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New Hampshire Dentist Indicted on 189 Counts of Medicaid Fraud

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

On December 20, 2013, a New Hampshire dentist was indicted on 189 counts of Medicaid fraud, according to a number of news sources. The dentist is alleged to have made false claims to the New Hampshire Medicaid office for procedures such as oral exams, X-rays, tooth extractions and orthopedic treatments performed between 2008 and 2013. According to the Concord Monitor, the dentist faces a maximum sentence of 1,323 years in prison. However, it is unlikely the dentist will receive such a long sentence. It is even more unlikely that he will serve the entire sentence, even if he does receive the maximum.

To read an article from the Concord Monitor, click here.

Medicaid Fraud Control Unit of the New Hampshire Attorney General’s Office Brought Charges.

According to an article in the Union Leader, the Medicaid Fraud Control Unit (MFCU) of the state Attorney General’s (AG) Office handed down the charges against the dentist. Most of the indictment alleges that the claims made by the dentist were unjustified based on treatment records. The dentist is also accused of billing the Medicaid program for individual services he was already being reimbursed for under a lump-sum treatment plan.

The dentist was also allegedly indicted on nearly 30 counts of falsifying evidence. According to the Union Leader, once the dentist found out he was being investigated, the dentist allegedly attempted to alter his medical records.

According to his attorney the dentist plans to plead not guilty at his arraignment on January 15, 2014.

Click here to read the entire Union Leader article.

Poor Documentation or Fraud?

When we look at cases of this nature, we always ask was this just a case of poor documentation or was it intentional fraud? Was this a case of an incompetent biller or was it intentional submission of false claims? In many cases, poor administration or poor documentation can explain what may look like fraud to a regulator or prosecutor.

Tips for Responding to a MFCU Investigative Subpoena.

The MFCU is in charge of investigating and prosecuting health care providers suspected of defrauding the state’s Medicaid program. When the unit opens a case against a provider, the first step is usually the issuance of an investigative subpoena, requesting specific records. It is important to remember that the MFCU would not be involved unless criminal fraud was suspected. This is not a routine audit. Click here to read practice tips on how to properly respond to a subpoena.

Fraud Charges Should be Taken Seriously.

We have been consulted by many individuals similar to the subject of this story, both before and after criminal convictions for fraud or related offenses. In many instances, we are convinced that the person is actually not guilty of fraud. However, in many cases those subject to Medicaid or Medicare fraud audits and investigations refuse to acknowledge the seriousness of the matter or they decide not to spend the money required for a top quality attorney to defend them.

If you are accused of Medicare or Medicaid fraud, realize that you are in the fight of your life. Your liberty, life and profession are at stake. You need to hire the absolute best criminal defense attorney available who has experience in defending such cases to represent you.

If you win and are acquitted, at least you still have a professional license and can start over. However, if you lose, you will most probably be in prison for years. You will lose your license. You will be excluded from Medicare. You will be a convicted felon. You will have nothing and will have no way of starting over successfully.

Contact Health Law Attorneys Experienced in Representing 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, Board of Dentistry and other types of investigations of health professionals and providers.

Our firm also routinely represents physicians, dentists, orthodontists, medical groups, clinics, pharmacies, home health care agencies, nursing homes and other health care providers in Medicare and Medicaid investigations, audits and recovery actions.

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

Comments?

Have you heard of the MFCU? How would you respond to a subpoena from the MFCU? Please leave any thoughtful comments below.

Sources:

Blackman, Jeremy. “Manchester Dentist Faces 1,300 Years in Medicaid Fraud Scheme.” Concord Monitor. (December 30, 2013). From: http://www.concordmonitor.com/home/10005460-95/manchester-dentist-faces-1300-years-in-medicaid-fraud-case

Siefer, Ted. “Manchester Dentist Indicted on 189 Counts of Medicaid Fraud.” Union Leader. (January 1, 2014). From: http://www.unionleader.com/article/20140101/NEWS03/140109940

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.

By The Health Law Firm|2024-03-14T10:01:44-04:00May 15, 2018|Categories: Dentist Defense attorney, Dentists|Tags: AG, alter medical records, Attorney General, defense attorney, defense lawyer, defraud Medicaid, dental license, dental office, dental practice, dentist, dentist attorney, dentist lawyer, Department of Justice, DOJ, false claims, health care fraud, health law firm, medicaid, Medicaid billing practices, Medicaid fraud, Medicaid fraud attorney, medicaid fraud control unit, Medicaid fraud indictment, medicaid fraud lawyer, Medicaid reimbursements, mfcu, mfcu subpoena, the health law firm|Comments Off

Dangerous Dentistry: What One Connecticut Dentist Did That Got His License Suspended

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

Connecticut officials have suspended the license of an Enfield, Connecticut, dentist after a patient apparently died in the dentist’s chair on February 17, 2014. In a single visit the dentist allegedly attempted to extract 20 teeth from a 64-year-old woman who had prior health issues on record. One of the dental assistants reportedly begged for the procedure to be cut short after the patient began gurgling and lost consciousness. CPR was performed on the unresponsive patient before she was transported to a local hospital where she was pronounced dead.

According to WGGB ABC40, the dentist faces a hearing before the Connecticut State Dental Board on June 18, 2014.

To read the article from WGGB ABC40, click here.

A Repeat Offender.

The state of Connecticut alleges that in addition to the botched extraction, the dentist also failed to properly respond when the patient’s oxygen levels dramatically dropped. According to New York Daily News, state records show a four-count petition claiming that the dentist “deviated from the standard of care in that he did not timely and/or properly respond to (the patient’s)… respiratory distress and/or cardiopulmonary distress.” The patient’s official cause of death is yet to be formally determined.

The dentist’s license, issued by the state of Connecticut in 2003, was suspended April 21, 2014, pending the hearing. This is not the first legal run-in for the dentist. According to New York Daily News, in December 2014 the dentist was performing a procedure when his patient began to “aspirate the throat pack” and was rushed to a nearby hospital. The patient in this case spent six days in the hospital with heart and lung damage.

The dentist was also sued for malpractice by a former employee in 2009. Shoddy dental work was cited as the claim. The ruling ended in an out-of-court settlement. To read more from the New York Daily News article, click here.

Take ESOs Seriously.

An emergency suspension order (ESO) can be issued when a healthcare professional is posing a threat to the public. In this case, the dentist had a lengthy past of legal issues that would inevitably draw attention to his practice as a hazard. It is important to note that when a practitioner exhibits a pattern of reckless behavior numerous times, an ESO commonly follows thereafter. When an ESO is issued, a practitioner must immediately cease all practice until the suspension is lifted. Even an alleged case of malpractice can deem a healthcare practitioner an ESO. Receiving an ESO is a very serious matter. Many healthcare practitioners tend to overlook the severity of this action. You need to consistently practice proper ethics and install a system of checks and balances within your office to ensure the protection of your practice and license.

As a professional, you should take any and all necessary precautions to protect your license and reputation. Proactively avoid any irregular behaviors or fraudulent actions that could put your license at risk. If you find yourself in a situation where you are served an ESO it is vital that you immediately hire a professional and experienced healthcare attorney to represent you. If it’s a matter of not being able to afford the expenses in hiring an attorney, look at it this way: your livelihood is on the line, you can’t afford NOT to.

Anytime you suspect a claim or a complaint may be filed against you, immediately hire an attorney experienced in such matters.

Comments?

Emergency suspension orders are a common concern for healthcare professionals and their careers. What types of regulations, guidelines or practices do you mandate in your office in order to avoid a potential crisis such as an ESO? Do you have any personal experiences in dealing with ESOs? Please leave any thoughtful comments below.

Contact Health Law Attorneys Experienced with Emergency Suspension Orders and Other Licensure Actions.

The attorneys of The Health Law Firm are experienced in handling licensure and disciplinary cases, including emergency suspension orders, administrative complaints, investigations, administrative hearings, investigations, licensing issues, settlements and more. If you are currently facing adverse action by the DOH contact one of our attorneys by calling (407) 331-6620 or (850) 439-1001. You can also visit our website for more information at www.TheHealthLawFirm.com.

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

Sources:

“Conn. Suspends Enfield Dentist’s License After Patient Death.” WGGB ABC40. (May 19, 2014). From: http://www.wggb.com/2014/05/19/conn-suspends-enfield-denists-license-after-patient-death/

Goldstein, Sasha. “Connecticut Dentist Suspended After Patient Dies While Having 20 Teeth Pulled in One Visit.” New York Daily News. (May 27, 2014). From: http://on.flatoday.com/1vBJZAd

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.

By The Health Law Firm|2024-03-14T10:01:09-04:00May 15, 2018|Categories: Board of Dentistry, Dental Law, Dentist Defense attorney, Dentistry Law, Dentists, Emergency Suspension Order, ESO, Licensure matters|Tags: administrative complaint, Administrative Hearing, attorney, Board of Dentistry, defense attorney, defense lawyer, dental defense attorney, dentist, dentist attorney, dentist lawyer, dentistry, department of health, doh, emergency suspension order, formal hearing, health law firm, Informal hearing, license revoked, licensure lawyer for dentists. licensing, medical license, the health law firm|Comments Off

Florida Dentist Performs Disappearing Act With Patients’ Money

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

A Pensacola, Florida, dentist has disappeared, with his patients’ cash, and now the Escambia Sheriff’s Office is looking for both, according to a number of news sources. According to the Pensacola News Journal, the dentist closed his practice months ago without alerting his patients or performing services for which they had already paid. On January 23, 2014, the sheriff’s office sent out a request for former patients of the dentist to come forward.

Click here to read the Pensacola News Journal article.

Dentist’s Checkered Past.

According to the Florida Department of Health (DOH), in 2003 and 2006, the dentist had disciplinary actions taken against him by the Florida Board of Dentistry. The Board ruled that the dentist was negligent and failed to meet minimum standards of dental performance for misdiagnosing a patient and failing to correct the patient’s dental issues. The Board also ruled that the dentist misrepresented himself as an orthodontic specialist, when he was a general practice dentist practicing in the area of orthodontics. Click here to view the discipline cases.

Currently, the DOH website lists the dentist’s license as active.

Victims Paid for a Number of Services Never Performed.

According to the Escambia Sheriff’s Office, a number of former patients have already come forward. They claim they paid for braces, dentures and other orthodontic work that was never performed. The sheriff’s office is looking for other former patients. The ABC station in Pensacola is reporting that these victims are organizing themselves on a Facebook group.

Click here to watch the news story.

Contact Health Law Attorneys Experienced in Representing 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, Board of Dentistry and other types of investigations of health professionals and providers.

Our firm also routinely represents physicians, dentists, orthodontists, medical groups, clinics, pharmacies, home health care agencies, nursing homes and other health care providers in Medicare and Medicaid investigations, audits and recovery actions.

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

Comments?

What do you think of this story? Please leave any thoughtful comments below.

Sources:

Robinson, Kevin. “ECSO: Investigators Seeking Victims of Disappearing Dentist.” Pensacola News Journal. (January 23, 2014). From: http://www.pnj.com/article/20140123/NEWS11/140123006/ECSO-Investigators-seeking-victims-disappearing-dentist?nclick_check=1

Fernandez, Jenise. “Updated: Orthodontist Disappearance Investigation.” WEAR. (January 23, 2014). From: http://www.weartv.com/news/features/top-stories/stories/updated-orthodonist-disappearance-investigation-40700.shtml

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.

Board of Dentistry Considers Adding Failure to Provide Dental Records to “Citation” Offenses

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

At the Florida Board of Dentistry meeting held on November 21, 2014, it discussed a proposed change to Rule 64B5-13.0046, Florida Administrative Code. The amendment would add a provision for failing to timely produce dental records to patients. This addition should help dentists avoid receiving permanent discipline on their records for a minor technical violation.

Considered was the addition of the following language to the existing Rule, listing citation-approved offenses:

Violation of subsection 466.028(1)(n), F.S., failure to timely make available to a patient or client, or to his legal representative or to the Department, if authorized in writing by the patient, copies of documents in the possession or under control of the licensee, which relate to the patient or client. Timely means less than 30 days from the receipt of the written authorization. The subject of the citation has 10 days from the date the citation becomes a final order to release the patient records. Failure to comply will result in a $1,000.00 fine.

Citation vs. Charge.

An administrative citation such as those discussed is not considered to be discipline, but an alternative to discipline. The dentist can accept the citation and pay the fine; therefore the citation will not be recorded on his/her record as discipline. For more on this issue, read my blog on citations against physicians and other health professionals.

This is a good development for dentists as it allows the resolution of minor technical violations of statutes and rules without the very undesirable effect of creating a disciplinary record. We sometimes jokingly refer to these as “speeding tickets” since they carry a fine but are not considered to be permanent disciplinary action.

Carefully Review and Promptly Respond in Citation Cases.

Take immediately action on any proposed citation you receive from the Department of Health (DOH). Consult immediately with a health attorney who is experienced at representing dentists in Board of Dentistry matters. Click here for a previous blog on why you should speak with an attorney first.

In most cases, you will probably be advised to accept the citation and pay the fine. If so, be sure to submit the signed agreement, ending it by a method that documents sending and receipt (such as certified mail, return receipt requested), and keep a copy of all documents you submit. Make sure it is received (not sent) by the due date. Call to make sure it was received.

For additional information on citations in disciplinary cases, click here.

In Limited Circumstances, You May Not Want to Accept the Citation.

In limited circumstances, it may not be advisable to accept a citation. This may occur if there is pending litigation involving the subject of the citation. If the wrong person is named in the citation, this may be another reason for not accepting it. If you did not commit the offense and you are sure you can prove this, you may also desire to not accept the citation. This is especially true if you have dental liability insurance coverage which pays for a legal defense in such administrative disciplinary cases involving professional license defense.

For more information on dental license defense, read this previous blog.

If You Do Not Accept the Citation, Be Prepared for an Administrative Complaint.

If you do not accept the citation within the limited time given (usually 30 days), or if you send back a statement regarding why it is unfair or why you did not commit the violation, this will usually be treated as a statement disputing material facts. In this event, the case will be treated as though you were requesting a formal administrative hearing. You will be given a regular formal hearing (trial) with an administrative law judge from the Division of Administrative Hearings (DOAH). For information on hearings in dental cases, click here.

Be Sure Your Staff Knows How to Treat Record Requests.

Be sure that when your office receives a request for a patient’s dental chart that the request is promptly reviewed by someone in management. Management must make sure the authorization or subpoena is valid (remember HIPAA) and that the record is provided in a timely manner. Paying attention to such requests may allow you to detect and act on potential dental medical malpractice claims or DOH complaints. You should have a written office policy on this that every employee has signed.

Remember you are not authorized to withhold a patient’s dental record because the patient has not paid a bill. You are not authorized to withhold the chart because you are angry at the patient or the patient has threatened to sue you. Be sure to provide the patient (or his/her representative) a copy of the record within 30 days. Keep a copy of the letter transmitting the copy in the chart and annotate the HIPAA medical information disclosure form in the record.

Comments?

What do you think of a citation versus a charge in regard to promptly getting patients their dental records? Please leave any thoughtful comments below.

Consult With An Attorney Experienced in the Representation of Dentists.

We routinely provide deposition coverage to dentists, dental hygienists and other health professionals being deposed in criminal cases, negligence cases, civil cases or disciplinary cases involving other health professionals.

The lawyers of The Health Law Firm are experienced in both formal and informal administrative hearings and in representing dentists and dental hygienists and other health professionals in investigations and at Board of Dentistry hearings. Call now or visit our website http://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.

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 © 1999-2015 The Health Law Firm. All rights reserved.

By The Health Law Firm|2024-03-14T10:01:10-04:00May 15, 2018|Categories: Board of Dentistry, Dental Law, Dentist Defense attorney, Dentistry Law, Dentists|Tags: administrative citation, administrative complaint, Administrative Hearing, citation, defense attorney, defense lawyer, dental board, dental lawyer, dental records, dentist, dentist attorney, department of health, disciplinary action, disciplinary record, doh, doh complaint, Florida Board of Dentistry, Florida dentist, Florida laws, formal hearing, Informal hearing, license defense, patient records, requests for patient records|Comments Off

Florida Medicaid Audits Dental Claims

By Michael L. Smith, R.R.T., J.D., Board Certified by The Florida Bar in Health Law

The Agency for Health Care Administration (AHCA) is auditing Medicaid claims submitted by dental providers in Florida. AHCA is auditing dental practices looking for claims that were not billed in compliance with the Florida Medicaid Dental Services Coverage and Limitations Handbook. AHCA’s audits are focused on claims that are billed too frequently, claims that are billed on the same date of service as a redundant code, and claims that have been unbundled when they should have been billed as part of a comprehensive code.

Specific Dental Codes Being Audited.

Dental providers that are the subject of these audits may not learn of the audit until they receive the Preliminary Audit Report. It is extremely important to immediately retain experienced health care counsel if you receive a Preliminary Audit Report so that a timely rebuttal with additional documents can be submitted. The audits are performed by the AHCA based entirely on the claims submitted by the provider.

Some of the specific procedure codes included in the audits are:

– D0120,
– D0272,
– D1110,
– D1120,
– D1203,
– D1330,
– D0150,
– D0210,
– D0330,
– D4355, and
– D4341.

Take Preliminary Audit Reports Seriously.

Every dental provider that receives a Preliminary Audit Report from AHCA has a limited time to respond to the audit. AHCA may also impose sanctions and assess costs against dental providers in these audits. Any dental provider that receives notice of an audit by the Agency should contact legal counsel experienced in these matters without delay.

Click here for a previous blog on tips for responding to an AHCA audit.

Contact Health Law Attorneys Experienced in Representing 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, Board of Dentistry and other types of investigations of health professionals and providers.

Our firm also routinely represents physicians, dentists, orthodontists, medical groups, clinics, pharmacies, home health care agencies, nursing homes and other health care providers in AHCA investigations, audits and recovery actions, as well as Medicare and Medicaid investigations, audits and recovery actions.

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

Comments?

Have you ever received a Preliminary Audit Report from the AHCA? Did you know how to respond? Please leave any thoughtful comments below.

About the Author: Michael L. Smith, R.R.T., J.D., is Board Certified by The Florida Bar in Health Law. He is an attorney with 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 © 1996-2014 The Health Law Firm. All rights reserved.