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Fraud Prosecutions Target Dentists’ Billing Practices

On January 15, 2020, L.M.G., Inc., d/b/a TMJ & Orofacial Pain Treatment Centers of Wisconsin (“LMG”) agreed to a $1 million settlement to resolve allegations that it violated the False Claims Act. LMG operates four clinics that specialize in temporomandibular joint disorder and often prescribed oral appliances to stabilize or reposition patients’ jaws. However, the U.S. Attorney’s Office alleged that LMG submitted false claims to Medicare and TRICARE as the practice billed for its appliances that were fabricated by an outside laboratory under a billing code applicable to more expensive prosthetic devices in order to increase their reimbursements from federal health care programs.

Two Dentists and Office Manager Indicted for Allegedly Arranging and Participating in a Scheme to Defraud MassHealth
On January 16, 2020, a federal grand jury in Boston indicted two dentists and an office manager for allegedly arranging and participating in a scheme to defraud MassHealth, the Massachusetts Medicaid program. Dr. Anthony DiStefano III was excluded from MassHealth due to concerns regarding the quality of dental care he rendered to patients. He subsequently recruited Dr. Scott Cale to join his practice in an arrangement allegedly designed to circumvent Dr. DiStefano’s exclusion status, i.e., Dr. DiStefano impermissibly used Dr. Cale’s provider identification credentials to submit claims for services that Dr. DiStefano personally rendered, and upon receiving reimbursements from MassHealth, Dr. Cale reportedly split the money with Dr. DiStefano. Robin Cronin, the office manager, participated in the scheme by knowingly submitting false claims to MassHealth. As a result of the indictment, all three individuals face the possibility of up to ten years in prison, three years of supervised release, and a $250,000 fine.

Dentist Convicted of Forty-Six Counts of Felony Medical Assistance Fraud, Scheming to Defraud Medicaid, Illegal Practice of Dentistry and Reckless Endangerment
On January 17, 2020, Dr. Seth Lookhart, infamously known as the “hoverboard dentist” from Anchorage, Alaska, was convicted of forty-six counts of felony medical assistance fraud, scheming to defraud the Alaska Medicaid program, the illegal practice of dentistry, and reckless endangerment. He is alleged to have coaxed Medicaid beneficiaries to opt for IV sedation for their dental procedures, in lieu of less expensive anesthesia options. Additionally, he reportedly violated Medicaid payment rules by offering his private pay patients a $450 flat fee for IV sedation, but charging the program $2,049 for the same service. Since obtaining an IV sedation license in 2015, Dr. Lookhart is estimated to have received $1.9 Million from Medicaid for the IV sedation services. Dr. Lookhart faces the possibility of up to ten years in prison and a fine of up to $100,000.

State Regulations and State and Federal Laws Regarding the Practice of Dentistry
Dentists are subject to a variety of state regulations regarding the practice of dentistry, and state and federal laws aimed at preventing fraud, waste, and abuse. Providers who participate with federal healthcare programs and commercial plans must also comply with payor-specific requirements.

How Frier Levitt Can Help
For more information regarding laws governing the practice of dentistry, contact Frier Levitt to speak to an attorney in our firm’s Dental Practice Group. Our Practice Group consists of attorneys with deep familiarity of the unique legal and business issues that affect the practice of dentistry and we work with dental clients throughout the country.