Dental Medicaid Fraud

We all suffer when dental practices put profits over patients.

Families need proper dental care. Without it, children and adults can face pain, infection, and serious medical complications. But when dental practices become dental factories, more concerned about profits than patients, everyone suffers.

Dental Medicaid fraud, like other types of health care fraud, costs our country millions of dollars in fraudulent reimbursements from Medicare and Medicaid. It costs even more in the pain and fear that it can generate for the children who are too often the victims of this particular type of scam. How and why did this happen to dental care? Why are Medicaid beneficiaries becoming the victims?

Dentistry is an honorable field providing valuable medical treatment. Without proper treatment, the risk of serious health complications increases. Unfortunately, when dental practices become corporate dental factories, the focus on patient needs becomes lost. Their needs are replaced with the potential for profits from government programs. Both patients and taxpayers suffer. The drive to maximize profits can lead to the following types of dental Medicaid fraud:

  • Billing Medicaid for unnecessary procedures,
  • Billing Medicaid for procedures that were never performed,
  • Billing Medicaid for intentionally substandard work, and
  • Disregarding ethical treatment standards:
    restraining patients, and abusing patients to speed up procedures.

The problem is multiplied when dental practices are operated by for-profit corporations, and making money becomes more important than taking care of patients’ real dental needs. Past are the days when you could safely assume a dentist was the one operating a dental practice. Many dental practices today are operated by corporations who hire dentists as employees. Because state law generally requires a dentist to own and operate a dental practice, the corporation will have a dentist pretend to be the one in charge. While it may look like the dentists are making decisions about patient care, the corporate decision makers may actually be the ones calling the shots.

It goes without saying that for-profit corporations exist to make money – literally, they operate “for profit.” So when corporations are in charge of dental practices, they are looking above all for a way to make money.

Medicaid-paid dental services can add up to big money, especially if the volume of patients and procedures is high. Some corporate-operated dental clinics will offer services to low-income families at schools or community centers, sending Medicaid the bill regardless of whether the work was necessary or even performed.

Sometimes dentists or dental assistants find themselves employed in a practice that they know is engaging in fraud. They may know about unnecessary procedures that are being done or be aware that Medicaid is being billed for procedures that aren’t performed. In some cases, dentists have found themselves being pressured to engage in dental Medicaid fraud themselves.

Dental Medicaid fraud is against the law. Filing a claim with Medicaid for dental procedures that are medically unnecessary or that have not been performed is a violation of the federal False Claims Act. Many states also have false claims acts as well, so that perpetrators may face state as well as federal charges for engaging in dental Medicaid fraud.

If you know about an instance of dental Medicaid fraud, you may feel unsure of what to do next. It may help to have someone to talk to about your circumstances and your legal rights – someone who has worked with whistleblowers confronting situations like yours.

How Waters & Kraus can help whistleblowers

With a national presence and in-depth experience fighting fraud against the government, Waters & Kraus provides aggressive representation of whistleblowers in qui tam actions and related complaints. The firm currently represents whistleblowers seeking to recover funds on behalf of the federal and state governments in a variety of cases, including medical and dental Medicaid fraud.

Law makers know that it’s not easy to come forward and report fraudulent conduct, especially when it involves your own employer. The False Claims Act encourages people to take this step by giving whistleblowers a share in any recovery the government makes as a result of their courageous willingness to tell the truth.

To learn more about qui tam representation at Waters & Kraus, or to have one of our attorneys review your potential case, contact us online or call 800.226.9880.

What is Qui Tam?

Under the Federal False Claims Act (FCA), whistleblowers have the power to save taxpayers billions of dollars each year by taking a stand against fraud. The U.S. False Claims Act allows private citizens to file suits on the government’s behalf when the government has been defrauded through any federally funded contract or program. The qui tam provisions of the False Claims Act allow these citizens to recover damages. A number of states and the city of Chicago also have laws similar to the False Claims Act to protect against fraud. To learn more about the different types of fraud … READ MORE

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