In 2008, Roy Shelburne, DDS spent two years in jail for Medicaid fraud. I thought it might be the time to revisit Dr. Shelburne, in hopes to educate dentists who have found themselves in the trences of corporate dentistry, including Medicaid fraud dental clinics. I also thought it was the perfect time to open the eyes of those dentist who have found themselves in a pickle, for Medicaid fraud, since I suspect that number is about to increase greatly!
Dr. Shelburne appeared to live above his means and that was a huge factor in his trail- lavish cars, home, etc.
DentistryIQ interviewed Dr. Shelburne just after his release:
Excerpts:
“One of the most difficult times for me during the trial was sitting on the witness stand and being cross-examined by the prosecution. He asked why I provided a particular service. I outlined why I did it, and the prosecutor went back to my patient record and said, “Well, that’s not explained completely in this record. So, how do you now justify what you did then when you did not fully record it? This seems like you are saying this to protect yourself after the fact.”
“Bill what you did, exactly what you did, and when you did it. Make sure it’s done in a timely and accurate manner, and do your due diligence. Go back, review, make sure that everything you did is on that claim and coded correctly.
“I urge all dentists to make sure they know what goes on in their practices in terms of billing because a mistake is not necessarily a mistake in the eyes of the law. Ignorance is no excuse! We are responsible as practitioners and owners of our businesses for whatever goes out of our offices.
“Be very careful. Be diligent and be precise, because you may be called on one day to justify the services you have provided. You should be comfortable saying this is exactly what I did, and this is what I need to be paid for that service.”
Today Roy is trying to educate, I'd say he's got plenty of clientel. At his website -Roy S Shelburne, DDS: A Prisoner Set Free! Dr. Shelburne says,
"Most dentists live in fear of litigation but few worry about going to prison. Nonetheless, I went to prison on August 20, 2008 and was released on May 14, 2010. If you'd like, take a deep breath, hold on, and take a ride with me through a health care providers worst nightmare. Take heart....there are ways to prevent what happened to me from happening to you. Listen up! Your future freedom could depend upon it."
and
"I was ordered on March 6, 2008 to forfeit $200,000 as a result of the RICO and Structuring conviction. A penalty of $75,000 were ordered on July 10, 2008. The restitution represents "restitution to each victim in the full amount of each victim’s losses”. The Government began an appeal of the decision in the criminal case; however, has since abandoned that appeal. The criminal case is now final as a matter law; however, the government is continuing their prosecution via a civil complaint that was filed on November 6th, 2009 against me and the practice. The complaint is based on the same alleged course of action and claims as in the criminal action so the trial is not over...literally and figuratively."
He further states:
The ADA dental claim form is a legal document. The claim form is the instrument by which a practice coveys complete and accurate information to a payor for reimbursement. Any misrepresentation made on this claim form may have legal repercussions AND no specific intent to misrepresent the information is necessary to be considered guilty of fraud. That just doesn't sound right, does it? No specific intent to misrepresent the information is necessary to commit fraud is necessary to be guilty of fraud????? What??? I invite you to read: http://oig.hhs.gov/compliance/physician-education/roadmap_web_version.pdf, a government publication directed toward training medical professionals. The government notes that: "You do not have to intend to defraud the Government to violate the False Claims Act. You can be punished if you act with deliberate ignorance or reckless disregard of the truth.
Imagine the consequences for thousands of dentists in practice these days who have every intention of defrauding every morning they walking into the office, or in ReachOut Healthcare America's case, pull up to that school campus.
Dr. Shelburne asks, "just how much is your freedom worth?"
Dr. Shelburne asks a dang good question. To see the massive number of dentists who have turned, what put Dr. Shelburne in jail into a full time career. I'd say the answer to that is "not as much as my mansion, Bentley or my Lamborghini."
If you chose to do the Time, maybe this will help you:
