State Attorney General Bob Ferguson announced Thursday a lawsuit against two Vancouver dentists and their business, CareOne Dental, claiming they defrauded Medicaid of $1 million.
Ferguson filed the civil lawsuit against CareOne Dental, its owner, Dr. Liem Do, and his wife, Dr. Phuong-Oanh Tran, in Clark County Superior Court on Thursday morning. The lawsuit claims Do and Tran systematically billed Medicaid for noncovered services that they misrepresented in their billings, for more expensive versions of actual services provided and for services they didn’t provide.
The alleged fraud stretches over five years. In that time, the attorney general’s office suspects at least 20 percent of CareOne’s Medicaid billings were fraudulent.
“Medicaid funds are a precious resource in our state,” Ferguson said during a press conference in Vancouver. “If you knowingly commit Medicaid fraud, my office will hold you accountable.”
CareOne Dental did not respond to The Columbian’s request for comment Thursday.
The attorney general’s office launched its investigation in October 2014 after the state Health Care Authority, which oversees the Medicaid program, noticed anomalies in CareOne’s billing records, Ferguson said.
CareOne operates four offices in Clark County — in Minnehaha, Orchards, Battle Ground and Camas — and two offices in Oregon — one in Portland, the other in Happy Valley. The practice has been in operation in Vancouver since 2004, formerly under the name Comfort Dental, according to the attorney general’s office.
From January 2011 to June 2015, CareOne filed 139,000 claims to Medicaid for reimbursement of $5 million in services. In a random sampling, the attorney general’s office found 20 percent of those claims — or about $1 million of services — were allegedly fraudulent, Ferguson said.
One of the most common practices at CareOne, according to the attorney general’s office, was to bill most tooth extractions as requiring surgery, even when no evidence of a surgical extraction was provided, Ferguson said.
A former dentist told the attorney general’s office that Do informed him “at CareOne all extractions are surgical,” according to court documents. Another former provider said Do would change billing codes from what she entered after performing a procedure to different codes, such as changing a sealant to a more expensive filling, Ferguson said.
The attorney general’s office also alleges CareOne misrepresented patient conditions in order to receive Medicaid reimbursement. For example, chart notes for one of Tran’s patients show a “slight cavity” on 10 teeth and “deep grooves” on six teeth. Neither is serious enough to warrant fillings under Medicaid, Ferguson said.
Still, CareOne billed Medicaid for 17 fillings costing $3,023. Had the claim been billed properly, it would not have been paid with Medicaid funds, Ferguson said.
The attorney general’s office also uncovered a July 2011 billing for four X-rays and four fillings but found no evidence those services were ever provided, Ferguson said. The total for those allegedly fraudulent claims totaled more than $800, of which Medicaid reimbursed $263, he said.
Thousands of small fraudulent claims add up over five years, Ferguson said.
“These bad billings add up, in our view, to approximately $1 million,” he said. “My office and I will not tolerate this fraud.”
The lawsuit was brought forward under the state’s Medicaid Fraud False Claims Act, which allows the state to pursue fraud cases through civil actions. Each false claim can be subject to triple damages and a separate fine of $5,500 to $11,000.
Since the act went into effect in 2012, the attorney general’s office has recovered $6.1 million it otherwise would not have been able to without its authority under the act.
Without action from the Legislature, the act will sunset June 30, 2016.
“This is a robust statute that gives us power to go after fraudsters where it hurts — their pocketbook,” Ferguson said.
