Tooth Fairy

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The tooth fairy is a fantasy character that many children delight in, especially after they have tucked their baby tooth under their pillow and woken up to find a small payment in exchange. Today’s ”Fraud of the Day” details how a dentist mistook the government to be the Tooth Fairy. (Apparently, he exchanged thousands of Medicaid claims for bogus tooth extractions for hundreds of thousands of dollars in payments from the Georgia Medicaid program.)

The dentist’s practice came under fire after the Georgia Department of Audits and Accounts performed an audit on the dentist’s records and found multiple billing irregularities. The state’s Medicaid Fraud Control Unit stepped in to investigate the irregularities and found that over about 21 months, the dentist submitted 3,145 claims and received more than $789,000 for tooth extractions that never occurred. (That rounds out to be about $250 per tooth. Now that’s definitely more generous than the Tooth Fairy I had as a kid.)

It didn’t take long for the investigators to determine that the dentist had not extracted the teeth from many of the patients for whom he had submitted claims. One person even claimed to not know that the dentist was a dentist.

The 55-year-old dentist eventually admitted that he had submitted claims to Medicaid for teeth he did not pull and pleaded guilty to one count of health care fraud. At sentencing, he faces a maximum of ten years in prison, a fine of up to $250,000 and up to three years supervised release. As part of his plea agreement, the dentist also agreed to pay $789,841 to the Georgia Medicaid program.

When this dentist shows up for sentencing, neither the prosecutor nor the judge will be wearing a sparkling tutu or waving a magic wand. This fraudster is going to need a little more than fairy dust to escape his impending punishment and the reality that the Medicaid program is not his own personal Tooth Fairy.

Source: Today’s ”Fraud of the Day” is based on an article entitled, ”Dentist pleads guilty to Medicaid fraud,” published by The Valdosta Daily Times on October 17, 2016.

VALDOSTA — A Valdosta dentist pleaded guilty this week to allegations he charged Medicaid for extracting teeth he did not pull.

Dr. Stanley B. Marable, DDS, 55, pleaded guilty to one count of health care fraud in the federal courtroom in Valdosta, according to court records.

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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.