Dental Audits & Compliance

Texas Medicaid Dental Fraud: Is the State Partly to Blame?

(August 12, 2014):  Texas Medicaid dental fraud has been an ongoing concern of both federal and state law enforcement agencies. As set out in an August 2014  report titled “Texas did Not Ensure that the Prior Authorization Process was Used to Determine the Medical Necessity of Orthodontic Services,” the U.S. Department of Health and Human Services, Office of Inspector …

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Investigations of Medicaid Dental Fraud in Texas

(July 1, 2014): Law enforcement authorities are actively investigating and prosecuting health care providers for crimes based upon allegations of Medicaid dental fraud in Texas. When looking for fake billing to the Medicaid program, investigators have historically targeted hospitals and doctors, but increasingly dentists have come under watch. In Texas, new measures have been adopted to …

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Dentist Indicted on Nearly 200 Counts of New Hampshire Medicaid Dental Fraud

(January 3, 2014):  A 57-year-old Queen City, New Hampshire dentist has recently been charged with 189 counts of Medicaid dental fraud. As a result, he could face many years in prison. The New Hampshire Medicaid program is a joint federal and state-funded health care program that serves individuals and families in that state who meet certain …

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Dentist Alleged to Have “Systematically Bilked” MassHealth Dental Fraud Scheme

(December 23, 2013):  A recent state audit of a Massachusetts dentist has reportedly uncovered numerous instances of MassHealth dental fraud, alleging that dentist fraudulently billed the state’s “MassHealth Insurance Program.”  According to the state’s auditor, the dentist “systematically bilked the MassHealth Dental Program.”  In all, the audit claims to have found over $150,000 in improper MassHealth …

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Hospital Outpatient Dental Services are Being Audited

(December 4, 2013): Generally, Medicare does not cover hospital outpatient dental services. Under the general exclusion provisions of the Social Security Act, items and services in connection with the care, treatment, filling, removal, or replacement of teeth or structures directly supporting the teeth (e.g., preparation of the mouth for dentures or removal of diseased teeth …

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Is Your Dental Practice Prepared to Undergo a Medicaid Dental Audit?

Is Your Practice Ready for a Medicaid Dental Audit? (November 25, 2013):  The link between oral health and overall health has been increasingly acknowledged over the years. Emphasis has been placed on children’s oral health in particular. In fact, the Children’s Health Insurance Program Re-authorization Act of 2009 (CHIPRA) mandates that “child health assistance provided to a …

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TSBDE Update: Texas State Board of Dental Examiners

(November 11, 2013): TSBDE Update – The Texas Legislature first provided for licensure of dentists in 1897, whereby district judges were empowered to appoint a Board for their districts consisting of three practicing dentists living in the district. In 1905, Senate Bill 84 created the Texas State Board of Dental Examiners (TSBDE or Board). The …

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Improper Medicaid Dental Billing Practices Can Result in False Claims Act Liability

(August 15, 2013): The primary civil enforcement tool utilized by the federal government is the civil False Claims Act.  As discussed below, the False Claims Act is an extraordinarily useful statute for government prosecutors, both in terms of ease of use and in terms of the damages which may be recovered by the government. Sometimes referred …

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Medicare Dental Audits are Being Conducted by ZPICs. Is Your Specialty Dental Practice Ready?

(January 18, 2013): Specialty dental practices around the country are receiving audit letters from “Zone Program Integrity Contractors” (ZPICs), contractors working for the Centers for Medicare and Medicaid Services (CMS). This latest audit focus by ZPICs is rather surprising in light of the fact that very few dental procedures qualify for Medicare coverage and payment.  …

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A Credible Allegation of Fraud Related to Medicare or Medicaid Services Will Result in Your Dental Practice Being Placed on “Suspension” or “Payment Hold.”

(December 31, 2012):  Over the last year, many dentists, orthodontists and oral surgeons around the country who participate in federal health care benefits programs such as Medicare and Medicaid have found themselves accused of a “credible allegation of fraud,” levied by federal / state investigators or agents contracted to audit dental providers on behalf of the …

A Credible Allegation of Fraud Related to Medicare or Medicaid Services Will Result in Your Dental Practice Being Placed on “Suspension” or “Payment Hold.” Read More »