April 7, 2014 — Dental Medicaid fraud rarely goes unnoticed by dental clinic insiders. But many just keep their heads down and try to hold onto their jobs — until they are asked to participate. For some, that’s the point at which they seek legal help to stop billing fraud schemes against the government. When tipsters file a lawsuit against unethical dental practices under the qui tam provisions of the False Claims Act, they may be rewarded for their courage with a share of the government’s recovery.
Dental Clinic Owner Allegedly Had No License to Practice Dentistry
Charges have been filed against nine people in Anderson, Indiana alleged to have participated in a years-long dental Medicaid fraud operation. Those charged include Sally Metzner, who owns Anderson Dental Center Inc. and three dentists — Dr. Thomas Dubois, Dr. Paul Pangallo and Dr. Jeffrey Rich. Indiana’s Attorney General’s Office alleges that Metzner and the dentists filed hundreds of thousands of dollars’ worth of false claims with the state’s Medicaid program.
Metzner and the dental care providers reportedly billed for procedures they did not perform and billed for more expensive services than those they did provide. In addition, Dubois allegedly billed Medicaid from 2006 to 2010 for services to Medicaid patients even though he was not a licensed Medicaid provider. Further, the dental clinic allegedly billed Medicaid for procedures done by a dentist who no longer worked for the practice and supplied forged signatures on documentation submitted to Medicaid.
Anderson Dental allegedly submitted over $300,000 in false claims to Medicaid between 2006 and 2011 for deep sedation of patients. Deep sedation is reimbursable by Medicaid, while local anesthesia is not. In fact, no dentist in Indiana filed more Medicaid claims for deep sedation than Anderson Dental. There were two alleged problems with these claims for reimbursement, however. None of the clinic’s dentists was licensed to administer anesthesia and the patients who were supposed to have received the deep sedation actually received local anesthesia instead.
Eighty percent of Anderson Dental’s patients are Medicaid eligible.
Metzner has been charged with running a dental practice without a dental license, racketeering, money laundering, theft, forgery and Medicaid fraud. The three dentists also have been charged with theft, money laundering and corrupt business influence. In addition, five members of the office staff have been charged, as well.
Insiders with a Conscience Collaborate to End Fraudulent Billing Schemes
State Medicaid programs around the country have been targeted with false claims like those alleged in this Indiana case. The qui tam lawyers at Waters & Kraus have years of experience working with state officials to recover funds lost to dental Medicaid fraud. Contact us by email or phone us at 855.784.0268 to consult with a whistleblower lawyer about how to play your part in protecting Medicaid for those who need it.