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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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“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2019 The Health Law Firm. All rights reserved.

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30 Major Mistakes Dentists Make After Being Notified of a Department of Health Investigation- Part 1

5 Indest-2008-2By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

The investigation of a Department of Health (DOH) complaint which could lead to the revocation of the dentist’s license, usually starts with a simple letter from the DOH.  This letter should not be ignored. This is a very serious legal matter and it should be treated as such by the dentist who receives it.  Yet, in many cases, we are consulted by dentists after the entire investigation is over. The case has been presented to the Probable Cause Panel and formal charges have been filed against them.  They have attempted to represent themselves throughout the case unsuccessfully and the damage has already been done.  Often, the mistakes that have been made severely compromise our ability to achieve a favorable result for the dentist.

This is part one in a two part blog series.

These are the 30 major mistakes we see in the cases we are called upon to defend after a DOH investigation has been initiated against a dentist:

1. Failing to keep a current, valid address on file with the DOH (as required by law), which may seriously delay the receipt of the Uniform Complaint (notice of investigation), letters, and other important correspondence related to the investigation.

2. Contacting the DOH investigator and providing him/her an oral statement or oral interview.  Note:  There is no legal requirement to do this.  We recommend that you never do this.  Anything that you state may be used to help the state prove its case against you.  The DOH investigator is the equivalent of a police investigator attempting to make a case against you.  Don’t help them.

3. Making a written statement in response to the “invitation” extended by the DOH investigator to do so.  (Note:  There is no legal requirement to do this.  See above.)

4. Failing to carefully review the complaint to make sure it has been sent to the correct dentist.  (Note:  Check the name and license number, especially if you have a common name.)

5. Failing to ascertain whether or not the investigation is on the “Fast Track” which may then result in an emergency suspension order (ESO) suspending the physician’s license until all proceedings are concluded.  (Note:  This will usually be the case if there are allegations regarding drug abuse, alcohol abuse, sexual contact with a patient, mental health issues, failure to comply with PRN instructions, or default on a student loan.)

6. Providing a copy of the physician’s curriculum vitae (CV) or resume to the investigator because the investigator requested them to do so.  Note:  There is no legal requirement to do this.  We have actually had information from the dentist’s CV used against him in the case presented against the dentists.

7. Believing that if they “just explain it,” the investigation will be closed and the case dropped.  This never happens.  Every case is presented the Probable Cause Panel of the Board of Dentistry.

8. Failing to submit a timely objection to a DOH subpoena when there are valid grounds to do so.  If there are valid grounds for objecting to a subpoena issued by a DOH Investigator (or by an Order from the Surgeon General to do so) then it can and should be made.  The Department of Health does not have any authority to enforce subpoenas.

9. Forwarding only a portion of or failing to forward a complete copy of the patient’s dental record when subpoenaed by the DOH investigator as part of the investigation, when no objection is going to be filed.  We have seen this, especially with electronic dental records such as those maintained using the Dentrix system.   If you do provide a copy of the patient’s dental record (whether to the DOH investigator or to your attorney) you must be ceratin you produce each and every part of it.  This includes, daily journal entries, progress notes, periodontal charts, bills, treatment plans, x-rays, photographs, history & physical, informed consent forms, notes and telephone messages, correspondence, insurance company bills and EOBs.

10. Delegating the task of providing a complete copy of the patient medical record to your office staff, resulting in an incomplete or partial copy being provided.

11. Signing a “certificate” or “affidavit” that the copy of the record you have provided to the DOH investigator is complete.  There is no legal requirement of which we are aware that requires this.  Furthermore, we have seen this used against the dentists in a number of cases when he later discovers additional records (from another office or another source) that he had but did not include in the initial production.

12. Not being knowing or being able to tell that the investigation against them is a “fast track” or “Priority 1” investigation which is likely to be submitted to the Surgeon General for an Emergency Suspension s Order (ESO).

13. Failing to keep an exact copy of any dental records, documents, letters or statements provided to the investigator.

14. Believing that the investigator has knowledge or experience in dental procedures, medical procedures or the health care matters or the specific care or procedures investigated.

15. Believing that the investigator is merely attempting to ascertain the truth of the matter and this will result in the matter being dismissed.
Not every case will require submission of materials to the Probable Cause Panel after the investigation is received and reviewed.  There will be a few where the allegations made are not “legally sufficient” and do not constitute an offense for which the physicians may be disciplined.  However, only an attorney who has handled a large number of dentistry cases will be able to tell which cases these are.

In other cases, an experienced health care attorney may be successful in obtaining a commitment from the DOH (prosecuting) attorney to recommend a dismissal to the Probable Cause Panel.  In still other cases (usually the most serious ones), for tactical reasons, the experienced health care attorney may recommend that you waive your right to have the case submitted to the Probable Cause Panel and that you proceed directly to an administrative hearing.  The key to a successful outcome in all of these cases is to obtain the assistance of a health care lawyer who is experienced in appearing before the Board of Dentistry in such cases and does so on a regular basis.


Contact Health Law Attorneys Experienced with Department of Health Investigations of Dentists.

The attorneys of The Health Law Firm provide legal representation to dentists in Department of Health (DOH) investigations, Drug Enforcement Administration (DEA) investigations, FBI investigations and other types of investigations of health professionals and providers.  To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

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.

KeyWords: Legal representation for dentists, dentist attorney, dentist defense attorney, legal representation for DOH investigations, legal representation for DOH investigations against dentists, DOH defense attorney, DOH investigation attorney, legal representation for DOH complaints, legal representation for complaints against dental license, legal representation for health care professionals, health law defense attorney, legal representation for revocation of license, legal representation for Probable Cause Panel issues, legal representation for Probable Cause Panel investigations, legal counsel for Probable Cause Panel investigations, The Health Law Firm, reviews of The Health Law Firm, The Health Law Firm attorney reviews
“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.Copyright © 2017 The Health Law Firm. All rights reserved.

 

30 Major Mistakes Dentists Make After Being Notified of a Department of Health Investigation- Part 2

Attorney 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

This two part blog series discusses the seriousness of receiving a letter of investigation from the Department of Health (DOH) and the importance of consulting an experienced health law attorney. In many cases, we are consulted by dentists after the entire investigation is over. Often, the mistakes that have been made severely compromise our ability to achieve a favorable result for the dentist.

This is part two in a two part blog series. To read part one of this series, click here.

These are the major mistakes we see in the cases we are called upon to defend after a DOH investigation has been initiated against a dentist:

16. Failing to check to see if their dental malpractice insurance carrier will pay the legal fees to defend them in this investigation.  In the absence of coverage by their insurance carrier, failing to retain the services of a health care attorney experienced in dental board cases to represent them from the beginning of the investigation.

17. Talking to DOH investigators, staff or attorneys, in the mistaken belief that they are capable of doing so without providing information that can and will be used against them.  Note:  Every telephone conversation with DOH personnel is entered into their computer data base and often internal e-mails Are exchanged sharing this information afterwards.

18. Believing that because they haven’t heard anything for six months or more the matter has “gone away.”  The matter does not ever just go away.

19. Failing to submit a written request to the investigator at the beginning of the investigation for a copy of the complete investigation report and file and then following up with additional requests until it is received.

20. Failing to wisely use the time while the investigation is proceeding to interview witnesses, obtain written witness statements, conduct research, obtain experts, and perform other tasks that may assist defending the case once it has been completed.

21. Failing to exercise the right of submitting documents, statements, and expert opinions to rebut the findings made in the investigation report before the case is submitted to the Probable Cause Panel of your licensing board for a decision.

22. Taking legal advice from their colleagues regarding what they should do (or not do) in defending themselves in the investigation.

23. Retaining “consultants” or other non-lawyer personnel to represent them in the matter, instead of experienced legal counsel.

24. Believing that the case is indefensible so there is no reason to even try to have it dismissed by the Probable Cause Panel.

25. Attempting to defend themselves.

26. Believing that because they know someone on the Board of Dentistry, with the Department of Health, or a state legislator, that influence can be exerted to have the case dismissed.  This is definitely not the case.  If you do know someone on the Board of Dentistry, that person is required by law to recuse (disqualify) themself from any discussion or vote on your case.

27. Failing to immediately retain the services of a health care attorney who is experienced in such matters to represent them, to communicate with the DOH investigator for them, and to prepare and submit materials to the Probable Cause Panel.

28. Believing that if an emergency Suspension Order (ESO) is entered against them that it may be successfully appealed.  In realty, ESO’s are reviewed by the appellate courts when there is an appeal based on what is contained “within the four corners of the document.”  Nothing outside the document may be considered.  If the ESO appears to state a sufficient case for an emergency suspension (whether the facts it states are actually true or not), the court of appeal is required to uphold the emergency suspension.

29. Communicating with the Department of Health about the pending case.

30. Failing to obtain legal representation.

The key to a successful outcome in all of these cases is to obtain the assistance of a health care lawyer who is experienced in appearing before the Board of Dentistry in such cases and does so on a regular basis.

Contact Health Law Attorneys Experienced with Department of Health Investigations of Dentists. 

The attorneys of The Health Law Firm provide legal representation to dentists in Department of Health (DOH) investigations, Drug Enforcement Administration (DEA) investigations, FBI investigations and other types of investigations of health professionals and providers.  To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

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.

KeyWords: Legal representation for dentists, dentist attorney, dentist defense attorney, legal representation for DOH investigations, legal representation for DOH investigations against dentists, DOH defense attorney, DOH investigation attorney, legal representation for DOH complaints, legal representation for complaints against dental license, legal representation for health care professionals, health law defense attorney, legal representation for revocation of license, legal representation for Probable Cause Panel issues, legal representation for Probable Cause Panel investigations, legal counsel for Probable Cause Panel investigations, The Health Law Firm, reviews of The Health Law Firm, The Health Law Firm attorney reviews

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.Copyright © 2017 The Health Law Firm. All rights reserved.