March 19, 2014 — Dental clinic insiders are often the first to spot dental Medicaid fraud, but they may wonder, how do I go about collaborating with the government to stop it? The False Claims Act empowers dental practice employees to file a whistleblower claim for the benefit of state Medicaid programs. If the government receives a recovery, the informant also receives a reward for taking the risks involved in coming forward. Under the qui tam provisions in the Act, whistleblowers may share in the government’s proceeds.
Texas Health and Human Services Commission Judge Finds Credible Evidence of Fraud Against Dental Practice Accused of Billing Medicaid for Ineligible Orthodontic Procedures
A judge working for the Texas Health and Human Services Commission (HHSC) has overturned many of another judge’s findings in a case involving a dentist accused of fraud. The overturned findings had been made earlier by an administrative law judge with the State Office of Administrative Hearings. The HHSC is prosecuting the alleged dental Medicaid fraud case against Antoine Dental Center, which the state alleges was one of the dental providers that from 2007 to 2011 billed Texas Medicaid for unnecessary orthodontic work performed on disadvantaged children.
The dentists charged claim that ACS State Healthcare, which HHSC retained to process Medicaid claims, gave them pre-approval for the procedures, and that ACS allegedly rubber-stamped the dentists’ paperwork without conducting a medical review. HHSC’s in-house judge, Rick Gilpin, re-evaluated the evidence heard by the administrative law judge, however. Judge Gilpin found considerable evidence that Antoine Dental had defrauded Texas Medicaid.
Jim Moriarty, a Houston lawyer retained to help the state recover millions lost when Texas dentists allegedly billed Medicaid for ineligible orthodontic work, is quoted as saying: “[The administrative law judge] badly missed the boat. This is a game-changer.” The HHSC was also pleased with Judge Gilpin’s ruling, explaining that “[HHSC] felt the earlier ruling misinterpreted the federal law that requires us to withhold payments.”
Dental Medicaid Fraud Reported by Concerned Insiders
Medicaid programs around the country have been plagued with fraudulent claims like those Texas is battling now. The qui tam lawyers at Waters & Kraus have vast experience working to help state governments redress dental Medicaid fraud. Contact us by email or call our whistleblower lawyers at 855.784.0268 when you’re ready to get involved in protecting our public healthcare programs.