X-ing Out Fraud

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The Connecticut State Dental Association is quite clear about the requirement for all state dental assistants to pass the dental radiography portion of the Dental Assistant National Board’s exam before being allowed to take x-rays in any dental office.A Connecticut dentist who operated two practices skipped that important requirement and let his uncertified dental assistants take x-rays of his Medicaid patients. His offices also billed the government health care program for more than $1.3 million in dental claims despite the infraction.

In order to be a provider under the Connecticut Medical Assistance Program, health care professionals must follow the rules and regulations set forth under the Medicaid program. This protects both the Medicaid patients as well as the provider and their employees. (Dentists should provide quality care through certified employees. Would you want someone who doesn’t know what they are doing to point an x-ray beam at you?) The dentist in this particular case submitted false claims for x-rays knowing that they had been taken by uncertified dental assistants for approximately four years. (I guess he thought the government would be numb to his illegal acts.)

The dentist agreed to pay $1,367,466, of which 60 percent or $820,479 will go to reimburse the Connecticut Department of Social Services. He also agreed to adhere to a compliance program that meets state and federal healthcare laws over the next three years. In addition, the dentist will comply with a separate Integrity Agreement with the Office of the Inspector General of the Department of Health and Human Services

Medicaid beneficiaries have a right to receive a high standard of care. This dentist tried to cut corners and put the safety of his patients and employees at risk, not to mention the integrity of the Medicaid program. Let’s hope that the parameters put in place will be successful in x-ing out any more x-ray fraud from occurring in this dentist’s offices in the future.

Source: Today’s ”Fraud of the Day” is based on an article entitled, ”Milford Dentist to Pay $1.3M in Medicaid Fraud Case,” published by The Milford Patch on September 14, 2016.

MILFORD, CT — A pediatric dentist with practices in Milford and West Haven, has agreed to pay more than $1.3 million to the state and federal government to resolve allegations that uncertified assistants took X-rays of patients.

Dr. Jesus Villegas and his pediatric dental practices – Fairfield Pediatric Dentistry, LLC, in Milford and Haven Pediatric Dentistry, LLC, in West Haven – will pay $1,367,466 to resolve allegations that they violated the federal and state False Claims Acts by authorizing certain dental assistants who were not certified by the Dental Assisting National Board (DANB) to take dental X-rays of his Medicaid patients, according to authorities.

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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.