Dentistry,  Heartland Dental

Heartland Dental Pays $3 Million to Settle Medicaid Fraud Charges

heartland

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.


5 Comments

  • sam

    Did Heartland change the claims as indicated on the record or did the individual doctor upgrade to increase their personal production?
    How can a management company possibly police if a surgeon says it’s a surgical extraction and it’s not or if a dentist does an modbl and it fails, requiring a crown. Does that make it a crown build-up?

  • Bob

    That seems like a small price to pay to get out from under this despicable mess. These white collar con artists are who’s making business tough for the rest of the medical industry. Even though the fine has been paid this will end up in generating more regulation you can be promised of that! Thanks a (three) million Heartland!

  • Dr. Halloway

    Heartland dental will ruin your teeth for money. I never had a cavity and after my regular dentist died, I had no choice but to go to Heartland because they were the only place covered by my insurance. Although I had no cavities, they told me that I had 17 “thin” spots in my enamel and recommended composite fillings to prevent future cavities. Sure, I was young and naive and ever since then my low maintenance mouth had become high maintenance. In retrospect, I should have said no and just waited until I actually had a cavity before getting a filling. I then started noticing a pattern. They would somehow find problems that are covered to the exact amount of my insurance allowance for the year. If I had no insurance, I had no problems, but as soon as I had insurance, they would conveniently find dental work that so happened to use my yearly plan allowance. Please everyone, avoid these crooks. Your teeth are not as important to them as the money they can milk from your insurance plan.