Florida Medicaid Audits Dental Claims

MLS02PJGBy Michael L. Smith, R.R.T., J.D., Board Certified by The Florida Bar in Health Law

The Agency for Health Care Administration (AHCA) is auditing Medicaid claims submitted by dental providers in Florida. AHCA is auditing dental practices looking for claims that were not billed in compliance with the Florida Medicaid Dental Services Coverage and Limitations Handbook. AHCA’s audits are focused on claims that are billed too frequently, claims that are billed on the same date of service as a redundant code, and claims that have been unbundled when they should have been billed as part of a comprehensive code.

Specific Dental Codes Being Audited.

Dental providers that are the subject of these audits may not learn of the audit until they receive the Preliminary Audit Report. It is extremely important to immediately retain experienced health care counsel if you receive a Preliminary Audit Report so that a timely rebuttal with additional documents can be submitted. The audits are performed by the AHCA based entirely on the claims submitted by the provider.

Some of the specific procedure codes included in the audits are:

- D0120,
– D0272,
– D1110,
– D1120,
– D1203,
– D1330,
– D0150,
– D0210,
– D0330,
– D4355, and
– D4341.

Take Preliminary Audit Reports Seriously.

Every dental provider that receives a Preliminary Audit Report from AHCA has a limited time to respond to the audit. AHCA may also impose sanctions and assess costs against dental providers in these audits. Any dental provider that receives notice of an audit by the Agency should contact legal counsel experienced in these matters without delay.

Click here for a previous blog on tips for responding to an AHCA audit.

Contact Health Law Attorneys Experienced in Representing Dentists.

The attorneys of The Health Law Firm provide legal representation to dentists in Department of Health (DOH) investigations, Drug Enforcement Administration (DEA) investigations, FBI investigations, Board of Dentistry and other types of investigations of health professionals and providers.

Our firm also routinely represents physicians, dentists, orthodontists, medical groups, clinics, pharmacies, home health care agencies, nursing homes and other health care providers in AHCA investigations, audits and recovery actions, as well as Medicare and Medicaid investigations, audits and recovery actions.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Comments?

Have you ever received a Preliminary Audit Report from the AHCA? Did you know how to respond? Please leave any thoughtful comments below.

About the Author: Michael L. Smith, R.R.T., J.D., is Board Certified by The Florida Bar in Health Law. He is an attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. http://www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1996-2014 The Health Law Firm. All rights reserved.

New Hampshire Dentist Indicted on 189 Counts of Medicaid Fraud

4 Indest-2009-3By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On December 20, 2013, a New Hampshire dentist was indicted on 189 counts of Medicaid fraud, according to a number of news sources. The dentist is alleged to have made false claims to the New Hampshire Medicaid office for procedures such as oral exams, X-rays, tooth extractions and orthopedic treatments performed between 2008 and 2013. According to the Concord Monitor, the dentist faces a maximum sentence of 1,323 years in prison. However, it is unlikely the dentist will receive such a long sentence. It is even more unlikely that he will serve the entire sentence, even if he does receive the maximum.

To read an article from the Concord Monitor, click here.

Medicaid Fraud Control Unit of the New Hampshire Attorney General’s Office Brought Charges.

According to an article in the Union Leader, the Medicaid Fraud Control Unit (MFCU) of the state Attorney General’s (AG) Office handed down the charges against the dentist. Most of the indictment alleges that the claims made by the dentist were unjustified based on treatment records. The dentist is also accused of billing the Medicaid program for individual services he was already being reimbursed for under a lump-sum treatment plan.

The dentist was also allegedly indicted on nearly 30 counts of falsifying evidence. According to the Union Leader, once the dentist found out he was being investigated, the dentist allegedly attempted to alter his medical records.

According to his attorney the dentist plans to plead not guilty at his arraignment on January 15, 2014.

Click here to read the entire Union Leader article.

Poor Documentation or Fraud?

When we look at cases of this nature, we always ask was this just a case of poor documentation or was it intentional fraud? Was this a case of an incompetent biller or was it intentional submission of false claims? In many cases, poor administration or poor documentation can explain what may look like fraud to a regulator or prosecutor.

Tips for Responding to a MFCU Investigative Subpoena.

The MFCU is in charge of investigating and prosecuting health care providers suspected of defrauding the state’s Medicaid program. When the unit opens a case against a provider, the first step is usually the issuance of an investigative subpoena, requesting specific records. It is important to remember that the MFCU would not be involved unless criminal fraud was suspected. This is not a routine audit. Click here to read practice tips on how to properly respond to a subpoena.

Fraud Charges Should be Taken Seriously.

We have been consulted by many individuals similar to the subject of this story, both before and after criminal convictions for fraud or related offenses. In many instances, we are convinced that the person is actually not guilty of fraud. However, in many cases those subject to Medicaid or Medicare fraud audits and investigations refuse to acknowledge the seriousness of the matter or they decide not to spend the money required for a top quality attorney to defend them.

If you are accused of Medicare or Medicaid fraud, realize that you are in the fight of your life. Your liberty, life and profession are at stake. You need to hire the absolute best criminal defense attorney available who has experience in defending such cases to represent you.

If you win and are acquitted, at least you still have a professional license and can start over. However, if you lose, you will most probably be in prison for years. You will lose your license. You will be excluded from Medicare. You will be a convicted felon. You will have nothing and will have no way of starting over successfully.

Contact Health Law Attorneys Experienced in Representing Dentists.

The attorneys of The Health Law Firm provide legal representation to dentists in Department of Health (DOH) investigations, Drug Enforcement Administration (DEA) investigations, FBI investigations, Board of Dentistry and other types of investigations of health professionals and providers.

Our firm also routinely represents physicians, dentists, orthodontists, medical groups, clinics, pharmacies, home health care agencies, nursing homes and other health care providers in Medicare and Medicaid investigations, audits and recovery actions.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at http://www.TheHealthLawFirm.com.

Comments?

Have you heard of the MFCU? How would you respond to a subpoena from the MFCU? Please leave any thoughtful comments below.

Sources:

Blackman, Jeremy. “Manchester Dentist Faces 1,300 Years in Medicaid Fraud Scheme.” Concord Monitor. (December 30, 2013). From: http://www.concordmonitor.com/home/10005460-95/manchester-dentist-faces-1300-years-in-medicaid-fraud-case

Siefer, Ted. “Manchester Dentist Indicted on 189 Counts of Medicaid Fraud.” Union Leader. (January 1, 2014). From: http://www.unionleader.com/article/20140101/NEWS03/140109940

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.

Copyright © 1996-2012 The Health Law Firm. All rights reserved.

Connecticut Dentist Gets Drilled in Huge Medicaid Fraud Case

4 Indest-2009-3By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

A dentist and owner of a number of clinics in Connecticut is feeling the pain of justice. According to a number of news sources, Gary Anusavice will spend the next eight (8) years in prison for targeting poor patients, performing unnecessary dental procedures and collecting $21 million in fraudulent Medicaid claims. He was sentenced on October 9, 2013.

To read an article on the dentist’s sentencing from The Hartford Courant, click here.

Dentist Must Forfeit Luxury Items.

On top of prison time, the dentist will have to pay $3.3 million in restitution and $1.9 million to the Internal Revenue Service (IRS) as a result of his Medicaid fraud scheme, according to The Hartford Courant. He was also ordered to forfeit his mansion, a 2008 Mercedes-Benz, a yacht and more than $91,000 in cash that was found in his home.

According to news reports, this is far from the first time he has been accused of defrauding the Medicaid program.

Dentist Previously Barred from Practicing in Massachusetts and Rhode Island.

According to an article in the Connecticut Post, the dentist had previous run-ins with authorities in Massachusetts and Rhode Island involving health care fraud. Both states allegedly stripped him of his dental licenses. He was also allegedly barred from participating in Medicaid in those states.

Since the dentist could no longer practice in those states, in 2008, he opened three dental groups in Connecticut, according to the Connecticut Post. In these new practices, it’s alleged he hired other dentists and offered them commissions for performing expensive procedures, paid patient recruiters to solicit poor neighborhoods, and provided shuttle services for patients. In two years, his Connecticut clinics received $21 million in Medicaid payments, according to the Connecticut Post.

Click here to read the Connecticut Post article.

In June 2013, the dentist pleaded guilty to health care fraud and tax evasion.

Being Barred from the Medicare and Medicaid Program Can have Devastating Effects.

Few health care practitioners really understand the significance of being excluded from the Medicare or Medicaid programs. Exclusion usually occurs as a direct result of disciplinary action being taken by the state board of medicine, board of nursing, board of dentistry, board of pharmacy or other health care licensing entity. To read more on the effects of exclusion from the Medicare or Medicaid programs, click here.

Take Fraud Charges Seriously.

If you are accused of Medicare or Medicaid fraud, realize that you are in the fight of your life. Your liberty, life and profession are at stake. You need to sell everything you own, borrow everything you can and hire the absolute best criminal defense attorney available who has experience in defending such cases to represent you.

If you win and are acquitted, at least you still have a professional license and can start over. However, if you lose, you will most probably be in prison for years. You will lose your license. You will be excluded from Medicare. You will be a convicted felon. You will have nothing and will have no way of starting over successfully.

Do not delude yourself. This is extremely serious. Be prepared to give up whatever you have if you can avoid a conviction.

Often Fraud Claims Can Give Rise to Large Rewards Paid to Whistleblowers.

Practically every state now has statues which allow a monetary recovery to be a person bringing a claim on behalf of the state for false Medicaid payments. These are modeled after the federal False Claims Act, used to reward whistleblowers or qui tam relators for recovers in Medicaid fraud cases.

Contact Health Law Attorneys Experienced in Handling Medicaid Audits, Investigations and other Legal Proceedings.

Medicaid fraud is a serious crime and is vigorously investigated by the state MFCU, the Agency for Health Care Administration (AHCA), the Zone Program Integrity Contractors (ZPICs), the FBI, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (DHHS). Often other state and federal agencies, including the U.S. Postal Service (USPS), and other law enforcement agencies participate. Don’t wait until it’s too late. If you are concerned of any possible violations and would like a confidential consultation, contact a qualified health attorney familiar with medical billing and audits today. Often Medicaid fraud criminal charges arise out of routine Medicaid audits, probe audits, or patient complaints.

The Health Law Firm’s attorneys routinely represent physicians, dentists, orthodontists, medical groups, clinics, pharmacies, assisted living facilities (AFLs), home health care agencies, nursing homes, group homes and other healthcare providers in Medicaid and Medicare investigations, audits and recovery actions.

To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Comments?

Why was it so simple for the dentist to move to another state and continue to defraud Medicaid after being previously reprimanded for the same crime? Please leave any thoughtful comments below.

Sources:

Mahony, Edmund. “Dentist in Massive Medicaid Fraud Case Sentenced to 8 Years.” The Hartford Courant. (October 9, 2013). From: http://www.courant.com/health/connecticut/hc-medicaid-fraud-1010-20131009,0,1388813.story

Mayko, Michael. “Fraudulent Dentel-Group Owner Sentenced.” Connecticut Post. (October 9, 2013). From: http://www.ctpost.com/local/article/Fraudulent-dental-group-owner-sentenced-4883112.php
About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1996-2012 The Health Law Firm. All rights reserved.

The Lone Star State’s New Task Force to Take a Bite Out of Medicaid Dental Fraud

George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

There’s a new task force riding into Texas. According to The Texas Tribune, the Texas Attorney General’s (AG) Office and the Office of Inspector General (OIG) at the Health and Human Services Commission (HHSC) have teamed up to increase investigations of fraud in the state’s Medicaid dental program for children. The article, published on October 10, 2012, states the creation of the Medicaid and orthodontic task force was created in response to a significant increase in fraud by Medicaid providers.

To read the full article from The Texas Tribune, click here.

Everything is Bigger in Texas, Including Fraud.

A report released in April 2012, by the U.S. House Committee on Oversight and Government Reform, stated that in 2010 the Lone Star State spent as much on orthodontic services as every other state in the U.S. combined. In the report the state said the reason fraud was so widespread is that the organization the state hired to assess prior authorization forms was “rubber stamping” the forms for approval.

Click here to read the entire report from the U.S. House Committee on Oversight and Government Reform.

Patient Recruiting Contributing to Medicaid Fraud Problems.

An announcement on the Texas HHSC OIG website stated Texas authorities have found that some dental clinics hired representatives to stand outside retail and grocery stores and hand out gift cards in exchange for signing up for a “free” dental exam. The Inspector General said offering incentives to Medicaid clients is illegal. Those caught can be fined up to $10,000 per violation.

To see the announcement from the OIG of the HHSC, click here.

Crackdown Leaving Dentists Uneasy.

The task force and the overall crackdown on dentists and orthodontists have limited the number of dental professionals willing to take referrals for Medicaid patients. In The Texas Tribune article, the HSSC warns orthodontic providers that the Texas dental board can suspend or revoke their license for abandoning Medicaid patients.

Having a license suspended or revoked is an entirely different and very serious issue.
However, patient abandonment is very narrowly defined in the law and is difficult to prove.

What many state Medicaid regulatory authorities fail to appreciate is that indentured servitude is illegal in the United States. They seem to believe that if the professional is dumb enough to sign up for the Medicaid program, then he or she is dumb enough to be forced to provide services without pay or to be forced to see patients they don’t want to.

This may be largely an idle threat, however. I myself have had several articles published in major healthcare publications regarding what is and isn’t “patient abandonment.” Lay people and investigators bandy the term about figuring it will strike fear into the hearts of physicians (and often it does).

Contact Health Law Attorneys Experienced in Handling Medicaid Audits.
Medicaid fraud is a serious crime and is vigorously investigated by the state MFCU, the Agency for Healthcare Administration (AHCA), the Zone Program Integrity Contractors (ZPICs), the FBI, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (DHHS). Often other state and federal agencies, including the U.S. Postal Service (USPS), and other law enforcement agencies participate. Don’t wait until it’s too late. If you are concerned of any possible violations and would like a confidential consultation, contact a qualified health attorney familiar with medical billing and audits today. Often Medicaid fraud criminal charges arise out of routine Medicaid audits, probe audits, or patient complaints.

The Health Law Firm’s attorneys routinely represent physicians, dentists, orthodontists, medical groups, clinics, pharmacies, assisted living facilities (AFLs), home health care agencies, nursing homes, group homes and other healthcare providers in Medicaid and Medicare investigations, audits and recovery actions.

To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at http://www.TheHealthLawFirm.com.

Comments?

What do you think of the new task force? Do you think it will help put a stop to Medicaid dental fraud? Is Medicaid dental fraud a problem in your state? Should providers be charged with “patient abandonment” for not treating Medicaid patients? Please leave any thoughtful comments below.

Source:

Aaronson, Becca. “Joint Task Force Tackles Medicaid Dental Fraud.” The Texas Tribune. (October 10, 2012). From: http://www.texastribune.org/texas-health-resources/medicaid/joint-task-force-tackles-medicaid-dental-fraud/

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. http://www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1996-2012 The Health Law Firm. All rights reserved.