Prepared by: Carlos Arce, Esq.
Florida Healthcare Law Firm
Recently the Department of Justice released a statement relating to a Dentist and Dental Hygienist being charged for fraud.[1] The dental practice is being accused of fraud and false claims against Medicaid. The fraudulent allegations include false claims related to dental services bill toward D.C. Medicaid for two CPT codes (clinical crown lengthening and space maintainers) totaling more than $4,000,000 in Medicaid funds. The charges also include conspiracy and wire fraud, that carry 20-year maximum prison time, and the false claims carry a 10-year maximum prison time. The decision on sentencing will be determined by the court under advisory sentencing guidelines and other factors.
Typically, dentists don’t focus heavily on traditional healthcare law compliance, but they should. Most dentists inherently take Medicare, Medicaid, Tricare, and many forms of commercial insurance. Most patients who have insurance which reimburses for dental care is in the form of federal insurance, not commonly through in commercial insurance. Over the last few years many Medicare Advantage plans have incorporated dental care in their benefits, which will only heighten compliance for dentists in the years to come.
What does this mean for a dentist? For starts the typical fraud & abuse healthcare laws apply and are relevant as they relate to their operations and billing practices. The Anti-Kickback Statute 42 U.S.C. § 1320a-7b(b), False Claims Act 31 U.S.C. § § 3729-3733, Physician Self-Referral Law 42 U.S.C. § 1395nn, Civil Monetary Penalties Law 42 U.S.C. § 1320a-7a, and the equivalent laws at the state level are just a few of the Fraud & Abuse laws which would apply to a dental practice or dental group who takes insurance.
Not only does non-compliance with the health care laws raise legal concerns, but it lowers the overall value of a dental enterprise with multiple locations. Acquisition teams backed by private equity and venture capital are only looking to invest in enterprises which are compliant and operating legally, the risk is not tolerable when Acquisition teams are using investment money for acquisitions.
A few of the items to consider; does your dental enterprise have a compliance plan, does your dental enterprise bill federal and state insurances, does your dental enterprise transfer patients between locations for designated health services, and are you billing under multiple EIN’s.
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Attorney Carlos Arce works with the Florida Healthcare Law Firm in Delray Beach, FL. He has deep experience with bodily injury trial work and in health law. Carlos has handled multi-million-dollar healthcare transactions and serves as out-of-house counsel to various small to large types of healthcare entities. He can be reached via email at [email protected] or by calling 561-455-7700.
[1] Local Dentist and Hygienist Charged With Offenses Related to Healthcare Fraud and False Claims to D.C. Medicaid, April 20, 2023. https://www.justice.gov/usao-dc/pr/local-dentist-and-hygienist-charged-offenses-related-healthcare-fraud-and-false-claims-dc
