The 2012 news was full of reports of outrageous incidents of Medicaid fraud by Texas dentists and orthodontists whose practices are owned and operated by private-equity dental chains. These dentists often do not run their own practices. Instead, they work for a for-profit business owned by investors who are only concerned about the bottom line. Rather than making their own decisions about the dental care their patients need, dentists who work for private-equity clinics are often pressured by demands to meet a quota each month, or week and to bring in a certain amount of money for the investors. When dentists are more focused on big profits than good dentistry, they sometimes perform unnecessary procedures that are good for business, but not for the patient.
Texas Dental Chains Driven by Profits, Not Patients?
The Texas Senate’s Health & Human Services committee is chaired by Republican Senator Jane Nelson, ordinarily no proponent of government regulation. But after hearing report after report of all the Medicaid fraud committed in Texas by dental clinics that are owned by private-equity investors, Senator Nelson had had enough. That’s why the Senator has introduced a bill in the Texas Senate that would permit Texas to regulate dental clinic chains and prevent chain management from imposing production quotas and other arbitrary revenue targets on dentists who are supposed to be guided only by their patients’ well-being.
In Texas, news reports suggest that many unscrupulous dental chains target children’s dentistry that is reimbursed by the state’s Medicaid program. FRONTLINE reports, for example, that the Texas Attorney General has launched an inquiry into possible Medicaid fraud by an Atlanta-based dental chain operating clinics in many Texas cities.
At first, the Medicaid fraud scandal in Texas was focused on dentists who allegedly billed Medicaid for children’s braces that were either unnecessary or that did not meet the standards for reimbursement by the Texas Medicaid program. Funding for the Medicaid program is limited and the state cannot afford to provide free cosmetic orthodontic work for every child with a slightly crooked smile. Now the problem with improper billings to Medicaid by Texas dentists appears to be more widespread. Texas authorities say they are looking at 89 dental providers that may have submitted $154 million in improper billings to Texas Medicaid. Dentists at some private-equity owned chains are alleged to take unnecessary X-rays and use expensive stainless steel crowns for cavities in young children’s primary teeth when all they needed was an old-fashioned filling.
Whistleblowers Call a Halt to Dental Medicaid Fraud
How is dental Medicaid fraud uncovered? Often, clinic employees and dentists are the whistleblowers who come forward. Under the qui tam provisions of the False Claims Act, a whistleblower is permitted to sue on behalf of the government and share in any monetary recovery made as a result of the lawsuit.
Whistleblowers are vital in the fight against dental Medicaid fraud. Our lawyers at Waters & Kraus are prepared to offer the skilled representation you need and deserve. Contact us or call our whistleblower attorneys at 800.226.9880 to learn more about your rights and how we can assist.
