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.
Any dentist who has patients with federal insurance that reimburses for dental care, i.e., Medicare, Medicaid, and Tricare must invest in understanding the laws, options and risks associated with this business decision. Over the last few years many Medicare Advantage plans have even incorporated dental care in their benefits, which will only heighten the need for attention to regulatory compliance for dentists in the years to come.
A few of the fraud & abuse laws which apply to a dental practice or dental group which takes federal insurance include the laws that relate to operations and billing practices, such as: 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 each state level.
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. Simply put, taking the risk of investing in anything that isn’t completely buttoned up is not worth it.
A few more questions 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? Are you billing under multiple EIN’s? Not knowing the answer to any of these is no excuse for noncompliance, and may have far reaching and expensive penalties.
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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