Heartland Dental of Effingham, Illinois

A whistleblower law suit was the start of Heartland Dental’s difficulties with the state of Illinois and the Feds.

An Effingham-based company that manages dental practices in Springfield, Lincoln, Litchfield and dozens of other Illinois communities will pay more than $3 million to resolve allegations of Medicaid fraud and improper prescription writing that arose from a federal whistle-blower lawsuit.

The settlement, involving Heartland Dental Inc. and Heartland chief executive officer Richard E. Workman, was announced Friday by the Springfield office of Rodger Heaton, U.S. attorney for the Central District of Illinois.

Heartland Dental denied any wrongdoing as part of the civil settlement, and Deborah Gersh, one of the company’s lawyers, noted that federal officials made no allegations that any dental procedures were performed unnecessarily or caused any harm to patients.

In the first of civil settlements to resolve the allegations, Heartland agreed to pay $1.65 million — $990,000 to state government and $660,000 to the federal government — to resolve allegations of improper billings to Illinois’ Medicaid program.

In a related settlement, Heartland agreed to pay the federal government $1.35 million to resolve allegations that newly hired dentists in Illinois and other states issued prescriptions for painkillers and antibiotics before those dentists underwent the required federal registration.

According to the U.S. attorney’s office, the first settlement resolved allegations that Heartland submitting claims to Medicaid for tooth restorations when the procedures performed were actually “crown buildups,” which don’t qualify for coverage.

It also was alleged that the company wrongly billed Medicaid tooth extractions as “surgical extractions” — procedures that resulted in higher payments.

Federal officials said the alleged improper Medicaid bills took place from 1999 through October 2005.

How difficult is it to obtain a DEA license? Not very but you have to be dentally licensed and pass the background check. Is Heartland’s credentialing that lacking? Or was it a deliberate oversight?

And, the issue of overbilling Medicaid always seems to be a continual problem for large providers of welfare dentistry. When the government pays, why not game the system? Illinois and Indiana have more generous welfare payments for dentistry as compared to California and other western states.

Under the terms of federal and state laws that encourage citizens to report fraud and allow them to be rewarded, former Heartland employee Lori Jamison will receive $412,500 from the federal government’s $660,000 settlement.

Jamison also will be paid an additional $325,000 by Heartland to take care of her attorney’s fees and related costs.

Jamison, who used to work for one of the companies that merged in 2006 to form Heartland, filed a whistle-blower lawsuit in 2003. That suit, which had been sealed, was unsealed and dismissed Friday in Springfield’s U.S. District Court.

Flap’s advice to dentists (particularly new graduates) is to know who you are working for and scrutinize the billing if you are a Medicaid provider. After all, it is your license to practice that may be affected.