Several elements make this case very special. First, in the spirit of governmental full disclosure and transparency, the complete investigative report of Diane Hedges, the state investigator for the Indiana Medicaid Fraud Control Unit (MFCU), was posted on the Office of the Indiana Attorney General's website. This report and investigation, assisted by Sheila Green of the U.S. Health and Human Services Office of Inspector General (HHS-OIG) and Neal Freeman of the FBI, was exemplary in its thoroughness and detail. This type of evidence and report is the solid backbone of a criminal case for any state or federal criminal prosecutor. Good governmental investigators such as these are not paid nearly enough, nor appreciated enough by the public. Their work deserves great praise.
Michael W. Davis, DDS.
Too frequently, criminal charges are not brought forth in prosecution of dental Medicaid scams. Often, only civil charges are rendered, and cases are usually settled for pennies on the dollar, with no admission of guilt. Prosecutors are allowed to close a case. Nondentist owners who may be pulling all the criminal strings are rarely indicted. The crooks go back to business as usual, poor children are hurt, and taxpayers are ripped off once again. The cycle continues. Perhaps this time a chain was broken?
Furthermore, the Indiana attorney general did not stop at the typical indictments for Medicaid fraud (a class D felony). More severe class C felony charges (forgery, money laundering, corrupt business influence -- aka racketeering) also were included in the indictments. These charges potentiate far more serious criminal penalties. Realistically, these charges are not brought forward in most dental Medicaid fraud indictments, as they require more thorough investigation and production of evidence. The superb report of MFCU investigator Hedges allowed state prosecutors to bring forth complete and thorough indictments.
Too often, state or federal prosecutors only want to build their résumés by closing cases on their desk and stacking up felony convictions, all without dealing with the underlying criminal activity. Cases that could be prosecuted both civilly and criminally are only prosecuted civilly. Frequently, regulators enable dental Medicaid fraud via "wrist-slap" sanctions. These are merely viewed as a modest business expenses, or speed bumps, on the road to riches with Medicaid fraud and abuses.
“Nondentist owners who may be pulling all the criminal strings are rarely indicted. The crooks go back to business as usual, poor children are hurt, and taxpayers are ripped off once again.”
As a result, instead of tackling the entire web of a criminal dental Medicaid fraud operation, a "fall guy" is selected. This is often a Medicaid provider dentist who works within a larger criminal conspiracy. Facing an investigation, the beneficial owners of the dental clinics proclaim to give their "full and complete cooperation" to state and federal investigators.
Other employees actively involved in the Medicaid fraud, racketeering, forgery, etc. are off the hook. The fall guy, usually one of several dishonest dentists within the operation, is offered a deal to keep his or her mouth shut, and may serve a lesser penalty than otherwise expected, but may actually face prison time. Almost everyone except the fall guy escapes with a wrist slap, and business (criminal activity) resumes largely as before. State or federal prosecutors figuratively carve another notch in their gun handle, but do little to permanently stop Medicaid fraud and abuses. The taxpayer money flow continues.
We must not underestimate the cost of dental Medicaid fraud on both U.S. taxpayers and our disadvantaged citizens, who depend on sound governmental safety-net programs. Those who defraud dental Medicaid, either by "treating" imaginary dental decay, misrepresentating through billing upcoding, or submitting bills for care never rendered, must be permanently curtailed from such criminal activity.
This case represents an impressive and perhaps historic effort by Indiana Attorney General Greg Zoeller. Elements of the state attorney general's office are effectively teamed with federal investigators. Not only were criminal indictments rendered to all parties allegedly involved, but also the totality of criminal activity was addressed in the indictments. Very importantly, the true beneficial owner of the dental clinic (not a licensed dentist) was criminally indicted in this landmark case.
I trust this criminal case sets precedence and a template for future investigations and prosecutions of dental Medicaid fraud nationally.
Michael W. Davis, DDS, maintains a private general dental practice in Santa Fe, NM. He serves as chairperson for the Santa Fe District Dental Society Peer Review. He is also active in expert witness legal services.
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