Fraudulent Claims Against Government Healthcare Programs a Problem in Scotland and the U.S.

February 20, 2014 — The United States is not the only country grappling with fraudulent dental claims to federal and state healthcare programs. False claims are also a problem in Scotland. While countries abroad often rely on public investigators to ferret out health care fraud, the U.S. government counts on insider employees to collaborate with the government to end Medicaid dental fraud. The federal False Claims Act empowers tipsters to file a whistleblower lawsuit on behalf of the government. The qui tam provisions of the statute reward whistleblowers with a sizeable portion of the government’s proceeds.

Dentist in Scotland Billed the Government for $1.3 Million in False Claims

A dentist in Scotland, Stuart Craig, has been convicted for dental fraud against the country’s National Health Service (NHS). Craig operated a thriving dental office in Auchinleck, East Ayrshire. The problem was, Craig’s practice was so successful that he drew the attention of John Cameron, the senior dental advisor of NHS Scotland. A former dentist, Cameron now works to curb false claims against NHS Scotland by unscrupulous dentists.
Cameron was surprised at the frequency with which Craig was reimbursed for gold crowns as compared to his counterparts. Noticing that Craig was one of the highest-paid dentists in Scotland, Cameron conducted a random check on Craig’s dental practice.
Cameron selected 40 cases involving gold crowns, checked the laboratory bills and discovered that in every case, the crown actually provided to the patient was made of a non-precious metal, not of gold.
Cameron called in NHS Scotland Counter Fraud Services, which conducted a broader investigation of 200 claims filed with NHS Scotland between 2008 and 2012. The investigation revealed a very high rate of false claims for gold crowns — high enough that the inaccurate billings could hardly be viewed as an oversight or mistake on the part of the dentist.
In November 2012, Craig was removed from the General Dental Council’s roles. During the summer of 2013, Craig was convicted of NHS fraud and fined.
According to the BBC, Craig owes NHS Scotland £782,896 — about $1.3 million. Dr. Craig, however, appears to have vanished.

Blowing the Whistle on Medicaid Dental Fraud

The qui tam lawyers with Waters & Kraus are undisputed leaders in whistleblower litigation directed at dental Medicaid fraud. With offices in Los Angeles, Dallas and the Washington D.C. area, we’ve earned our reputation for working hand-in-hand with conscientious insiders. Contact us by email or call our qui tam lawyers at 855.784.0268 to learn more about our False Claims Act practice.

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