D-I-Y Fraud

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Do-It-Yourself or D-I-Y projects are pretty popular. There are television networks and a multitude of websites devoted to explaining how to accomplish a variety of projects from start to finish. While D-I-Y projects usually save a lot of money, a Connecticut dentist who concocted a fraud scheme that involved D-I-Y dentistry, ended up costing the state’s Medicaid program hundreds of thousands of dollars.

There’s a reason why dentists and dental hygienists have to be licensed. (Wouldn’t you want to be reassured that the person operating a drill in your mouth is certified to wield a weapon of mouth destruction?)According to an article on ctwatchdog.com, a dentist and his unlicensed employees either performed pediatric dental cleanings and fluoride treatments or demanded that patients perform these services on their own. Then he billed Medicaid for the services his practice unlawfully performed or did not perform at all. (Obviously, this is against the law.)

After an investigation and a 7-day court hearing, the dentist and his practice were ordered to pay $717,046 in restitution and civil penalties. A Superior Court judge found that the dentist violated the Connecticut Unfair Trade Practices Act, which protects consumers from businesses who have used unfair or deceptive trade practices.

It’s hard to understand how a dentist, who had been licensed and practicing in the State of Connecticut for decades, could not know that his employees would need to be licensed to perform pediatric dental cleanings and fluoride treatments. Yet, he violated state law by improperly billing Medicaid for years.

Just like many dental patients who forget to floss or brush their teeth on a regular basis, this D-I-Y dentist tried to avoid following government mandated business hygiene rules. (While brushing and flossing prevent cavities and other painful dental procedures, the government also has preventative and corrective medicine for those who don’t follow procedures – prosecution.)As a result of the court’s decision, the dentist agreed to suspend his participation in the Medicaid program and any other Department of Social Services program for 10 years and has also closed the doors to his practice in Connecticut. (Let’s hope he hasn’t opened his doors to practice in a neighboring state.)

Source: Today’s ”Fraud of the Day” is based on an article entitled, ”Winstead Dentist Fined $717,046 for Illegal Medicaid Bills,” posted on ctwatchdog.com on August 10, 2016.

A Winsted dentist and his practice were ordered to pay $717,046 in restitution and civil penalties after a Superior Court judge found his conduct violated the Connecticut Unfair Trade Practices Act, also known as CUTPA, Attorney General George Jepsen said today.

The ruling, which followed an investigation and seven-day court hearing, finds that Dr. Douglas Macko and his dental practice – Douglas Macko, D.M.D., P.C. – devised and implemented an illegal scheme over several years to improperly bill the Connecticut Medicaid program for pediatric dental cleanings and fluoride treatments.

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Larry Benson
Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.