The CareOne Dental Corporation and its owners will pay $1 million over allegations that they repeatedly billed Medicaid for non-covered services and for services the company didn’t provide, according to Washington State Attorney General Bob Ferguson, noting that this is the second largest resolution of a False Claims Act case in the state.
One of the defendants, Liem Do, DDS, also agreed to no longer provide or be employed in any setting that involves state Medicaid and Medicare services. He further agreed that if Medicaid and Medicare initiate proceedings to bar him, he waives his right to contest them, a process known as voluntary exclusion.
In 2015, Ferguson filed a Medicaid fraud lawsuit in Clark County Superior Court against the Clark County company and its owners, Do and his wife Phuong-Oahn Tran, DDS. Ferguson alleged that CareOne Dental filed about $1 million in fraudulent claims to Medicaid between January 2011 and June 2015.
At one point, the couple operated four dental offices in Southwest Washington and two in Oregon. They currently operate a single clinic in Vancouver.
“Medicaid funds are a precious resource meant for the healthcare of Washington families in need,” said Ferguson. “When healthcare providers defraud Medicaid for their own gain, thereby harming Washington families, my office will hold them accountable.”
One of the defendants’ common practices was to bill non-covered services to Medicaid as covered procedures, such as billing sealants, which aren’t covered, as restorations or fillings. They also billed for more expensive procedures than those provided, known as upcoding.
For example, CareOne submitted bills for fillings on eight teeth when the dentist only provided non-covered sealants. Former CareOne employees verified these behaviors and confirmed that Do would alter billings submitted to Medicaid to reflect more lucrative services than what had been performed.
Assistant Attorneys General Matthew Kuehn and Karl Sloan with the Attorney General’s Medicaid Fraud Control Division handled the case. The division’s investigators can issue search warrants without the assistance of other law enforcement agencies. Like all recoveries from the division, the $1 million will go back to Medicaid through the state Medicaid Fraud Penalty Account.