A former employee recently filed a claim against a dentist. In this claim, the worker does not allege that they were personally injured. In fact, the claim does not even directly involve the worker. Instead, the claim states the dentist and oral surgeon fraudulently billed Medicaid for dental restoration services and x-ray images, a False Claims Act (FCA) violation. According to the claim, the services and images were either never provided in the first place or medically unnecessary.
Doesn’t the worker need to be directly involved to file a claim?
In most cases, anyone who files a claim must have legal standing. This generally means that the claim must impact that person directly. A court could dismiss a lawsuit if the person filing the lawsuit cannot establish standing. In this case, state and federal law allow the worker to file the suit on behalf of the government as a whistleblower lawsuit, or qui tam action.
Why would a worker want to file a claim against their employer? Doesn’t the government just take the case over?
Although the government may intervene in the case, former workers are still incentivized to file a claim. If the claim is successful, they can take a portion of the winnings or settlement. In this case, the dental professional agreed to pay $300,000 to settle the claim. Of that amount, the whistleblower will receive approximately $45,000.
What should other dental professionals learn from this case?
It is important to keep good records to back up claims made to Medicare, Medicaid and other insurance providers. A failure to have these records in order can make it difficult to defend against allegations of false or fraudulent billing practices. As shown with this case, such allegations can lead to serious penalties. In addition to the settlement, dentists and oral surgeons could lose the ability to receive reimbursement from Medicare and Medicaid in the future. The allegations could also put their licenses to continue to practice in their chosen profession at risk.