Dental fraud and abuse rob Medicaid

Dental fraud and abuse cases have drawn the eye of the Office of Inspector General. Medicaid is the main source of dental benefits for about 35 million children, and many dentists and dental chains have been prosecuted for providing unnecessary care that's harmed children, according to a commentary by former U.S. Department of Health and Human Services Inspector General Richard P. Kusserow.

In New York, for example, the OIG identified questionable billing by 23 general dentists and six orthodontists who received $13.2 million in Medicaid payments for pediatric dental care in 2012. Each provider received high payments per child, provided a high number of services per child or provided services such as pulpotomies or extractions to many children.

Almost 33 percent of these general dentists were associated with a single dental provider chain that settled lawsuits for rendering services that were unnecessary or failed to meet professionally-recognized pediatric dentistry standards, Kusserow noted.

Meanwhile, Sally Metzner, the unlicensed owner of an Indiana-based dental center, faces criminal charges of Medicaid fraud, money laundering, corrupt business influence, theft, forgery and practicing dentistry without a license, The Herald Bulletin reported. Three dentists and four employees of Anderson Dental Center also are implicated in this case, which resulted in a Medicaid overpayment topping $300,000, the Indiana Attorney General's Office announced earlier this month.     

"The allegation here is that these defendants defrauded Medicaid so brazenly and repeatedly in operating their practice that it cannot be attributed to mistake or paperwork errors," Indiana Attorney General Greg Zoeller said in the announcement. Metzner has pleaded not guilty. 

The defendants reportedly claimed payment for services not rendered, upcoded claimed services, billed for work by dentists who were not authorized Medicaid providers, filed claims for work by a dentist who left the practice and forged signatures on Medicaid forms. Dental center staff also are charged with prescription drug fraud, The Bulletin reported.

For more:
- read the Indiana Attorney General's Office announcement
- here's The Herald Bulletin article
- see Kusserow's commentary