The feds can pursue allegations of healthcare fraud against basically any entity that files false healthcare claims. This can extend far beyond physicians, nurses, and hospitals to include chiropractors and dentists.
What types of allegations can lead to criminal charges for healthcare fraud?
In the dental field, these allegations can include:
- Billing for services not rendered. A common example in dentistry occurs when a dentist provides a standard exam but also bills for services that were not provided during the visit, like fluoride treatments or the use of a sealants.
- Overbilling or upcoding. Use of the wrong procedure code can lead to allegations of upcoding or trying to get a higher reimbursement rate for services.
- Unbundling services. It is unlawful to separate dental procedures into individual charges when doing so to increase the overall cost of the visit.
In a recent example, the feds accused a dentist of filing false claims involving the use of crowns for his patients. The dentist fought back, maintaining his innocence. As a result, the case went all the way to court. The federal government built its case by gathering evidence to show that the dentist would intentionally break his patients’ teeth and then sell the patients procedures for expensive crowns. The prosecution claims that these actions led to more than $4 million to pay for over 3,000 unnecessary crown procedures from 2016 through 2019.
When presented with this evidence the jury found the dentist guilty of five charges for healthcare fraud and two counts of making false statements about healthcare matters.
What types of penalties are possible for these kinds of allegations?
The penalties are serious. In the example above, the dentist now faces up to 50 years imprisonment for healthcare fraud and an additional 10 years for false statements at his sentencing, which is scheduled for this summer.
Attorney John Rivas is responsible for this communication