For those in need of some sunshine, braces can truly brighten the smiles of children and adults in Texas. However, some dentists have been accused of trying to brighten some smiles that may not have needed any help in the first place. With over half a million dollars paid out for what may have been unnecessary procedures, several dentists in Texas have been accused of committing Medicaid fraud, although none of have actually been convicted.
Three locations of a local Texas dental provider saw over 2,500 patients every year between 2010 and 2011. During that time, they managed to pull in $2 million for outfitting braces on underprivileged children. However, a 2012 investigation into the use of certain Medicaid funds caused the Medicaid reimbursement money to stop rolling in.
It turned out that Texas wasn't just spending a lot on orthodontic services -- they were spending more than the next nine states combined. This may have been in part to the fact that Texas only had one dentist to review the thousands upon thousands of orthodontic claims that rolled in every month. With only so many hours in a day, it is likely that he may have simply been stamping and passing the claims without giving them much attention.
Although three years into the investigation, no intentional Medicaid fraud has actually been proved. Instead, roughly $10 million has been collected through multiple settlements, which subsequently cleared the accused of any charges of fraud. Despite the alleged fraud against multiple dentists across the state of Texas, the settlements that subsequently cleared other dentists may be a solid guide for those who have been accused and their defense council in order to procure the most favorable outcome possible.
Source: The Texas Tribune, "Company That OK'd Unnecessary Braces Kept Its Contract", Becca Aaronson, May 1, 2014