A former dentist in the D.C. metro area was recently sentenced to 71 months’ incarceration for engaging in an estimated $13.6 million health care fraud scheme.
Bilal Ahmed owned and operated a dental practice, Universal Smiles. Following the suspension of his dental license by the D.C. Board of Dentistry, Ahmed opened and operated Dental Equipment and Service (“DES”), a Maryland company that employed dentists to work at Universal Smiles’ former business location in the District of Columbia. Through these two entities, Ahmed and his office manager reportedly conspired to defraud the D.C. Medicaid program. From August 9, 2012 to February 26, 2014, the Medicaid program paid the entities approximately $13.6 million, more than one-third of which was for dental services that were never provided, including approximately $5.4 million for provisional crowns that patients never received.
How Frier Levitt Can Help
The vast majority of providers do not engage in elaborate fraud schemes, but even well-intentioned providers may be investigated and disciplined if they do not strictly observe the rules and regulations established by the various payors and programs with which they participate, and other applicable laws governing the practice of dentistry. Payors use data mining techniques to identify aberrant billing and regularly seek to recoup monies for a variety of reasons, including but not limited to improper coding, lack of medical necessity, and routine waivers of copayments and/or coinsurance. Providers should periodically self-audit their practices to ensure regulatory compliance. For more information, contact Frier Levitt to speak with an attorney in the firm’s Dental Practice Group.
