March 10, 2014 — Medicaid dental fraud is a challenge for many state healthcare programs. When dental offices file fraudulent claims with Medicaid, which is funded in part by the federal government, American taxpayers are saddled with the bill. With the assistance of inside employees, however, Medicaid programs have a way to fight back. Using federal and state False Claims Act statutes, tipsters have the authority to bring a lawsuit on behalf of the government. The qui tam provisions in the federal Act reward whistleblowers with a share of any recovery.
Easton Dentist Allegedly Violated Medicaid Rules Concerning House Calls to Nursing Home Patients
A Massachusetts dentist will pay $400,000 to settle allegations of improper billings to the state’s Medicaid program. Dr. Donald P. Prohovich, of Easton, Massachusetts, allegedly filed improper claims to the MassHealth program for providing dental care to nursing home residents.
In 2010, Massachusetts’ Medicaid program initiated a rule that limits dental providers to treating just one patient in a facility in a single day. Between July 2010 and September 2013, news sources report, Prohovich allegedly billed MassHealth for house calls to residents in nursing homes in eastern Massachusetts in violation of that rule.
To resolve the state’s allegations, Prohovich has consented to certify future compliance with MassHealth billing rules and to pay $400,000 in restitution for the state healthcare program’s overpayments for “house calls” to Medicaid patients in nursing homes.
Tipping Off the Government to Dental Medicaid Fraud
The qui tam lawyers with Waters & Kraus in Los Angeles, Dallas and the Washington D.C. area are recognized nationwide for their assertive role in whistleblower cases against dentists engaged in Medicaid fraud. We understand that it can be difficult to fight corrupt billing practices all on your own. Contact us by email or call our dental fraud lawyers at 855.784.0268 to learn about our False Claims Act practice and how we can assist you.