US dentists defraud federal healthcare benefit programme at detriment of the vulnerable
Healthcare benefit programmes, whether federal in the US or the NHS in the UK, are established to provide national health services for people in need of medical and dental treatment. These programmes often are funded to benefit the neediest people, such as pensioners, those earning low income, children and people suffering from severe disabilities or life-threatening diseases.
When medical professionals, such as the recent case of employees at Valley Oral and Maxillofacial Surgery (VOMS ) in McAllen, Texas, defraud the system by illegally soliciting and receiving payments totalling 15 percent of the total payment made by Medicaid (the US federal healthcare benefit programme) for referral of falsely claimed referral beneficiaries; employing unlicensed medical staff to perform dental services; and billing for treatments not performed during 2007 and 2010; they put the health of the most vulnerable people at risk.
By claiming for false referral beneficiaries and billing for services not performed, these “employees” have taken from government funds and services that would otherwise be used to treat people, including the aged and children, with real illnesses. In addition, by employing unlicensed staff to perform dental services, patients have not received the quality of dental care expected through government standards and regulations for the overall wellbeing of patients. An effect is that patients, due to the poor standard of treatment, may then need to seek treatment elsewhere at addition cost to either themselves or the benefit programme.
In the US, the penalty for such illegal and unethical behaviour that also damages the healthcare profession is high. Whether it should be higher is disputable. However, the three implicated dentists, if convicted, face sentences for health care fraud and violating the kickback statute. The sentences are ten years in prison without parole and up to a $250,000 fine, and five years in prison with a maximum $25,000 fine, respectively.
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