In a rare False Claims Act settlement involving dental care, an Oklahoma-based dentist has agreed to pay $5 million to settle claims of false invoices to the federal government for dental services. The company, which actually operates facilities in seven U.S. states, is alleged to have engaged in the familiar practice of unlawful upcoding and billing for services never rendered. The case actually did not involve a whistleblower, but was investigated by a concerted effort between the Federal Bureau of Investigation, the U.S. Department of Health and Human Services, Office of Inspector General, the Oklahoma Attorney General’s Office Medicaid Fraud Control Unit, and the Oklahoma Healthcare Authority. The case was prosecuted by Assistant United States Attorneys Ronald R. Gallegos and Scott Maule, and Oklahoma Assistant Attorney General Niki S. Batt.
Details of the case against Ocean Dental
Ocean Dental, P.C. is an interstate provider of dental services that provides dental care to patients receiving Medicaid benefits due to financial hardship. Since Medicaid is also administered by the states, the extent of coverage varies by jurisdiction. For instance, states like California and New York provide comprehensive coverage for dental care, including routine cleanings and preventative services. Other states provide a limited range of services or provide emergency services only – such as extraction of diseased teeth. Oklahoma is one of the states that provides limited coverage for Medicaid patients seeking dental services, and generally only covers emergency dental services.
According to the allegations, for a five-year period spanning from 2005 through 2010, Oklahoma-based dentist Robin Lockwood, D.D.S. submitted thousands of claims for reimbursement for services that either should have been billed at a much cheaper rate or were never provided at all. Under the terms of the settlement, Ocean Dental and its owner are released from all liability. Dr. Lockwood also pled guilty in 2012 to criminal healthcare fraud, served 18 months in federal prison, and was ordered to pay over $375,000 in restitution to Oklahoma’s Medicaid program.
While dental fraud is not necessarily at the forefront of the healthcare fraud crackdown, it is just as costly and wasteful as any other form of fraud against the government. In a comment, the U.S. Attorney’s Office said:
“Preventing fraud is a priority at the Attorney General’s Office because fraud limits the ability of those truly deserving of assistance from receiving the help for which they are eligible….We appreciate partnering with the U.S. Attorney’s Office in order to hold accountable those who would perpetrate fraud against the taxpayers.”
Oklahoma’s U.S. Attorney similarly commented:
“We continually strive to protect government programs, such as Medicaid, from fraud and abuse by ensuring they are used properly and only by those who are in need and are eligible….This case is a good example of the value of coordination between state and federal law enforcement, as well as the coordinated use of parallel proceedings, to achieve a successful civil and criminal resolution.”
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