Fraud

Mass. dentist to return $500K to state Medicaid program

August 22, 2017 -- A Massachusetts pediatric dentist will return $500,000 to the state's Medicaid program for improperly billed palliative care, according to the Massachusetts Attorney General's Office. Annie Watson, DDS, and her practice, Gentle Smiles in Springfield, are alleged to have improperly billed MassHealth, the state's Medicaid program, for emergency pain treatment between March 2010 and June 2013. The claim also states that the practice failed to comply with MassHealth rules on the use of the emergency treatment billing code.The attorney general's investigation began after MassHealth identified Dr. Watson as the top biller of the palliative care code among the program's dental providers. Dr. Watson was found to have routinely billed for palliative care without providing supporting documentation, including when patients received only cleanings and x-rays.Under the terms of the civil settlement, Dr. Watson and her practice will pay MassHealth $500,000 as restitution. Dr. Watson and her employees are also required to review and comply with all applicable state and federal statutes, as well as all regulations for participating in the MassHealth program.

W.Va. dentist pleads guilty to Medicaid fraud

August 23, 2017 -- A dentist from Charleston, WV, has pleaded guilty to Medicaid fraud, according to the U.S. Attorney's Office for the Southern District of West Virginia. Antoine Skaff, DDS, 58, admitted to billing West Virginia Medicaid and Medicaid managed care organizations for dental procedures he did not perform, falsely inflating or upcoding his billings, and double billing for more than five years. He upcoded billings by claiming he performed more complex procedures than he actually had, such as extractions of impacted teeth instead of simple extractions.

HHS, DOJ crack down on $1.3B in healthcare fraud

July 14, 2017 -- A Nebraska dentist and two Michigan dentists were three of more than 400 people charged with healthcare fraud on July 13, 2017, by the U.S. Department of Justice (DOJ) and Department of Health and Human Services (HHS). The defendants allegedly billed the U.S. government approximately $1.3 billion in fraudulent services.

Mass. dentist to pay $650K to settle Medicaid billing case

February 3, 2016 -- A Massachusetts dentist has agreed to pay $650,000 to the state's Medicaid program for improperly billed dental work, according to the Massachusetts Attorney General's Office. Ekaterina Mamulashvili, DMD, is alleged to have used multiple oral examination codes to bill MassHealth, the state's Medicaid program, for services received by the same patients on the same day from February 2007 through July 2012."We allege this dentist knowingly and frequently overbilled MassHealth by improperly using multiple oral examinations codes in violation of state law," stated Attorney General Maura Healey in a press release. "This settlement will provide restitution to MassHealth and will ensure that taxpayer dollars are used to benefit members, not to enrich providers."The issues were discovered during an audit of Dr. Mamulashvili’s billing practices. The attorney general's office conducted an investigation into Dr. Mamulashvili and her professional dental corporations, Everett Dental Management, Sameka Dental Management in South Boston, and Malden Dental Management Center.

Texas chain to pay $8.45M to settle Medicaid fraud case

January 10, 2017 -- The U.S. Department of Justice announced an $8.45 million Medicaid fraud case settlement with a Texas dental company and its affiliated practices. Dental firm MB2 Dental Solutions and 19 pediatric dental practices affiliated with the company have agreed to pay the U.S. and the Texas Medicaid program to resolve Medicaid fraud allegations. The case against the company alleged that for six years, from January 1, 2009, to December 31, 2014, the company and its affiliates submitted claims to the Texas Medicaid Fee for Service Program for single-surface fillings that were not provided, according to the U.S. Attorney's Office for the Northern District of Texas. The company's actions were revealed by a former employee.

19 dentists convicted of Medicaid fraud in 2014

April 22, 2015 -- In 2014, 19 dentists were convicted of Medicaid fraud, according to an annual report issued by the U.S. Department of Health and Human Services (HHS) Office of the Inspector General (OIG). More than $4.1 million was recovered from these convictions. In comparison, 64 physicians and 56 counselors/psychologists were convicted last year. Almost $22 million was recovered from the counselors/psychologists, while more than $52.4 million was recovered from the physicians (see table below).However, dental fraud only accounted for 0.5% of Medicaid fraud recoveries last year, with $2.26 billion recovered in total. Home healthcare agencies were a particularly notable source of fraud, contributing $193.77 million to the total.