Dental fraud is a major and growing problem in this country. Dentists perform thousands of unnecessary procedures each year, so they can bill federal and private insurance companies and increase their bottom lines. An article in the Journal of Insurance Fraud in America recently said, “Medicaid fraud is the most lucrative business model in U.S. dentistry today.” Patients are often told that healthy teeth need to be capped, or that teeth needing only minor fillings need expensive crowns. Patients are also sometimes given nickel-chromium steel crowns rather than standard fillings, because Medicaid pays more for these procedures. Other horror stories abound, such as a dentist who was performing general, rather than localized anesthesia, and a dentist who used his drill to intentionally break patients teeth so he could replace them.
Such fraudulent activity creates a litany of legal issues. It often gives rise to claims for dental malpractice. It also would violate state and federal criminal statutes. Lastly, it would likely violate the federal False Claims Act. The FCA provides that any person who knowingly submits a false claim or causes another to submit a false claim to the government or knowingly makes a false record or statement to get a false claim paid by the government is liable for the government’s damages plus a penalty for each false claim. Under the FCA is a qui tam provision, or whistleblower provision, that allows private individuals to file suit on behalf of the government. If the government intervenes, the relator is entitled to receive 15 – 25% of the amount recovered. If the government does not intervene, the relator’s share increases to 25 – 30% of the total recovery.
The qui tam provisions of the FCA are powerful tools that help the government combat fraud. If you are an individual who has knowledge of dental fraud, consider speaking with a FCA attorney today. Josh Borsellino is an attorney that understands the rules and regulations regarding qui tam lawsuits. He works on a contingency fee basis meaning that you owe him nothing unless there is a recovery. Call him today to see if you have a viable claim. 817.908.9861 or 432.242.7118.