Medicaid Fraud Busters Learn From Experience

Excerpt from Government Technology: (click for entire article)

Texas had an unusually high Medicaid orthodontics bill in 2010. At $185 million, the state was reportedly spending more than the other 49 states combined. Claims data showed that it had led the nation for three consecutive years in total dollars spent to help children with crooked teeth. Or at least that’s what state and federal regulators thought. 

As it turns out, Texas did not have a higher percentage of children with orthodontic needs. Nor was the Medicaid program doing a better than average job of providing dental care for the poor. Instead, a handful of orthodontists were bilking Medicaid by putting braces on thousands of children who did not require them. They were also tweaking the braces more often than recommended and keeping them on much longer than was normal.

In fact, a small number of fraudulent orthodontic practices in the Dallas area had been operating in plain sight for years. Road signs advertised “free braces,” and dental workers solicited parents in pizza parlors and parking lots outside of social service agencies. The fraudsters’ offices were so crowded that parents had to wait outside.