Thursday, January 31, 2013

Blowing the Whistle Pays

Attorney General Chris Koster said today that his office has awarded $8,239 to a Medicaid fraud whistleblower who alerted the state to fraudulent billings by a group of dental clinics. The award money is 10 percent of $82,000 that the dental provider is paying in restitution and penalties to the state of Missouri, as allowed by Missouri law.

“Medicaid fraud tips are an important part of our efforts to investigate and punish Medicaid fraud,” Koster said. “We encourage anyone who suspects a health care provider is engaged in Medicaid fraud to contact our office so we can investigate.”

Koster said the whistleblower contacted his office in January 2011 with concerns about Ozark Family Dentistry, and the clinics’ owner, Dr. Arrash Ahmadnia. Dr. Ahmadnia, based in Rolla, owns dental clinics in Rolla, Thayer, Osceola and Springfield.

The whistleblower, who worked briefly at one of the clinics, alerted the Attorney General’s Office that Dr. Ahmadnia had instructed him to perform unnecessary work on patients, presumably to bill the costs to Missouri Medicaid. The Attorney General’s investigation found that the clinics had billed Medicaid for treatments under the code for dental fillings, but had actually performed different procedures – preventative resin restorations – which are not covered by Medicaid. The investigation also found some instances of double billing and billing for ineligible adults.

Under a settlement, Dr. Ahmadnia is required to pay more than $208,000 in restitution and penalties to the state and federal Medicaid programs. He is also required to immediately stop submitting reimbursement claims to Medicaid for the preventive resin restoration treatments. The agreement is a compromise of disputed claims and does not contain an admission of wrongdoing by Dr. Ahmadnia. The Attorney General’s Office is continuing to review billing procedures at the clinics.