Some dentists would commit fraud by charging patients and Medicaid for unperformed treatments in order to get “unauthorized benefits” (Lewis Jr. and Farragher 2013). Patients may not be aware about being overbilled since “[many of them] are sedated when the work is performed. Even if they are awake, it is highly unlikely that they will know the difference between a costly dental procedure and one that is much less costly” (Liles 2017). According to Robert W. Liles, “Managing Partner at the health care law firm Liles Parker, PLLC,” “Unfortunately, this type of dental fraud is still relatively common in cases prosecuted by both Federal and State law enforcement authorities” (2017). When they are discovered committing fraud, dentists face devastating consequences.
Dentists can get caught with overbilling patients and Medicaid for unperformed treatments. For instance, Federal law enforcement investigators, State Medicaid Fraud Control Units (MFCUs), and private SIUs can do data mining, in which they could discover “how long it should take for [the dentist] to perform all of the dental services [he or she] billed in a single day. They will also compare [his or her] billing patterns to those of [his or her] peers. If any of [his or her] billing practices or patterns appear to be irregular, they will initiate an audit” (Liles 2017). Regarding billing Medicaid for unperformed treatments, dentists that “fail to report and return an overpayment within 60 days… are liable for damages and penalties under the Civil False Claims Act (FCA)” (Liles 2017). Furthermore, employees could expose the dental practice for this fraud due to the FCA’s whistleblower provisions, which “allow an individual to essentially step into the shoes of the government and file a case under seal against a wrongdoer. If the government intervenes and there is a settlement, the whistleblower can receive between 15% and 25% of the recovery” (Liles 2017).
Dentists face consequences with the law and live with damaged reputations. When dentists’ overbilling practices are discovered, they “could face criminal penalties and fines, prison time, civil fraud penalties, and loss or suspension of a professional license” (Schroeder and anitra 2017). For instance, a dentist, Robin Lockwood, spent 18 months in federal prison because she “[billed] Medicaid for dental services that were not provided” (Howley 2012). Another dentist, Dr. Marino F. Vigna, was arrested because he “allegedly [billed] the Medicaid program more than $14,000 for services not rendered,” such as “dentures that recipients never received and for tooth extractions [he] never performed” (Attorney General Bondi’s Communications Office 2016). Due to his alleged crime, “Vigna faces one count of grand theft, a third degree felony. If convicted, Vigna faces up to five years in prison, fines and restitution” (Attorney General Bondi’s Communications Office 2016). Furthermore, these fraud cases can go on public record, “[destroying the dentist’s] practice and [his or her] reputation” (Schroeder and anitra 2017).
Dentists could be discovered for billing unperformed treatments through many ways. They should not risk their clinics and reputations for more money.