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Dental visits are usually met with trepidation. (It’s rare that you find anyone super excited to make the twice-yearly trek into the dentist office for a routine cleaning, x-rays and mouth cancer check). Under the guise of some much needed dental procedures, a Bucks County, Pennsylvania dentist committed $1.5 million in Medicaid fraud by billing patients in alphabetical order for dental services that were not needed or never performed.

Patients usually have two reasons for not wanting to visit the dentist: 1) something painful might have to be done and, 2) dental work can be expensive. Today’s fraudster adds a third reason that individuals might be skeptical of seeking dental treatment after they read this article: the procedure is not needed.

The Bucks County dentist, who operated two offices, one in Feasterville and the other in Philadelphia, submitted fraudulent claims for crown restorations and other repeat dental services over a two-year period. He also submitted claims in an alphabetical order by patient last name for dental work that was never performed. For example, during one week in August 2015, he claimed he saw 120 patients and 107 of them had the last name beginning with the letter “G”. (Coincidence? I think not. It was his orderly system of fraudulent billing that signaled an anomaly.)

A statewide investigating grand jury used the Fraud Abuse Detection System, the data system used by the Office of Attorney General and Pennsylvania Department of Human Services, to investigate the dentist’s numerous fraudulent claims. As a result of their findings, the 63-year-old dentist from Langhorne pleaded guilty to Medicaid fraud and tampering with public records. (I imagine he had a pretty severe case of dry mouth when he had to stand before the judge.)

The Pennsylvania dentist paid $1.5 million in restitution for the dental work that was never performed. (I bet that hurt worse than a root canal.) But, that’s not all he owes. He must also fork over fines of $15,000; surrender his Pennsylvania dentist license and agree not to practice dentistry for the next seven years; complete 500 hours of community service; and, he and his dental practice cannot participate in any state or federally-funded healthcare programs for at least five years.

It sounds like this perpetrator has learned an important lesson when it comes to fraud hygiene. When you don’t follow the recommended advice of the government and maintain ethical business practices when it comes to billing Medicaid, the outcome can be as painful as extracting a tooth without a few shots of Novocain. (Instead of stealing taxpayer dollars for performing bogus crown restorations, this Pennsylvania dentist is now wearing a crown of shame for his fraudulent business practices.)

Today’s “Fraud of the Day” is based on an article entitled, Bucks County dentist pleads guilty, pays $1.5 million restitution for Medicaid fraud,” posted on Fox43.com on April 19, 2018.

HARRISBURG — Attorney General Josh Shapiro today announced a Bucks County dentist has pleaded guilty to felony Medicaid Fraud and paid $1.5 million in restitution after he and his company submitted fraudulent claims to the Medicaid Program for dental work which was never performed.

Dr. Ilya Babiner, 63, of Bridge View Road, Langhorne, pleaded guilty to Medicaid fraud and tampering with public records arising from $1.5 million in fraudulent claims he and his company submitted to Medicaid for dental work which was not performed at his offices in Feasterville and Philadelphia. Babiner owned and operated General Dentistry Number One in Feasterville, which was also a defendant in the case and pleaded guilty as well.

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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.