March 24, 2014 — Dental practice insiders are usually the first to spot dental Medicaid fraud, but many wonder, how can I notify the government to stop it? The False Claims Act gives health care employees the power to bring a whistleblower claim on behalf of state Medicaid programs. When the government makes a recovery, the qui tam provisions in the statute authorize a reward for the tipster.
Dental Practice CEO Informed by MassHealth that Billing Practices Were Illegal
Another Massachusetts dental practice has been named in a lawsuit by the Massachusetts Attorney General, Martha Coakley. The state alleges that a Wellesley provider overbilled MassHealth, the state’s Medicaid program, for house calls to residents of multiple nursing homes. This is the second such case in as many months in Massachusetts, which last month settled for $400,000 a matter involving an Easton dentist who received alleged overpayments from the state’s Medicaid program for dental house calls.
The more recent case, filed against against HealthDrive Corporation, alleges that the dental practice, which has a second office in Newton, has been overbilling MassHealth by charging several “house call” fees when treating multiple patients who live in the same nursing home on the same day. There is no prohibition against treating several patients in one facility on a single day, but Massachusetts Medicaid allows billing for just one “house call” charge per facility per day. The regulation concerning dental house calls has been in force since 2010.
MassHealth alleges that it made over $1 million in overpayments to HealthDrive as a result of the dental provider’s false claims. HealthDrive allegedly received Medicaid reimbursements on more than 34,400 improperly filed claims. Local news sources report that HealthDrive allegedly persisted in filing the multiple house call claims even after MassHealth officials informed the provider’s CEO that the claims were illegal.
The dental Medicaid fraud complaint asks for restitution as well as civil penalties and further compensation.
Concerned Insiders Collaborate with State Governments on Dental Medicaid Fraud
State Medicaid programs across the country have been plagued with fraudulent claims like those Massachusetts is fighting now. The qui tam attorneys at Waters & Kraus have valuable experience helping state officials to redress dental Medicaid fraud. Contact us by email or call us at 855.784.0268 to speak with a whistleblower lawyer about your role in protecting our public healthcare programs.
