If you are a dentist or manage dental clinics in Texas, you are very likely aware of the increase in governmental regulation in the form of Medicaid/Medicare fraud prevention. In 2013, David Heath for the Center for Public Integrity wrote:
"Texas has been embroiled in a Medicaid fraud scandal for the past couple of years. The initial focus was on overbilling Medicaid for unnecessary braces on children. But the scandal has since widened. State authorities said [...] they've identified 89 dental providers they suspect of overbilling Medicaid by $154 million," (Texas tries to crack down on dental chains that put profits ahead of patients).
What Are the Fraud Allegations?
The allegations generally involve fraudulent procedures, i.e. non-medically necessary services, or billing Medicaid for services that were not performed at all. Here is a common example: The investigatory entity alleges that a dental practice has billed Medicaid for the treatment of cavities that did not exist or did not otherwise require treatment.
Heath describes the "push to boost corporate profits," where dentists working in corporate chains may feel pressure to over-treat or perform unnecessary procedures.
The Other Side of the Coin
But Kerri Toloczko, writing for Forbes, defends corporate dental chains as a viable way to serve poor children in need of dental care, who have been historically underserved.
"Because most dental practices are small," Toloczko writes, "they cannot afford accommodating children in Medicaid. [...] Enter Dental Service Organizations (DSOs) – a new model for dental practice. DSOs perform the business requirements of a dental practice, leaving dentists free to perform dentistry," (George Soros & PBS v. Arthur Laffer).
According to Toloczko, DSOs help overcome the barriers to serving Medicaid patients, and have helped more children get the dental care they need. There have been a few wrongdoers, admits Toloczko, but these "suffered swift retribution" from the government.
We Will Counsel and Aggressively Defend You
In our law practice, we have represented several DSOs targeted by the Office of Inspector General (OIG) and the Attorney General. What often happens in these cases is the investigatory entity shows up with a subpoena seeking all medical and billing records in an effort to build a case against you for Medicaid or Medicare fraud.