Washington Seeks $72 Million for Alleged Dental Medicaid False Claims

June 20, 2014 — Washington State’s attorney general has alleged that Sea Mar Community Health Centers has filed improper claims for reimbursement to the state’s Medicaid program. Sea Mar, which runs 13 dental clinics in the Puget Sound area, has been told to pay $72 million.
Because Medicaid is in part federally funded, dental Medicaid fraud harms American taxpayers in every state, no matter where it occurs. Under the federal False Claims Act, employees are encouraged to notify the government about abuses by filing a whistleblower lawsuit on the government’s behalf. The qui tam provisions of the statute entitle informants to a sizable share of the government’s recovery.

Dental Providers Allegedly Improperly Billed Medicaid for Fluoride Treatments

The allegations in Washington state concern Sea Mar’s billing for over 43,000 dental exams and fluoride treatments. A dental exam must be performed by a dentist and costs around $160. A fluoride treatment, which can be performed by a dental hygienist or assistant, costs just $19. The state’s Attorney General, Bob Ferguson, claims that Sea Mar was billing Medicaid for a dental exam plus the fluoride treatment when patients in fact were receiving just the fluoride. Sea Mar dentists, the state alleges, were in many cases failing to provide sufficient documentation to satisfy the standard for an “encounter” under applicable Medicaid billing rules.
In 2012, Washington passed the Medicaid Fraud False Claims Act, aimed at preventing abuse of the state’s Medicaid program. The statute and new provisions of the Affordable Care Act aimed at curbing Medicaid fraud allow for substantial penalties when the state is notified of abuses. These statutes reportedly allowed the attorney general to impose $71 million in civil penalties.
Sea Mar, which has billed Medicaid $7 million for dental care services since 2006, has filed suit in U.S. District Court in Seattle asking the court to determine the propriety of its billings under Medicaid rules. Until the question is resolved, Sea Mar will file no further reimbursement claims with Medicaid for fluoride treatments.

Blowing the Whistle on Dental Medicaid Fraud

States across the country are grappling with dental Medicaid fraud. Few qui tam lawyers have more experience with the issue than Charles Siegel and Dan Hargrove in our Dallas, Texas office. With additional offices in Maryland and California, Waters & Kraus has earned a national reputation for its results in qui tam cases. Contact us by email or call our False Claims Act lawyers at 855. 784. 0268 to find out more about our whistleblower practice.

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