North Carolina Dentist Settles Medicaid Fraud Case for $567,125

Dentistry Today


North Carolina Attorney General Josh Stein has reached a $567,125 settlement with High Point dentist Dr. Stefan J. Simoncic and his Triad Oral Surgery practice to resolve allegations involving the submission of false claims to the North Carolina Medicaid program. 

This action is part of Operation Root Canal, an ongoing effort by the North Carolina Department of Justice’s Medicaid Investigations Division to find and stop fraud among dental providers.

“Our efforts to stop fraud among dental providers have gotten back more than $6 million for our state’s Medicaid program,” said Stein. “My office will hold providers accountable when they cheat taxpayers and people who need healthcare.”

According to the settlement, between January 1, 2015, and August 31, 2019, Simoncic and his practice submitted claims involving detailed oral evaluations and anesthesia services performed on Medicaid recipients.

The services were not medically necessary, had no supporting clinical documentation, or were performed in violation of Medicaid policy. Simoncic has agreed to pay back $567,125 to the Medicaid program.

Operation Root Canal involves a wide variety of dental services, including dental cleanings, use of nitrous oxide, repetitive restorations on the same tooth, palliative care, and upcoding of patient examinations. 

Through this effort, the Medicaid Investigations Division has reached settlements with 10 dental providers, resulting in more than $6.3 million being paid back to the Medicaid program.

The settlement was obtained with the assistance of the Medicaid Investigations Division and the North Carolina Department of Health and Human Services’ Division of Medical Assistance-Clinical Policy and Program Integrity.

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