Whistleblowers Needed to Stop Pediatric Dentistry Medicaid Fraud
A new report raises concerns about Medicaid billing practices at dental clinic chains in New York, California, Louisiana, and Indiana.
The report from the Office of Inspector General (OIG) at the U.S. Department of Health and Human Services found that pediatric dentists may be billing for services that are not medically necessary or were never provided. The OIG report also raised concerns about the quality of care provided to children with Medicaid.
The report noted that a small number of dentists and orthodontists billed for large numbers of services or provided certain services to an extremely large number of children. These services included extractions, stainless steel crowns, and pulpotomies, sometimes referred to as "baby root canals."
About half of the dentists who raised concerns worked for dental clinic chains. The majority of these dentists worked for just five dental clinic chains. One of the chains, Western Dental, already agreed to pay $1.7 million to settle fraud charges in a prior investigation.
The report expressed concern that dental clinic chains -- and private equity investors who finance them -- may be encouraging their dentists and orthodontists to perform unnecessary procedures to increase profits. In recent years, a number of dental providers and chains have been prosecuted for providing medically unnecessary dental procedures to children with Medicaid.
The government relies on whistleblowers to help uncover this type of Medicaid fraud, because it is very difficult to detect. The young patient and their parents may not know exactly what procedures were performed, or how the procedures were billed to Medicaid. Often the Medicaid fraud goes undetected until a whistleblower comes forward with evidence of the fraud.
To encourage whistleblowers, the government pays rewards of up to 30% of the amount it recovers from false claims. This can often amount to tens of thousands of dollars and sometimes hundreds of thousands of dollars in whistleblower rewards.
If you have evidence that a dentist or dental clinic chain is submitting false claims to Medicaid, then you should consult with an experienced whistleblower lawyer to find out if you may be eligible for a whistleblower reward. Call John Howley, Esq. at (212) 601-2728 to arrange a free and confidential consultation.
Do not delay. Only the first whistleblower to come forward may be eligible for a reward.
John Howley, Esq.
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