Dental Practices Can Be Charged With Healthcare Fraud

The Department of Justice recently announced an investigation and subsequent fraud indictment of a dental practice in Washington, D.C. The dentist and a dental hygienist were accused of submitting false claims to Medicaid for reimbursement.

According to the indictment, the dentist operated a practice, The Washington Smile Center, in Washington, D.C. The indictment alleges that, from January 2017 through March 2022, Dr. Steven A. Price and a dental hygienist conspired to defraud Medicaid. The claims involved more than $4 million in Medicaid funds.

As part of the scheme, it is alleged that Dr. Price submitted claims for treatments that were never performed. In some instances, patients were alleged to have been provided more than 30 clinical crown lengthening procedures and more than 20 space maintainers during the relevant period.

The indictment includes a forfeiture allegation seeking all proceeds of the alleged crimes.

In another dental-related case in Texas, charges have been filed against a dental clinic operator and two managers for their alleged roles in a multimillion-dollar fraud and kickback scheme. 

According to the charges, Rene Gaviola, the operator of Floss Family Dental Care clinic located in Houston, and two managers of the clinic submitted fraudulent claims to Medicaid for pediatric dental services, including numerous cavity fillings, that Floss did not provide or that licensed individuals did not conduct. At Gaviola’s direction, Floss allegedly employed someone to practice dentistry without a license, and Floss billed Medicaid for these dental services as if they were provided by a licensed dentist, according to the indictment.

Gaviola and the two managers also allegedly paid kickbacks to marketers and caregivers of Medicaid-insured children to bring them to Floss for dental services. From 2019 to 2021, the dental clinic allegedly billed Medicaid for nearly $7 million, for which Medicaid paid approximately $4.9 million.

Many Medicare Advantage plans have incorporated dental care into their benefits in the last few years. Moreover, Congress recently introduced legislation that would make comprehensive dental care a mandatory component of Medicaid coverage for adults in every state.

Some common billing and claims practices that are fraudulent include:

• Billing for services not performed.
• Waiving deductibles and copayments.
• Improperly using additional codes (unbundling).  
• Recruiting Medicaid recipients as patients by offering cash or something else of value.

Dental assistants or dental staff who work for a practice that accepts federal insurance (i.e., Medicare, Medicaid, or Tricare) for dental care should be aware of and look for such fraud.

Ross Feller Casey is a Philadelphia law firm that is nationally recognized for winning major whistleblower cases. The firm’s leading qui tam practice is committed to representing whistleblowers in False Claims Act cases and those filed under IRS, SEC, and other whistleblower statutes.

If you have information involving healthcare fraud, including dental fraud, you should contact one of our experienced whistleblower attorneys now for a free case review.