Provider Alert – Recent Prosecutions Against Dentists

Enforcement actions against dental providers have continued throughout the COVID-19 pandemic. Dental providers whose claims are under a formal payor review process should consider having experienced healthcare counsel assist you in responding and attempting to mitigate the impact of any adverse findings. Our Provider Alert is an update on recent fraudulent actions against dentists that we have been closely monitoring.

St. Louis Dentist Found Guilty of Health Care Fraud Subject to Monetary Restitution and Incarceration

Missouri dentist Dr. Yun Sup Kim was sentenced to one year and one day in Federal prison and ordered to pay restitution in the amount of $671,845.20 for defrauding the Illinois Medicaid program and Medicaid managed care organizations. From September 2014 to December 2017, Dr. Kim was found to have submitted false claims for cavity fillings and surgical tooth extractions that he never performed, and billing simple extractions as surgical extractions to obtain higher reimbursement rates. In total, Dr. Kim was determined to have submitted false claims for more than 1,300 patients. A regulatory audit revealed that Dr. Kim performed more cavity fillings and surgical tooth extractions than any other dentist in Illinois, which ultimately helped Federal prosecutors build their case against him. Although Dr. Kim entered into a consent decree revoking his license to practice dentistry in Illinois and already paid the monetary restitution amount, United States District Judge Staci M. Yandle, in her sentencing remarks, emphasized the need for Federal incarceration to deter other health care providers from engaging in similar conduct.

Texas Dentist Ordered to Pay $16.5 Million Due to Fraudulent Medicaid Billings

Texas dentist Dr. Richard J. Malouf was found guilty of submitting fraudulent claims to Texas Medicaid and ordered to pay back more than $16.5 Million. Dr. Malouf was determined to have submitted more than 1,842 claims to Medicaid for services that were actually rendered by a different dentist. Some of the claims at issue were submitted on dates when Dr. Malouf was outside of the country. Dr. Malouf was ordered to return $538,228.45, plus interest, to Medicaid, and to pay more than $9 Million in civil penalties and more than $1 Million to the State of Texas, representing twice the amount of the payments he received from the Medicaid program. Details are presently unknown regarding additional action against Dr. Malouf’s dental license and/or incarceration as a result of his conduct.

Kentucky Dentist Pleads Guilty to Health Care Fraud

Kentucky dentist Dr. Denver D. Tackett pleaded guilty to health care fraud and to submitting more than $95,000 in reimbursement claims to the Kentucky Medicaid program. Dr. Tackett admitted that  he submitted medically unnecessary claims, and also engaged in upcoding to receive higher reimbursement rates. For example, when he performed simple dental extractions, he upcoded the claims and submitted them as surgical extractions. As part of his plea agreement, Dr. Tackett agreed to permanently surrender his Drug Enforcement Administration registration, pay at least $70,000 in restitution, and pay an additional forfeiture money judgment of $20,000. Later this year, Dr. Tackett is scheduled to be sentenced, and he faces up to ten years in prison and a maximum fine of $250,000.

How Frier Levitt Can Help

It goes without saying that the purposeful acts of upcoding or submitting false claims are to be avoided, but even without a finding of fraudulent conduct, improper coding and billing can result in costly recoupments. Both commercial and federal healthcare program payors conduct routine audits to police aberrant billing and coding, and with the help of data mining and analytics, it is easier than ever to identify and investigate outliers.   For this reason, we recommend that dentists periodically conduct internal audits of their coding and billing practices.  In the event that an issue, such as an overpayment, is detected, experienced healthcare counsel can assist in crafting a plan of action that corrects the issue and potentially mitigates the risk of a harsh penalty. For more information, contact us to speak to an attorney in our firm’s Dental Practice Group.