3 WA dental practices pay more than $1M to settle Medicaid fraud allegations

Three dental practices in Southwest Washington have reached settlements that total more than $1 million to resolve allegations that they engaged in fraudulent billing practices and overcharged the Medicaid program.

“Accuracy and honesty from healthcare providers are fundamental to the integrity of the Medicaid system and our ability to help people get the care they need,” Attorney General Nick Brown stated in a news release. “These settlements are one piece of our many efforts to safeguard the Medicaid program from fraud and abuse.”

Investigators found the practices billed for services they didn’t actually provide

The following three dental practices reached settlements with the Washington Attorney General’s Office Medicaid Fraud and Abuse Division (MFA) after investigations found that they had submitted unjustified charges to Medicaid:

• Toothdocs: Camas, WA
• Comfort Dental Vancouver: Vancouver, WA
• Dentist at Felida: Vancouver, WA

Toothdocs agreed to a civil settlement of $500,000 to resolve claims that 100% of the company’s billings for parenteral medicaments, which are drugs that are not taken orally, were used for over-the-counter doses of ibuprofen.

The miscoded billings from October 2017 to March 2023 resulted in more than $370,000 in unjustified charges to Medicaid, according to the attorney general’s office.

Comfort Dental Vancouver agreed to a $230,000 civil settlement to resolve allegations of billing Washington Medicaid for parenteral medicaments when the services actually involved over-the-counter ibuprofen. The MFA investigation found that the miscoded bills resulted in roughly $153,000 in Medicaid losses.

Dentist at Felida agreed to a $360,300 civil settlement that resolved claims of the company improperly billing, which led to roughly $212,000 in Medicaid losses. The investigation found that the dental practice submitted bills for palliative (emergency pain) treatments and jawbone procedures without proper documentation or medical necessity.

Settlements add to more than 100 criminal convictions secured by the fraud division

Since October 2018, MFA has charged 127 criminal cases and obtained 104 criminal convictions related to either health provider fraud, abuse committed in connection with Medicaid services, or resident abuse and neglect in long-term residential care.

MFA has also recovered roughly $81 million on behalf of the Medicaid program through its civil prosecutions.

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