OIG reaches settlements in dental fraud cases

OIG investigators continue to settle cases with Texas dentists exhibiting similar patterns of fraudulent behavior.

OIG Provider Field Investigations initiated two cases against a dental provider with locations in Irving and Farmers Branch. Investigators found multiple instances where the provider billed for services not provided, billed a more expensive service code instead of the appropriate lower-cost service code, and lacked inadequate documentation for services during May 2016 through August 2018. In October, the dental provider agreed to repay $100,000.

In another case, the OIG obtained a joint settlement with two dental practices, located in Lancaster and Fort Worth, both owned and operated by the same two dentists. A review of client files discovered instances of inappropriate billing, services not rendered, upcoded services, missing or inadequate documentation, medically unnecessary services and failure to meet the professional standard of care. In November the provider agreed to pay $90,000 to resolve the overpayment caused by the identified violations.

Also in November, the OIG settled a case against a dentist in Garland. The dentist submitted inappropriate billing claims to Medicaid, including claims for services not rendered and upcoded services. The dentist worked collaboratively with the OIG to resolve some of the concerns and agreed to pay $12,068 to resolve the overpayment.

Anyone suspecting fraud by a Medicaid provider or client may report it to the OIG Fraud Hotline (800-436-6184) or with the reporting form at www.ReportTexasFraud.com.