James Anderson

Unlicensed or Unqualified People

Licensed dentists commit fraud by “[billing] for services provided by unqualified or unlicensed clinical personnel” by putting their name on the claim to insurance companies and Medicaid, lying that he or she did the procedures for the patient (Cutler 2012; “Dental fraud scams”). By doing so, dentists would make profit illegally (Lewis Jr. and Farragher 2013). Dentists should not commit this fraud due to not only its damaging consequences, but also its potential harm to their patients.
Dentists face a variety of charges when insurance companies discover their illegal actions. These unlicensed or even untrained people may include “hygienists, assistants or other staff” (“Dental fraud scams”). Some dentists that “[lost] their licenses for previous infractions” even resume their dental work on people (“Dental fraud scams”). Unfortunately, these unlicensed and/or unqualified people may provide poor services to their patients, harming them (“Dental fraud scams”). When charged with this fraud, dentists may not receive payments from Medicare and even be expelled “from the Medicare and Medicaid programs for a period of not less than five years” and their license may be “[suspended] or [revoked]” (Cutler 2012).
Several dentists have faced other types of consequences for this fraud. For instance, at Dr. Dennis B. Jaffe’s clinic in Atlanta, he allowed “unqualified staff [perform] services” and “billed as if he had performed the services” to Medicaid when he was not present (“Georgia Dentist Convicted of Misuse of Medicaid Funds” 2015). Once he got caught for his actions, he “pled guilty to one count of Misuse of Healthcare Funds, 18 U.S.C. § 669, and received a sentence of one year of probation, 50 hours of community service and restitution of $3,368.10. In connection with his plea, Dr. Jaffe also surrendered his license to practice dentistry” (“Georgia Dentist Convicted of Misuse of Medicaid Funds” 2015). Derrick L. Jackson, “Special Agent in Charge of the U.S. Department of Health and Human Services, Office of Inspector General in Atlanta,” warned against those who allow “‘unlicensed and unqualified staff’” perform dental work due to risking the patients’ safety (“Georgia Dentist Convicted of Misuse of Medicaid Funds” 2015).
In another case, the Medicaid Fraud Control Unit (MFCU) discovered that the dentist “allegedly [billed] Medicaid for services [i.e. periodontal root cleaning and scaling] provided by an unlicensed dental hygienist,” who treated children (Howley 2013). According to their parents, they were “mistreated” (Howley 2013). Furthermore, at another clinic, when the employees falsified the dentist’s certification documents in order to enroll him “into a large organization as an authorized provider,” these false credentials were discovered by the authorities and “the practitioner suffered significant damage to his personal and practice reputation. The staff were fired, and charged by state officials for filing false credential applications” (Lewis Jr. and Farragher 2013).
Based on these cases, dentists face a wide variety of consequences when they erroneously bill for unlicensed and unqualified people for profit. They also should not compromise their patients’ oral health in the hands of a nonprofessional.

Works Cited
Cutler, Erick. “Know the Law When it comes to Medicaid.” Goldin Peiser & Peiser, LLP, June
  1. https://dental.gppcpa.com/enewsletters/article/know_the_law_when_it_comes_to_medicaid/.
“Dental fraud scams.” Coalition Against Insurance Fraud. Accessed June 28, 2018.
“Georgia Dentist Convicted of Misuse of Medicaid Funds.” Office of Attorney General Chris
Carr, June 10, 2015. https://law.georgia.gov/press-releases/2015-06-10/georgia-dentist-convicted-misuse-medicaid-funds.
Howley, John. “Dentist Arrested for Employing Unlicensed Hygienist.” John Howley, Esq.,
February 19, 2013. http://www.johnhowleyesq.com/law-blog/dentist-arrested-for-employing-unlicensed-hygienist.
Lewis Jr., Donald P. and George P. Farragher. “Dental health-care fraud and abuse.” Dental
Economics, December 19, 2013. https://www.dentaleconomics.com/articles/print/volume-103/issue-12/features/dental-health-care-fraud-and-abuse.html.


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Dental Billing