April 3, 2014 — Dental Medicaid fraud is usually identified first by dental practice insiders. Many inside employees, however, are completely unaware that they have the power to stop billing fraud schemes against the government. When whistleblowers file a lawsuit against unscrupulous dentists under the qui tam provisions of the federal False Claims Act, they may be entitled to a significant share of the government’s recovery.
23 New York Dentists and 6 Orthodontists Participated in Dental Medicaid Fraud in 2012, Charges U.S. Department of Health and Human Services
A new federal report reveals that unscrupulous dental providers in New York billed Medicaid for numerous questionable procedures on young children. The report by the Department of Health and Human Services inspector general described, but did not name, 23 New York dentists and six orthodontists who took home $13.2 million in 2012 Medicaid payments for dental services that were either unnecessary or not provided at all.
The report urged New York’s Health Department to create measures to redress the problem of dental Medicaid fraud. New York’s Medicaid inspector, news sources report, is already working to identify fraudulent billing and is investigating many dentists and orthodontists in the state.
The many examples of dental Medicaid fraud listed in the report include the following:
-
- One dentist filed Medicaid claims for performing 42 fillings on one child in a single appointment.
-
- Another dentist filed claims for an average of 16 procedures per child, receiving $900 in Medicaid reimbursements per child. The state averages are five procedures per child and a corresponding $200 in Medicaid payments per child.
-
- One orthodontist treated nearly 5,000 children in one year — ten times higher than the average for other orthodontists in New York.
-
- Two dentists often billed Medicaid for three or more pulpotomies — baby root canals — in just one appointment.
-
- Four dentists pulled teeth from more than 38 percent of their child-patients, though the average for children treated by dentists statewide is ten percent.
-
- Seven dentists with the New York branch of the Small Smiles dental chain were on the federal government’s list. The chain closed its New York offices in 2012, after paying $24 million in 2010 to resolve charges that the dental chain provided unnecessary treatment to Medicaid-eligible children.
Insiders with a Conscience Collaborate to Stop Dental Medicaid Fraud
State Medicaid programs across the U.S. have been plagued with fraudulent claims like those highlighted in New York. The qui tam attorneys at Waters & Kraus have vast experience working with state officials to redress fraudulent billing schemes against Medicaid. Contact us by email or call us at 855.784.0268 to speak with a whistleblower lawyer about your role in protecting Medicaid for those who need it.
