Medicaid Dental Care Fraud Defense
We Represent Dentists and Other Dental Care Providers Facing Serious Medicaid Fraud Allegations
Facing fraud allegations under Medicaid and other federal healthcare programs poses substantial risks. While these allegations create exposure to civil penalties in most cases, targeted dental providers can also face criminal penalties (including federal prison time) when accused of intentional fraud.
We defend licensed dentists and other dental care providers who are facing civil liability and criminal prosecution for all forms of alleged Medicaid fraud. If you need legal representation, we can help, and we encourage you to contact us promptly for a complimentary and confidential consultation.
What Constitutes Dental Medicaid Fraud?
Dental practices can face Medicaid fraud allegations in a wide range of circumstances. All providers that bill Medicaid are subject to strict restrictions and requirements, and failure to comply with any of these restrictions or requirements can lead to fraud allegations. With this in mind, some of the most common allegations against licensed dentists and other dental care providers include:
- Allowing an unlicensed provider to perform dental procedures
- Billing for medically unnecessary dental services
- Billing for dental services not provided to Medicaid patients
- Falsifying patient records to substantiate Medicaid billings
- Practicing without an active state dental license (unlicensed dentistry)
These truly are just examples. Dental care providers targeted in Medicaid audits and investigations face penalties for controlled substances violations and numerous other forms of noncompliance as well. Medicaid fraud allegations can take many different forms; and, when facing scrutiny from state or federal authorities, it is critical to ensure that you have a clear and comprehensive understanding of the allegations that are on the table.
We Represent Providers During Dental Medicaid Fraud Investigations and Audits
From New York to California, we represent clients who are facing scrutiny from federal authorities, state Medicaid agencies, and Medicaid Fraud Control Units (MFCUs) across the country. We can provide representation for disciplinary matters involving state dental boards as well. We have extensive experience in federal cases involving the Drug Enforcement Administration (DEA), U.S. Department of Justice (DOJ), and U.S. Department of Health and Human Services Office of Inspector General (HHS OIG), as well as fee-for-service audit contractors working with the Centers for Medicare and Medicaid Services (CMS).
Whether you are facing scrutiny from the government or from an audit contractor, you need to be prepared to protect yourself (and your practice and employees) by all means available. Medicaid dental care fraud audits can—and do—lead to unwarranted consequences. Our Medicare fraud defense lawyers rely on their extensive experience to protect our clients by all means available, and we focus on resolving our clients’ audits and investigations without further consequences whenever possible.
We Also Represent Dental Providers Facing Federal Healthcare Fraud Charges
We also represent dental providers that are facing healthcare fraud charges under federal law. If auditors or investigators uncover evidence (or apparent evidence) of Medicaid billing fraud, they can refer the case to the DOJ for civil or criminal prosecution. From lack of medical necessity to submitting false requests for reimbursement, the DOJ pursues cases involving all forms of fraud, waste, and abuse—and, if prosecutors have evidence of criminal intent, they can seek fines and prison time. We discuss the potential penalties in Medicaid dental care fraud cases in greater detail below.
Dental Services Providers Can Face Steep Penalties Under the False Claims Act
The DOJ generally prosecutes Medicaid fraud cases under the False Claims Act. The False Claims Act prohibits dental providers (and other healthcare providers) from submitting “false or fraudulent” claims for reimbursement under Medicaid and all other federal benefit programs. Depending on the circumstances, violations of the False Claims Act can lead to either civil or criminal enforcement; and, depending on the nature of a case, potential penalties can include:
- Civil or criminal fines
- Recoupments and treble damages
- Mandatory pre-payment review when submitting claims
- Mandatory exclusion from Medicaid and other federal programs
- Federal prison time (in criminal cases)
Fines and other monetary penalties in False Claims Act cases can be crippling for many dental practices. Mandatory pre-payment review or program exclusion can have severe financial consequences as well. We fight to protect our clients’ practices by all means available, and we seek to resolve our clients’ cases without any additional liability whenever possible.
What to Do if Your Dental Practice is Facing a Medicaid Audit or Investigation
With all of this in mind, if your dental practice is facing a Medicaid audit or investigation, you need to prioritize your defense. Among other things, this means you should:
- Preserve All Relevant Documentation – When facing a Medicaid audit or investigation, it is important to preserve all relevant documentation. Failure to do so could lead to adverse consequences.
- Make Sure You Know Relevant Dates and Deadlines – It is critically important to make sure you know all relevant dates and deadlines. Depending on the circumstances, this may include the dates that auditors will visit your office or your deadline to respond to a civil investigative demand (CID) or subpoena.
- Promptly Engage Experienced Defense Counsel – Medicaid audits and dental Medicaid fraud investigations are complex and high-risk legal matters. Promptly engaging experienced defense counsel is critical for mitigating the risks involved and ensuring that you avoid costly mistakes.
- Conduct a Comprehensive Risk Assessment – After engaging experienced defense counsel, you should rely on your defense counsel to conduct a comprehensive risk assessment. This will allow you to make informed decisions about your practice’s defense strategy.
- Work with Your Defense Counsel to Target a Favorable Resolution – Working with your defense counsel, you should target a favorable resolution that avoids unnecessary consequences. What this entails will depend on the specific circumstances and dental Medicaid fraud allegations involved.
When you engage our law firm, we will get to work right away assessing your risk and building a comprehensive and custom-tailored defense strategy. We will also immediately intervene in the audit or investigation and begin communicating with the relevant authorities on your behalf. The sooner we can get started, the more we can do to help—so we strongly encourage you to start the process right away.
Read Our Latest Posts
Our lawyers regularly publish articles discussing important topics related to Medicare and Medicaid fraud cases. We encourage you to read our latest posts for more information.
FAQs: Defending Against Dental Care Fraud Allegations Under Federal Health Care Programs
When can Medicaid-participating dental providers face liability under the False Claims Act?
Medicaid-participating dental providers can face liability under the False Claims Act when they improperly bill for services rendered. This can involve everything from billing for medically unnecessary dental services provided to Medicaid beneficiaries to billing for services not provided. Paying and receiving unlawful kickbacks and referral fees can lead to a civil or criminal enforcement action under the False Claims Act as well. In short, dental providers that bill Medicaid face numerous risks, and a comprehensive and custom-tailored approach to billing compliance is essential.
What is a qui tam lawsuit under the False Claims Act?
A qui tam lawsuit (or qui tam action) under the False Claims Act is a lawsuit filed by a whistleblower on behalf of the federal government. Whistleblowers can file qui tam lawsuits involving numerous forms of fraud, waste, and abuse—including dental Medicaid fraud. Whistleblowers are often current or former employees; and, when facing a qui tam action, it is critical to discern what information the government has in its possession.
What should I do if I am facing a dental Medicaid audit?
If your practice is facing a dental Medicaid audit, you need to be very careful. This is a high-risk matter, and you will need to defend against the audit effectively to avoid unnecessary and unwarranted consequences. Defending against a Medicaid audit starts with engaging experienced legal counsel who can provide strategic advice and representation based on the specific circumstances at hand.
Do I need to hire a law firm for a dental Medicaid audit?
Defending against a dental Medicaid audit requires experienced legal representation. These are complex and high-stakes inquiries, and even seemingly minor oversights and mistakes can have serious consequences. To ensure that the audit does not lead to unwarranted recoupments and other penalties, you will need to engage experienced defense counsel who can oversee the audit process and ensure that auditors do not overreach, rely on flawed methodologies, or reach flawed conclusions about what the law allows.
When does improperly billing Medicaid for dental procedures constitute federal healthcare fraud?
Many dental practitioners are surprised to learn that both intentional and inadvertent Medicaid billing mistakes are classified as healthcare fraud under federal law. While proof of intent is required to substantiate criminal fraud charges, dentists and other providers can face civil liability for mistakenly submitting false claims for Medicaid reimbursement.
Get Help from the Experienced Medicaid Dental Care Fraud Defense Attorneys at Oberheiden P.C.
If you need experienced defense counsel for a Medicaid dental care fraud audit, investigation, or prosecution, we encourage you to contact us promptly. Call 888-680-1745 or tell us how we can reach you online now to arrange a free and confidential consultation.
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