Recent OIG Dental Medicaid Fraud Report Targets Louisiana Dentists

September 12, 2014 — In 2010, Medicaid spent $7.5 billion on dental care for America’s low-income families. Not all of that money went to pay for dental procedures that were necessary, or for that matter, even performed, however. Because Medicaid is partially funded with federal tax dollars, taxpayers everywhere have an interest in protecting the healthcare program from fraudsters. The federal False Claims Act invests dental clinic insiders with the authority to bring a qui tam lawsuit on the government’s behalf. The statute’s whistleblower provisions provide whistleblowers with a sizable portion of the government’s recovery.

Dental Medicaid fraud is a serious problem in some areas of the country, according to a recent report by the Office of Inspector General at the U.S. Department of Health and Human Services. In particular, the report examined Medicaid claims filed by two dozen Louisiana dentists. The claims were so much higher than those filed by the dentists’ counterparts in the state that the OIG suspects that overbilling may be involved. In response to the investigation, Louisiana officials reportedly have implemented oversights designed to correct the problem.

Dentists in several states are alleged to have committed dental Medicaid fraud by enticing Medicaid-eligible families to their dental clinics by handing out amusement park tickets, gift cards and manicures. Once the children are there, they are sometimes subjected to any number of tests and procedures — including X-rays, fillings and root canals — that they do not need. The unscrupulous dental clinics then file false claims for the services with Medicaid.

Several New York dentists and orthodontists were referenced in a similar OIG report from March 2014. In North Carolina, a dentist was sentenced to prison in 2013 for mischaracterizing dentures in Medicaid claims. In Oklahoma, a dentist was accused by prosecutors in 2012 of misrepresenting to Medicaid the extent of restoration work she had performed on patients’ teeth. And in Texas, officials are pursuing claims against orthodontists who allegedly made false claims on a widespread scale to the state’s Medicaid program for performing ineligible cosmetic orthodontic work.

Waters & Kraus represents a number of whistleblowers in False Claims Act lawsuits targeting dental Medicaid fraud. In Texas, for example, our qui tam lawyers, 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 dental clinic engaged in filing unscrupulous Medicaid claims, contact us by email or call our qui tam attorneys at 855.784.0268 to learn more about our practice and how we can work together to notify the government about fraudulent abuses of government-funded programs, like Medicaid.