July 21, 2014 — Because Medicaid is funded in part with federal tax dollars, U.S. taxpayers everywhere have an interest in ensuring that claims are properly filed in every state. The federal False Claims Act helps whistleblowers working inside dental clinics to make a difference by filing a qui tam lawsuit for the government’s benefit. The statute’s whistleblower provisions entitle tipsters of dental Medicaid fraud to a sizable share of the government’s recovery.
Buffalo Dental Clinic Third In Two Years To Be Investigated For Medicaid Billing Irregularities
Daniel Squire Oral Diagnostic & Treatment Center at the University at Buffalo has settled charges involving Medicaid billings that resulted from an investigation by the Medicaid Fraud Control Unit (MFCU) of the New York Attorney General’s office. Daniel Squire had been charged with $115,094 in excessive claims to Medicaid for dental services. This is reportedly the third investigation by MFCU in recent years against a Buffalo provider accused of violating Medicaid rules for dental billings.
The dental clinic is part of the UB School of Dental Medicine, which provides dental care to thousands of Medicaid recipients. An investigation over a five-year period ending in 2009 revealed that the dental clinic sometimes conducted cleanings, x-rays and dental exams in two separate visits, rather than in a single visit, as required by New York Medicaid billing rules. Medicaid was then billed for two visits, instead of one, resulting in a double reimbursement for dental services. On other occasions, the dental clinic’s records were not sufficiently detailed to support a Medicaid claim for services rendered to a dental patient.
In 2012, Baker Victory Services and Kaleida Health were involved in similar MFCU investigations into Medicaid billing irregularities. Baker Victory Services settled the charges against it for $325,000 and Kaleida Health resolved the investigation against it for $1.6 million.
Blowing the Whistle on Dental Medicaid Fraud
New York is not the only state focused on fighting dental Medicaid fraud. While Waters & Kraus is not handling this particular case, we are handling similar cases. In Texas, for example, Charles Siegel and Dan Hargrove have been working with whistleblowers to help the state redress false Medicaid claims. If you have similar claims against a different dental facility, contact us by email or call our attorneys at 855.784.0268 to learn more about our qui tam lawsuit practice.
