VANCOUVER — Washington State Attorney General Bob Ferguson recently announced a civil lawsuit against CareOne Dental Corporation, its owner, Dr. Liem Do, and his wife, Dr. Phuong-Oanh Tran, for alleged Medicaid fraud. CareOne is a dental services provider with four offices in Washington, including two located in Vancouver.
The lawsuit, filed in Clark County Superior Court, alleges the defendants systematically billed Medicaid for non-covered services which they misrepresented in their billings, “upcoded” services (more expensive versions of what they actually performed), and services they simply didn’t provide.
The Attorney General’s Office (AGO) currently estimates at least 20 percent of the claims CareOne Dental presented to Medicaid from January 2011 to June of 2015 were fraudulent, which would amount to approximately $1 million in single damages.
“Medicaid funds are a precious resource meant for the health care of Washington families in need,” Ferguson said. “I will not tolerate anyone defrauding those families and taxpayers, and I’ll use my legal authority to hold them accountable.”
According to the AGO, one of the defendants’ alleged common practices was to bill most tooth extractions as requiring surgery, even where there was no evidence a surgical extraction was provided. A former CareOne dentist recalled Do instructing him that “at CareOne, all extractions are surgical.”
Another dentist reported that Do allegedly “would change stuff” from the billing codes she entered, often “upcoding” to a more expensive procedure. For example, after this dentist reported providing dental sealants to one patient, Do changed them to “fillings” and billed Medicaid for the more lucrative fillings.
Chart notes for one of Tran’s Medicaid clients show the patient had a “slight cavity” on 10 teeth and “deep grooves” on six teeth. Neither condition is serious enough to warrant fillings under Medicaid.
The patient’s consent form showed 13 teeth would be filled, and ultimately Medicaid was billed for 17 fillings, representing a charge of $3,023. Had the claim been billed properly, it would not have been paid with Medicaid funds.
The lawsuit is brought under the Medicaid Fraud False Claims Act (FCA). Under the FCA potential recovery could include three times the single damages plus $5,500–$11,000 per false claim. Estimated single damages for this case are $1 million.
A recent preliminary report to Washington’s bipartisan Joint Legislative Audit and Review Committee (JLARC) found that for every dollar the state spent on enforcing the FCA, the Attorney General’s Office recovered $3.
