interpretation is unreasonable.

And I also want to go ahead and just let the Court know with regard to what, uh, the law has been saying about this type of thing when it comes to statutory interpretation, and then I’ll close.  What we’re looking at in this case is that we want to uphold the statute.  And this statute, our interpretation is not so farfetched or far-flung that it couldn’t be the right interpretation with regard to what the statute has to say.  And what we are saying is simply that if you come in and you have an abortion on the same day that you have all these ancillary services related to this whole pregnancy determination, how many weeks you are – which, by law, in Georgia you must know how many weeks a person is before you can actually perform the abortion at the onsite location for the physician because you cannot do that in that setting if the fetus is more than 14 weeks old – so there – there – there is a law that requires you to do that. 

And what Dr. Malloy wants to state is that, yes,

he can come in with the – knowing that these – and

this is where we differ.  We have the records to say:  Yes, I’m going to have the abortion.  We also have the records to say that:  Yes, the abortion was, in fact, performed on that day.  This is not a situation where you indicate in your letter (and I thought that was interesting) where you talk about, Well, if they come in for these tests and then they come back a week later or two week(sic) later or a month later or go somewhere else, then I can’t bill, because that is not the scenario that presented itself based upon these records.  The scenario that constantly presented itself was:  The purpose of my visit is a termination.  I come here.  I have these tests.  And we’re saying you’re splitting the billing.  I’m gonna bill you for this portion related to lab tests.  I’m gonna bill Medicaid for that portion.  Then I’m simply gonna bill you for the abortion because you know that you couldn’t bill Medicaid for the abortion and the lab tests because it does not meet the criteria of the Hyde Amendment in that it’s a position of rape, incest or the mother’s life is in danger.  That has been our position as it relates to this case, Your Honor, and we hope that, based upon the evidence and the testimony that was presented, that this – that’s what’s reflected as to how we see things, um, in this particular case based upon these [tapping] particular records and these particular facts, Your Honor.  And that is where we stand.

JUDGE TEATE:  Okay.  I understand legal position regarding the Hyde Amendment.  I mean, that becomes a question of law and I have to interpret that.  Uh, the other issue though that’s for purposes of doing this Utilization Review is that you’re alleging fraud or willful [indistinct] misrepresentation.  I’m not sure that the record establishes that.  I – I think it’s clear that you could probably coup(sic) the funds, you know, within the meaning of, you know, the [overlapping conversation].

TARA DICKERSON:  Right.  [Indistinct]

JUDGE TEATE:  That I’m – I’m not sure that it fits the fraud or willful mis – misrepresentation.  We’ve had a large amount – a lot of evidence presented that supports that it was not willful or there was not a misrepresentation.  We’ve even had references to people that actually work as agents of the Department of Community Health that have more or less condoned - -

TARA DICKERSON: Correct.

JUDGE TEATE:  - - exactly what has occurred.  Um,

I mean, I actual – these are the things that I’ll be

looking at, you know, as I’m making my decision.  I anticipate issuing a decision within 30 days of today.

TARA DICKERSON:  Thank you, Your Honor.

JUDGE TEATE:  Uh, just with regard to – before we close - -

TARA DICKERSON:  Uh-huh?

JUDGE TEATE:  - you had submitted, since you’re pro se, sir, otherwise I would require that you would move these into admission, but you have submitted Petitioner’s 1, which is really just for demonstrative purposes I think because it’s already an Exhibit.  [Note:  No mention is made of Petitioner’s 2.]

DR. MALLOY:  Okay.

JUDGE TEATE:  Uh, you’ve submitted Petitioner’s 3.

TARA DICKERSON:  Uh-huh.

JUDGE TEATE:  Which is, uh, 311.  I think you were probably using that for demonstrative purposes - -

DR. MALLOY:  Yes, sir.

JUDGE TEATE: - - either(sic) because it doesn’t have anything on it.  Uh, you were submitting a statute as Petitioner’s 4, which really that’s the law.  I have to take cognizance of the law regardless.  Um, Petitioner’s 5, which is your 24-hour notification, it’s just the form; it’s not specific to any of the records here.  Uh, Petitioner’s 6, the Pregnancy Verification Form which is – I mean, that’s in every record that we have here, I mean.  Uh, Petitioner’s 7, which is a message; now whether or not there would be objection to this, the person that issued the message was here and gave testimony.  And, at least, I think that would be corroborative of that person’s testimony, although it’s communication outside of this, uh, scenario.  Uh, do you have any objection to that - -

TARA DICKERSON:  No, Your Honor?

JUDGE TEATE:  - - with that proviso?  All right, that – that’s admitted into the record as Petitioner’s 7.  And Petitioner’s 8, um, was the communication from Ms. Holmes, and I think that that was clear, you know, how that was – the circumstances under which that was given.  And no objection to that, Ms. Dickerson?  All right.

TARA DICKERSON: Correct, Your Honor.

JUDGE TEATE: All right, those two are admitted into the record.  And, with that, we’ll adjourn.  Have a good day.

TARA DICKERSON:  Thank you, Your Honor. 

[Indistinct conversation in background]

***END***

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

This transcript has been reviewed and compared to the audio/visual recording submitted.  Every effort has been made to ensure it is an accurate transcription. 

I am neither of kin nor counsel to any of the parties involved in the action.

 

 

                        Rajeeyah Shabazz Price

                                  r. SHABAZZ PRICE

Transcriptionist

 

 

 

 

 

 

 

 

 

 

 

 

 


TRANSCRIPTS EXPRESS

ATLANTA, GEORGIA

(404) 217-1971

 

Dr. Tyrone Malloy - Current News

Dr. Tyrone C. Malloy: Testimonials

Marvin Simmers
2016-12-20, 19:15
I support the granting of a bond to Dr. Tryrone Malloy while waiting for appeal in consideration for the years of service he has provided to the … read more
William Ritchie
2016-12-19, 00:11
I am a retired Deputy Chief of Police and Chief of Detectives with the Metropolitan Police in Washington DC. Dr. Malloy and I were classmates at … read more
Michelle Reid Winston
2016-12-20, 19:23
Dr. Malloy is an excellent physician and upstanding member of the community. He should be granted bond while this case is appealed.
To ensure that … read more

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