Extracting Fraud

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Visits to the dentist are not always a fun thing, especially when a toothache is the reason for going. Not only is there pain associated with the toothache, but in general, patients can expect that the procedure to fix the pain could also involve more pain. A dentist in Massachusetts inflicted even more pain to her patients’ wallets and to the state Medicaid program by using improper billing practices.

A female dentist and her brother, who was the dental practice ‘s managing director, allegedly improperly billed MassHealth, the state ‘s Medicaid program. Bills for palliative treatment, which are emergency services that relieve pain, and definitive treatment like a tooth extraction, were billed on the same day of service. MassHealth and the American Dental Association do not allow both a palliative and a definitive treatment to be performed on the same day. (Too much pain in one day I suppose.)

In addition to billing for multiple treatments in one day, there were also improper submissions claiming that the female dentist had performed particular services. In reality, the services were performed by other dentists. (This improper billing practice allows the dental office to bill at a higher rate.)

The dentist agreed to pay $475,000 to the Massachusetts state Medicaid program to resolve the improper billing allegations across 21 dental offices. (That ‘s a pretty large dental practice.) In addition to the settlement, the dentist, her brother and the practices’ employees must review and comply with all applicable state and federal laws and regulations required to participate in the state ‘s Medicaid program.

Source: Today’s “Fraud of the Day” is based on an article entitled, “Newton dentist to pay $475K in Medicaid improper billing claim,” posted on Telegram.com on January 25, 2017.

BOSTON – A Newton dentist has agreed to pay $475,000 to the state’s Medicaid program to resolve allegations of improper billing for dental work at 21 area dental offices, including a practice in Worcester.

Worcester Family Dental was among the practices named by the state attorney general’s office in a news release Wednesday announcing it has resolved the allegations that Dr. Julia Faigel and her brother, Alexander Faigel, who was managing director at the practices, improperly billed MassHealth for concurrent palliative treatment of dental pain along with another code for definitive treatment (simple or surgical extraction) on the same date of service.

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Larry Benson
Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.