The U.S. government has become more active in cracking down on healthcare in recent years, and dental practice fraud is no exception. Dental spending is expected to reach over $203 billion, and fraud will likely cost the industry $6 billion. With the threat of federal and state action looming over the dental industry, it is essential to be aware of fraud and what could trigger an investigation.
Familiarizing yourself with the different types of dental fraud and knowing how to defend against allegations is crucial in this new regulatory landscape. Often, an attorney that has experience with dental fraud investigations is handy when creating a defense for your practice. Norman Spencer Law Group has precisely the sort of experience you can count on in these matters.
Common Types of Dental Practice Fraud Cases
The American Dental Association defines dental fraud as any crime where someone gets insurance money for false claims, inflating the costs of services, or charging for services not provided. There are many types of fraud, but they involve intention, deceit, and unlawful gain.
A few of the most likely types of fraud are:
- Upcoding or inflating prices on services
- Medicaid and Medicare fraud
- Kickbacks for patient referrals
- Intentionally or accidentally keeping government payments
- Pressing for excessive or unneeded dental procedures
- Misrepresenting non-covered procedures
- Unlicensed individuals performing dental procedures
- Misrepresenting the provider of a dental service
Patients, as well as providers, can commit dental fraud such as:
- Using a fake ID, another person’s ID, or multiple IDs to get benefits
- Requesting that a dentist misreport dates to alter calendar year maximums or limits
- Misrepresenting available dental coverage or asking a dentist to do so
While most fraud cases require intent, a few accidental cases can lead to investigations as well. For example, accidentally coding wrong, listing a different dentist than the one who performed a procedure, or misrepresenting a date for service can lead to a fraud investigation.
Many of the cases listed above can lead to either a federal or third-party audit into your practice, which can bring criminal and civil charges. The penalties can range from jail time, hefty civil fines, loss of your dental license, and exclusion from federal healthcare programs. There is also reputational damage to consider as well.
Ways to Fight Fraud
Luckily, you can do a few things to reduce dental fraud and help insulate yourself from an investigation. Here are a few ways to guard your practice against fraud allegations:
- Make sure to layout payment details for services before rendering them. Go over fees for covered and non-covered options so that patients know what their options are and how much they owe
- Try to create distance from patients that do not pay on time or do not make any effort to pay for services rendered
- Make sure that you have a detailed fraud policy in place, and have all of your employees read it
- Split up tasks related to processing payments among multiple employees
- Review all claims your practice submits as you are responsible for any claim that comes out of your practice
- Check profit and loss records for your dental practice regularly to make sure everything adds up
There are also outside organizations that can make defending against fraud easier. You can hire an auditing agency to go through your financials to ensure there are no questionable billing practices. Internal audits are also an excellent in-house option to check up on the health of your practice.
Why Choose a Dental Practice Fraud Attorney
One of the best things you can do as a dentist or dental healthcare worker is get in touch with a qualified attorney. No matter what kind of situation you may be facing, a lawyer is indispensable. If you need help fraud-proofing your practice, a lawyer can help set up your third-party audits through lawyer-client confidentiality. A lawyer can also help you create a comprehensive anti-fraud policy for your practice.
If you are facing allegations of fraud or even a legal investigation, getting in contact with a lawyer is essential. A professional healthcare fraud attorney can help you understand the allegations you are facing. They will help you gather the documents to defend your practice, prepare you and your employees for any meetings with investigators, and help you build a case for court if needed.
At Norman Spencer Law Group, we pride ourselves on our team of healthcare defense lawyers. Our attorneys have experience with various healthcare-related cases, including dental fraud defense. If you are facing allegations against your practice, are under investigation, or just need help to draft a fraud policy, call us now. We can set up a free consultation over the phone, through email, via ZOOM, or even in person.