More Than Just a Toothache

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Many people have a fear of visiting the dentist. (That’s why sedation dentistry is so popular.) It’s not because they don’t like their dentist, it’s just that anything involving drills, needles and pain are not on top of anyone’s bucket list. An article in the Tampa Bay Times reports on a dentist who was recently charged with Medicaid Fraud because she allegedly billed the government benefits program for some pretty painful and unnecessary procedures she performed on her patients.

The story states that the dentist is accused of recommending one 35-year-old Medicaid patient have all of her teeth pulled and a set of dentures made due to reoccurring jaw pain. (Did I mention that the patient had perfect teeth and no cavities?) Unfortunately, the patient continued to have jaw pain following the removal of all of her teeth. According to the article, the dentist allegedly told the patient that she would have to pay out-of-pocket for any additional treatment because Medicaid had reached its limit. (This was only one of many stories that were released in a 21-page affidavit charging the 46-year-old dentist with more than $140,000 in Medicaid Fraud.)

Criminal charges stem from a two-year period where the dentist allegedly billed for services she never provided, sedation services she was not licensed to provide and x-rays that were never given. Remember that the dentist is innocent until proven guilty; however, if convicted, the woman could face up to 10 years in prison and up to $10,000 in fines.

If the allegations are true, it is extremely unfortunate that some of this dentist’s patients had drastic procedures performed when not needed. Perhaps a second opinion could have prevented the toothaches that became major headaches for all of the victims involved.

Source: Today’s ”Fraud of the Day” is based on an article titled, ” Pasco Dentist Charged with Medicaid Fraud,” written by Jon Silman and published by the Tampa Bay Times on May 23, 2014.

SPRING HILL — The 35-year-old patient had perfect teeth, but her jaw hurt. She went to see dentist Miranda Smith, who told her the only way to fix her problem was to pull her teeth — all of them — and get fitted for dentures. The patient was understandably reluctant, as she didn’t have a single cavity.

After her teeth were gone, her jaw pain persisted. The dentures didn’t fit right. Smith’s response, according to a criminal complaint: Medicaid won’t pay for more procedures. If the woman wanted more dental work, she’d have to pay out of pocket.

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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.