An OIG fraud detection operation (FDO) uncovered potential illegal dental solicitation among Medicaid providers.
After data analysis in July flagged four North Texas providers, the OIG’s chief dental officer and dental team conducted onsite clinical examinations of the providers’ patients. The team set up a mobile clinic to conduct the examinations to verify that services billed to Medicaid was indeed performed. The team also checked the quality of procedures to ensure that the clients received the best care. Investigators interviewed parents and dental staff to gain further insight.
Initial clinical exams identified providers who received reimbursement for restorations when either sealants or no restorations were performed. Preliminary findings also indicated two of the four dental providers were engaging in illegal dental solicitation. The two cases are now under investigation.
Dental providers are prohibited from offering cash, gifts or other items to people who have Medicaid in order to influence their health care decisions. Providers may not offer and clients may not accept:
- Cash, cash equivalents or gift cards in any amount.
- Transportation unless it’s properly arranged through the Medicaid Transportation Program.
The OIG may investigate improper gifts to potential clients, including providers who hire people to canvass neighborhoods looking for Medicaid-eligible children and pay drivers to transport children for Medicaid services. The OIG may also investigate providers who advertise free transportation on their website. Learn more in this fraud and abuse prevention advisory.