It’s a Good Day

242
41913416 - medicaid torn newspaper headline on cash

It’s always a good day when a company that is alleged to have committed Medicaid fraud comes to a settlement with the government that doesn’t involve jail time. An Indiana-based dental company that operated nine practices and a Kansas-based company that provided administrative support services to the Indiana company came to an agreement over allegations of fraud. Together, they will pay $5.139 million to wipe their slates clean. (It’s kind of like how Novocain dulls the pain of a dental procedure while in progress, then allows you to go about your business normally within less than 24 hours.)

A whistleblower dentist, who previously worked for the Indiana company, alerted the state government as well as the federal government about the alleged Medicaid fraud committed over four years by the two companies. Supposedly, the Indiana dental company provided unnecessary treatment and the Kansas company engaged in fraudulent billing, both purportedly placing profits ahead of their patients.

Here are the claims involved in the case:

  • The billing company exerted excessive influence over the dental practices’ medical professionals and staff by providing rewards for production goals. If staff did not meet production objectives, there were consequences. (Have you ever had a dental procedure performed when you really didn’t think you needed it? Perhaps you experienced unnecessary pain so that your dentist could make his sales goal for the month.)
  • Both companies upcoded simple tooth extractions, but incorrectly billed them as surgical extractions so they could make more money.
  • Both companies billed for “deep cleanings” when they were either not performed or not medically necessary. (That sounds really painful. Just remember to floss your teeth every day and most likely, you will never need that procedure.)

The two companies agreed to pay the United States $3,400,270.74 and the state of Indiana $1,782,729.26 to settle allegations of Medicaid fraud. In addition, the Office of Inspector General (OIG) of the Department of Health and Human Services determined that the two companies needed some additional oversight, proposing they enter into a Corporate Integrity Agreement that would require compliance measures and monitoring. (Perhaps not in their best interest, the two companies refused to comply.) Consequently, the OIG determined that the two entities pose a high risk to federal healthcare programs and their beneficiaries. (Well, that might not bode well for future business.)

While the government is watching out for its citizens, self-advocacy is necessary. It’s always a good idea to get referrals from friends, family, co-workers, doctors, pharmacists or other members of the medical community when choosing a dentist. While going to the dentist can be scary for many, it’s a good day when you know that you can rest assured that your dentist is committed to ethical and honest dental practices.

Today’s “Fraud of the Day” is based on a Department of Justice press release entitled, “$5.1 Million Dollar Settlement Reached With Indiana Dental Firm to Resolve False Claims Allegations,” released on November 6, 2018.

LOUISVILLE, Ky. – United States Attorney Russell M. Coleman announced today that ImmediaDent of Indiana, LLC (ImmediaDent), which operates nine dental care practices in Indiana, and Kansas based Samson Dental Partners, LLC (SDP), which provides administrative support services to ImmediaDent, have agreed to pay the United States and the State of Indiana $5.139 million to resolve allegations that they improperly billed Indiana’s Medicaid program for dental services; the companies have been determined to continue to be a high risk to the United States health care programs and their beneficiaries.

The settlement comes as part of a coordinated effort between the United States Attorney’s Office in the Western District of Kentucky, working on behalf of the Office of Inspector General (OIG) of the Department of Health and Human Services, and the Office of the Indiana Attorney General, Medicaid Fraud Control Unit.

SHARE
Previous articleSelfish Endeavor
Next articleHitting the Identity Theft Jackpot
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.