The case began with a disgruntled employee. A former employee of the dentist filed a claim a lawsuit in 2017 stating that the dental practice was in violation of the False Claims Act (FCA). The former employee used this law to sue on behalf of the government, claiming the dentist who owns multiple offices in New Jersey and New York received fraudulent financial gain at the expense of children in the community.
What were the allegations?
According to the filing, the dentists that worked in these offices performed medically unnecessary pulpotomies, also known as baby root canals. This procedure can restore infected primary teeth for children. The government claimed the dentist and his group completed and billed New York and New Jersey Medicaid contractors for medically unnecessary pulpotomies.
How did the dentist respond?
The dentist agreed that there were some procedures over the span of seven years that were not supported by medical records. He ultimately agreed to a settlement with the government of over $753,000.
The former employee will get more than $135,000 from the settlement in exchange for bringing forward the lawsuit and providing evidence that led to the settlement.
What can other dentists learn from this case?
The feds take allegations of medically unnecessary procedures very seriously. These allegations can lead to allegations of an FCA violation if the dentist cannot support the need for these procedures as a medical necessity and the practice billed a government entity like Medicare or Medicaid. If successful, the practice can find themselves facing huge financial penalties.
Do not take such allegations lightly. Know that former employees and coworkers can come forward to support the government claims and the government incentivizes them to do so. Take steps to protect your interests and build a defense to the allegations.
Attorney John Rivas is responsible for this communication