Be Careful What You Bill For
Dental practice management procedures are being increasingly scrutinized for irregularities in billings and tax returns as well as claims on their patients’ insurance plans. Henry Schein Professional Practice Transitions (Henry Schein PPT) has long advocated that dental practitioners strongly reconsider deviating from industry norms for practice expenses and insurance filings. Take a close look at these two actual cases; then consider the potential risks for your dental practice.
Scott D. Geise, D.D.S.
Newfane Family Dentistry
Newfane, New York
Dr. Geise pled guilty to filing a false healthcare claim and a false tax return and was indicted on 57 felony counts in 2007. According to the U.S. Attorney’s Office, Dr. Geise long maintained his innocence in the case until his trial began, where he then admitted the fraudulent schemes.
According to the U.S. Attorney’s Office, Dr. Geise billed a patient’s insurance company for a mouth guard instead of a bleach-whitening kit requested by the patient, because the whitening kit was not covered by insurance. Dr. Geise also defrauded the insurance plans of General Motors and Delphi Financial Group by billing for amalgam fillings when he only applied sealants because the insurance plans covered amalgams but not sealants.
Dr. Geise also admitted that he failed to record cash receipts as income on corporate tax returns, failed to report more than $188,000 in income, and then failed to pay the additional corporate and personal taxes on the unreported income.
VERDICT: Dr. Geise was ordered by a federal judge to repay $40,023 to the insurance companies he defrauded and $87,782 to the Internal Revenue Service for taxes owed.
Michael Goodwin, D.D.S.
The second case considers the fraudulent dental practice management procedures of one orthodontist who managed multiple locations and staff.
The Texas Attorney General’s Medicaid Fraud Control Unit received information in 2009 that Dr. Michael Goodwin was billing Medicaid for work done by his assistants — some of whom, according to an affidavit, were unlicensed and performing procedures while he was out of town.
From April 2008 through April 2011, authorities allege Goodwin filed more than 20,000 fraudulent claims with Medicaid worth more than $1.6 million. FBI and state investigators monitored Medicaid claims, collected bank records and interviewed Goodwin and current and former employees during their investigation.
Employee interviews and airline tickets revealed Goodwin spent half of each month at another practice in Indiana, but Goodwin still submitted claims for services he supposedly rendered or supervised in Amarillo. Agents allege Goodwin hired a substitute orthodontist to be on duty in Amarillo while Goodwin was in Indiana, but that person never supervised any procedures, was not a Medicaid provider, and never recorded information in patient charts.
Agents allege it was assistants who put on and took off braces, made adjustments, and fixed broken brackets. Agents also said they interviewed 10 patients who did not recognize the substitute orthodontist’s photograph and reported “they rarely saw Dr. Goodwin, and it was the assistants who did nearly all the work.”
Verdict: Dr. Goodwin pled guilty to one count of healthcare fraud and was ordered to pay more than 1.8 million dollars in restitution as well as spend 50 months in a federal prison.
Lisa Jones, director of enforcement for the Texas State Board of Dental Examiners, said practicing dentistry without a license is a third-degree felony in Texas, and “…certainly can be prosecuted by local law enforcement.” Dental assistants hold registrations with the state that allow them to provide radiographic services. Jones further said that if someone is offering services above and beyond that, they could face administrative action after an investigation.
In a report issued earlier this year, the Government Accountability Office, the investigative arm of Congress, said Medicaid is a high-risk program because of its vulnerability to fraud, abuse and improper payments. In fiscal year 2010, the federal government estimated Medicaid and Medicare made more than $70 billion in improper payments, the GAO’s report said.
Of course, these cases do not represent the dental practice management activities of most practices. However, the increasing frequency of these stories indicates there are more fraudulent activities going on than anyone would have imagined in the past. Each dentist has the ethical and legal responsibility to ensure the integrity of patient treatment as well as correctness of the insurance billing process. Thinking that unethical or fraudulent activities are acceptable “because everyone does it” is not a defense.
It is obvious in these two highlighted cases that there was specific intent to defraud, but even negligence in dental practice management billing procedures is grounds for investigation. Filing falsified tax returns can ultimately be very costly in back taxes and penalties. Committing insurance fraud can cost you far more than a fine including loss of license to practice, which could be the worst transition option of them all.
Henry Schein Professional Practice Transitions, Inc. is a national leader in dental practice transitions. A subsidiary of Henry Schein, Inc. they provide expert guidance for dental practice management and fees, buying and selling a dental practice, assessing partnership and associateship opportunities, and performing dental practice appraisals and valuations.