A NY healthcare Fraud Lawyer Explains Dental Fraud
Dentists, like all healthcare providers, are expected to perform only services that are medically necessary for patients. Dentists are also expected to bill only for the specific dental services that are actually provided to patients. In many cases, however, dentists are accused of billing for unnecessary services or for services not performed. These fraud accusations can have serious ramifications, ending a career as a dentist and sometimes resulting in criminal convictions.
Bukh Law Firm, PLLC has helped many dentists and dental care centers to fight accusations of dental fraud. If you are being accused of any type of dental billing fraud or deceptive practices, give us a call as soon as possible so we can help you to develop a strategic defense.
What is Dental Insurance Fraud?
Dental insurance fraud involves making false claims to insurance providers in connection with providing dental services. The goal of dental insurance fraud is to successfully make misleading statements or false representations that result in a dental insurer improperly paying out funds.
Dental insurance fraud frequently takes the form of dental Medicaid fraud. While private dental insurance provides limited coverage for services and benefits, Medicaid must pay expansive benefits for people with low-incomes. Those who process Medicaid claims often do not understand dental billing codes well, opening up the door for dentists and those involved in fraud schemes to make millions before the fraudulent billing practices are identified. One New York state man, for example, reportedly faced decades in prison and large fines after playing a key role in a $21 million Medicaid dental fraud scheme.
Types of Dental Fraud
Dental fraud is usually committed by dental care providers. A provider may bill for services that have not been performed, or may perform medically unnecessary services in order to bill Medicaid or private insurers for those services. Dental providers may also commit fraud by billing for more expensive services than were actually offered.
Individual patients can also commit dental fraud as well. If a person uses someone else’s dental insurance to try to obtain dental services, this is a form of fraud against the dental insurer. While this is a serious crime, the most stringent penalties are generally reserved for providers who are participants in large-scale fraud schemes.
Bukh Law Firm, PLLC has experience representing clients after all types of dental insurance fraud and we are ready to help you fight against even serious accusations of involvement with complex schemes to defraud Medicaid or private insurers .
Dental Billing Fraud Penalties
The Federal Bureau of Investigation reported on the New York man who pled guilty to participation in a multi-million dollar Medicaid dental fraud scheme. He pled guilty to one count of obstructing the administration of a federal healthcare program.
There are myriad offenses that a person who is involved in a dental insurance fraud scheme could be charged with. For example, 42 U.S. Code Section 1320a-7B imposes a criminal penalty of up to five years jail time for making false statements or material misrepresentations on any application for payments or benefits under a federal health program like Medicaid.
Other federal laws including 18 U.S.C. Section 1347 and 18 U.S.C. Section 1035 impose ten and five years of prison time respectively for participating in a willful scheme to defraud health insurers in connection with benefits payments or for making false statements in connection with the delivery of health services.
Aside from criminal penalties and jail time, there is the risk of civil fines as well. 42 U.S. Code Section 1320a-7a indicates that improperly filing a claim for payment of dental or other health services can result in a fine of up to $10,000 per improper claim. While an investigation is pending, 18 U.S. Code Section 1345 gives federal authorities the right to freeze bank accounts and assets.
How a Dental Insurance Fraud Lawyer Can Help
You need to protect your money and freedom if you have been accused of involvement with any dental fraud scheme. Let the New York health insurance fraud lawyers at Bukh Law Firm, PLLC help you to fight against the serious criminal charges that go along with an accusation of dental insurance fraud. Call today so we can get started on your civil and criminal cases.
