State Attorney General Bob Ferguson has reached a $1 million settlement with two Vancouver dentists and their business, CareOne Dental, over allegations that they defrauded Medicaid.
It is the second-largest resolution of a Medicaid False Claims Act case in Washington, according to the State Attorney General’s office.
The dentists, Dr. Liem Do and his wife, Dr. Phuong-Oanh Tran, will have to repay $1 million to the state’s Medicaid fund. They used to operate four dental offices in Southwest Washington and two in Oregon. They now have a single clinic in Vancouver, All Clear Dental at 5409 N.E. St. Johns Road, according to an AG news release.
In addition to paying the settlement, Do has agreed to voluntarily exclude himself from participating in Medicaid and Medicare programs, according to the news release. Do didn’t respond to a request for comment.
Do and Tran remain licensed by the Department of Health as dentists. According to the state Department of Health’s provider database, Do is on probation as the result of a 2017 agreed order. The agreement was reached after a 2015 incident in which Do obtained an order to extract 10 teeth from a patient who was under the influence of sedating medication.
Matt Kuehn, civil section chief for the Medicaid fraud control division, and Karl Sloan, assistant attorney general for the Medicaid fraud control division, said their office estimated 12.6 percent of CareOne Dental’s Medicaid billings were fraudulent after reviewing a sampling of patient documents.
“Medicaid funds are a precious resource meant for the health care of Washington families in need,” Ferguson said in the release. “When health care providers defraud Medicaid for their own gain, thereby harming Washington families, my office will hold them accountable.”
Ferguson filed the lawsuit in Clark County Superior Court in September 2015. The Washington State Health Care Authority brought the issue to the attention of Ferguson’s office, according to Kuehn and Sloan.
The suit alleged Do and Tran repeatedly billed Medicaid for noncovered services and for dental services that the clinic didn’t provide. That amounted to about $1 million in fraudulent claims to Medicaid between January 2011 and June 2015, according to a news release from the AG’s office.
“There’s a lot of dispute over that (number),” Kuehn said of the $1 million. “This is settling in on an amount on what we believe is close to the amount fraudulently taken.”
According to the AG’s news release, the dentists would bill noncovered services to Medicaid as covered procedures. For example, they billed sealants, which are not covered under Medicaid, as restorations or fillings, which are covered. They billed Medicaid for more expensive procedures than they provided, which is called “upcoding.”
One example of this, according to the AG’s office, is that CareOne submitted bills for fillings on eight teeth, when the dentist actually performed sealants, which are not covered.
“Former CareOne employees verified these behaviors, and confirmed that Dr. Do would alter billings submitted to Medicaid to reflect more lucrative services than had actually been performed,” according to the news release.
Kuehn and Sloan said Ferguson has taken an interest in their office and Medicaid fraud, in general, and Kuehn explained their “aim in terms of trying to resolve these cases is to make up the lost funds from Medicaid.”
New legislation has expanded the authority of the Medicaid Fraud Division and investigators now have the power to issue search warrants without the help of other law enforcement agencies. Since 2012, the Medicaid Fraud Control Division has recovered more than $146 million for Washington state.
