Unpleasant Check-up

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There are a lot of folks who really don’t like going to the dentist for regular check-ups. In an ironic twist, dentists from 21 pediatric dental practices in Texas and their dental management firm got an unpleasant check-up from the government that cost them a lot more than the price of having a cavity filled. Altogether, those involved in the scam agreed to pay $8.45 million to resolve allegations that they had all participated in the submission of false Medicaid claims. (That’s a lot of money. In retrospect, perhaps they would have preferred a root canal instead.)

A former employee of the dental management firm is responsible for blowing the whistle on the management company and its affiliated dental practices. (It’s interesting to note that the whistleblower will receive $1.521 million from the U.S. and the State of Texas when all is said and done.)

It was alleged that the management firm’s marketing chief and the owners of the pediatric dental practices knowingly submitted false claims for pediatric dental services that were never performed. In addition, it was also alleged that kickbacks were paid to Medicaid beneficiaries, their families, marketers and marketing entities to entice them to use their dental practices. When services were legitimately performed, the person who completed the dental procedure was misidentified on the claims. Also, Medicaid provider numbers from doctors not in the dental practices were used to carry out the fraudulent scheme that occurred over a five-year period.

The five co-owners of the dental management company, the 19 affiliated dental practices, and their marketing chief agreed to pay a total of $8.45 million to resolve allegations of false Medicaid claims. As part of the settlement, the five dentists also agreed to each pay $250,000 to resolve the government’s claims against them.

The doctors also agreed to participate in a five-year Corporate Integrity Agreement (CIA) with the Department of Health and Human Services Office of Inspector General (HHS-OIG) which will mean that each of the doctors will be assessed on an annual basis to make sure that their claims are correctly coded, medically necessary and appropriately documented. In addition, the management company’s marketing executive was ordered to pay $100,000 to resolve his alleged personal liability.

This settlement can be attributed to the success of the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which is a partnership between the Attorney General and the Secretary of Health and Human Services. Together, these two departments have helped to greatly reduce and prevent Medicare and Medicaid financial fraud since 2009.

Source: Today’s ”Fraud of the Day” is based on an article entitled, ”Forney dental office among 21 to pay $8.45 million to resolve violations of False Claims Ace,” posted on Forney.com on January 9, 2017.

FORNEY, Texas — A Forney dental office is among 21 affiliated dental practices who have agreed to pay $8.45 million to resolve allegations of false Medicaid claims for pediatric dental services, U.S. Attorney John Parker of the Northern District of Texas announced Monday.

The allegations, according to Parker, stem from incidents between Jan. 1, 2009, and Dec. 31, 2014 in which Texas-based MB2 Dental Solutions (MB2), 21 pediatric dental practices affiliated with MB2, and their owners and marketing chief knowingly submitted, or caused the submission of, claims for pediatric dental services that were not rendered, were tainted by kickbacks, or falsely identified the person who performed the 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.