Medicaid fraud

Dental Clinic Owners Found Guilty of $1 Million Medicaid, Tax Scheme

George Indest HeadshotBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On February 21, 2019, a federal jury found the owners of several dental clinics in Missouri guilty of a $1 million scheme to defraud the government. The owners of All About Smiles LLC, were convicted of submitting false claims to Medicaid for dentures and other services and payroll tax fraud, according to prosecutors.

Submitting False Claims.

Prosecutors alleged that the couple that owned the practice ran several schemes through the dental clinics from 2010 to 2015, including conspiring to defraud Medicaid. A main part of the scheme was to provide dentures and other services to adults who didn’t qualify for Medicaid. They would then bill the Medicaid program anyway, receiving more than $720,000, according to the DOJ.

The pair also allegedly ran a similar scheme with orthodontic equipment, racking up an estimated 241 false claims, said prosecutors. All About Smiles was paid approximately $165,700 during the the duration of the scheme.

Payroll Problems.

In addition to the fraud, the owners allegedly failed to forward payroll taxes to the Internal Revenue Service (IRS) even though the money was withheld from employee paychecks. Instead, the married pair used the almost $195,000 to cover lavish personal expenses and make payments on a variety of vehicles, said the DOJ.

Not Smiling Anymore.

Jurors found the couple guilty on all charges detailed in a 40-count indictment accusing them of fraudulently operating three All About Smiles LLC dental clinics, said the DOJ. Additionally, their legal woes continued to stack up as each was also convicted on a count of theft of public money for collecting unemployment benefits while working.

The female owner faces up to 10 years in prison on every count besides the payroll tax conspiracy charge, which comes with a maximum penalty of five years. The husband owner could get up to a decade for obtaining unemployment benefits and five years for each additional charge, prosecutors said.

Click here to read the DOJ’s press release.

To read one of my prior blogs on a similar case about a dentist defrauding medicaid, click here.

Don’t Wait Until It’s Too Late; Consult with a Health Law Attorney Experienced in Medicaid Billing Issues Now.

The attorneys of The Health Law Firm represent dentists, oral surgeons, and other health care providers in Medicaid audits, Medicare audits, insurance billing audits, ZPIC audits, RAC audits, administrative litigation and civil litigation throughout Florida and across the U.S. They also represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in licensure complaints and investigations, DEA investigations, Medicare and Medicaid fraud investigations, audits, recovery actions and terminations from the Medicare or Medicaid Program.

For more information please visit our website at www.TheHealthLawFirm.com or call (407) 331-6620 or (850) 439-1001.

Sources:

“All About Smiles Owners Convicted of Fraud.” Ozark Independent. (February 21, 2019). Web.
Posses, Shayna. “Couple Found Guilty Of $1M Medicaid, Payroll Tax Scheme.” Law360. (February 21, 2019). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

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By |2019-04-18T18:44:05+00:00April 18th, 2019|Categories: Centers for Medicare and Medicaid Services, Dental Law Blog, Dentist Defense attorney, Health Care Fraud, Health care Law, Medicaid Fraud, Medicaid fraud|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |0 Comments

New Mexico’s Largest Mental Health Providers Accused of Defrauding Medicaid Out of $36 Million

George F. Indest III HeadshotBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

For months now, 15 New Mexico behavioral health agencies have been the subject of a Medicaid fraud investigation. The state’s largest mental health providers had their Medicaid funding frozen by the New Mexico Human Services Department (HSD) due to credible allegations of fraud, according to KUNM News. The behavioral health agencies are accused of collectively defrauding Medicaid of $36 million over three years. The findings in an audit conducted in 2012, by OptumHealth, the contractor that handles Medicaid payments for New Mexico’s behavioral health system, alarmed state officials to the point that they hired Public Consulting Group (PCG), a firm that specializes in Medicaid fraud, to conduct another audit in June 2013.

These behavioral health agencies provided services to approximately 30,000 patients. According to KUNM News, Arizona companies have been hired to step in to help patients needing treatment.

Click here to read the KUNM News article.

Audits and Whistleblower Claims Uncover Serious Accusations.

The reason for the Medicaid funding freeze, according to the HSD, was the initial audit conducted by OptumHealth, the company that manages Medicaid dollars for New Mexico’s behavioral health agencies. OptumHealth allegedly found problems with billing by the agencies in question. Then a second audit by PCG allegedly uncovered widespread overpayments for services that had never been provided. According to the New York Times, a quarter of patients’ claims were processed with mistakes.

During the PCG audit, whistleblowers also came forward with their own accusations, according to the New York Times. In one case, an employee was allegedly ordered not to inform the state that a patient had died. In another, an ex-employee at an agency reported being fired after refusing to overbill for services.

Click here to read the entire New York Times article.

To learn more on whistleblower cases, read our two-part blog. Click here for part one, and click here for part two.

Mental Health Providers Fight for Funding.

New Mexico officials state that they were obligated under federal law. Under the Affordable Care Act, states have more power to suspend payments when there is credible evidence that Medicaid dollars are being misused. All 15 mental health providers sought exceptions from the state so their Medicaid funding could be restored while the investigation continues. Only three exceptions were granted, according to the New York Times.

Mounting Pressure to Root Out Medicare and Medicaid Fraud.

Just this year, we’ve noticed the government become more aggressive in its anti-fraud and recovery efforts. The Affordable Care Act also gives investigators and prosecutors new tools to crack down on abuse. Now that the government is collecting more money, you can expect their efforts to get worse.

Since whistleblowers stand to receive up to thirty-five percent (35%) of a recovery made by the government, plus attorney’s fees and costs, you can expect more whistleblower lawsuits to be filed. Therefore, it is now more important than ever to verify accurate billing and coding.

Most Qui Tams Filed by Doctors, Nurses and Employees.

From our review of qui tam cases that have been unsealed by the government, it appears most of these are filed by physicians, nurses or hospital staff employees who have some knowledge of false billing or inappropriate coding taking place. Normally the government will want to see some actual documentation of the claims submitted by the hospital or other institution. Usually physicians, nurses or staff employees have access to such documentation. Whistleblowers are urged to come forward as soon as possible. In many circumstances, documentation that shows the fraud “disappears” or cannot be located once it is known that a company is under investigation.

Contact Health Law Attorneys Experienced with Qui Tam or Whistleblower Cases.

Attorneys with The Health Law Firm also represent health care professionals and health facilities in qui tam or whistleblower cases both in defending such claims and in bringing such claims. We have developed relationships with recognized experts in health care accounting, health care financing, utilization review, medical review, filling, coding, and other services that assist us in such matters. We have represented doctors, nurses and others as relators in bringing qui tam or whistleblower cases, as well.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Comments?

Individuals working in the health care industry often become aware of questionable activities. Often they are even asked to participate in it. In many cases the activity may amount to fraud on the government. Has this ever happened to you? Please leave any thoughtful comments below.

Sources:

Frosch, Dan. “Fraud Investigation Unsettles Mental Health Care in New Mexico.” New York Times. (September 16, 2013). From: http://www.nytimes.com/2013/09/14/us/fraud-investigation-unsettles-mental-health-care-in-new-mexico.html?pagewanted=all&_r=0

Ahtone, Tristan. “A Timeline of NM’s Shakeup of Behavioral Health Providers.” New Mexico In Depth. (September 13, 2013). From: http://www.nmindepth.com/2013/09/13/a-timeline-of-nms-shakeup-of-behavioral-health-providers/#

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.
“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999. Copyright © 1996-2012 The Health Law Firm. All rights reserved.