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A Close Look at a Whistleblower Case Involving Dental Services

Brewer & Pritchard, P.C. is providing legal representation in a Harris County whistleblower case. The whistleblower action is brought by a doctor who alleges that the defendant improperly billed Medicaid for services that were not rendered. Some of the serves the defendant allegedly billed for included services by the dentist, who claims that those services were never performed and were improperly billed. The action is brought on behalf of the state of Texas under the Texas Medicaid Fraud prevention Act. dental-office-751830-m

Whistleblower cases like this one provide an important benefit to the state, because if fraud is uncovered the state is able to recover money that was improperly paid out from benefits programs that have limited funds. The whistleblower who came forward and who helped the state to recover these misspent funds can also receive compensation from the damages in the lawsuit and money collected back from the party who committed fraud.

Whistleblower Alleges Improper Billing of Dental Services

Two individual defendants are named in the whistleblower action. These defendants own and operate six independently incorporated dental clinics. The dental clinics are marketed towards children who are eligible for the Children's Health Insurance Program (CHIP) or who are beneficiaries of Medicaid benefits. Approximately 90 percent of the businesses at the six independently-operated dental clinics is generated through either CHIP or Medicaid.

One of the owners of the dental clinics spoke to a dental school colleague, who agreed to perform work at one or more of the clinics. The dental school colleague is a licensed dentist, but his small dental practice was not authorized to provide Medicaid services and the dental school colleague does not have a Medicaid National Provider Identifier (NPI). The colleague has never submitted bills to Medicaid.

The colleague went to work for the clinic and was promised to make the greater of either 30 percent of his gross production or $1,000 per day. He was not paid the money he was promised and he was ultimately terminated for a failure to participate in fraudulent and improper conduct that the defendant dentists were trying to force him to participate in. The colleague came forward to report this fraud and file a whistleblower case.

The case alleges that the defendant's enterprise relies around abuse of the Medicaid system, such as improperly charging for services that were not rendered or for procedures that are expensive and unnecessary. Independent contractors are incentivized to improperly generate Medicaid payments, and to submit bills that fail to correctly identify the dentist who was providing the services. All of these behaviors are abuse of the Medicaid system that costs the government money and that can undermine the effectiveness of the Medicaid program to provide care to those who need it.

If it turns out that the defendants did defraud the government, the whistleblower action will help to protect the integrity of Medicaid and CHIP, and will allow both the government and whistleblower to obtain funds from the defendants who violated the rules.

Contact a Medicaid fraud attorney if you believe you have evidence of fraud. Call Brewer & Prichard P.C. today at 800-445-8710  or visit http://www.bplaw.com to schedule a consultation. Serving Texas, the greater Houston metropolitan area, Galveston Island, Montrose and surrounding areas.