Dentist pleads guilty to cheating Medicaid
Release date: 9/17/2013
Dentist with practices in Elizabeth City, Nags Head to pay $114,000 in restitution
Raleigh: A North Carolina dentist has pleaded guilty to charges related falsely billing Medicaid for dental and oral surgery services and will pay $114,000 in restitution.
Dr. Francis Bald, with practices in Elizabeth City and Nags Head, was one of nine North Carolina health care providers arrested last December as part of a sweep by the Attorney General’s Medicaid Investigations Division, which is made up of attorneys, financial investigators and State Bureau of Investigation agents. Six of the other providers arrested pleaded guilty earlier this year.
“Rooting out this kind of fraud protects taxpayers’ money and helps fight rising health care costs,” Cooper said.
Bald pleaded guilty to two counts of attempted medical assistance provider fraud and was sentenced by Wake County District Court Judge Ned Mangum on September 5th to 60 months of supervised probation and ordered to repay the Medicaid program $114,723.68 in restitution. If Bald violates the terms of his probation, he could face up to 90 days in jail.
Bald is expected to pay additional money under a related civil settlement that has yet to be finalized.
The North Carolina Medicaid Investigations Division (MID) began looking into Bald’s billing practices after a tip from a citizen indicated that his practices had billed Medicaid for dental services that were not provided. Investigators uncovered a pattern of Bald’s businesses billing Medicaid for dental services such as use of nitrous oxide, additional units of anesthesia time, and additional intraoral x-rays that were not provided to patients or were not medically necessary.
This investigation was handled by the MID with assistance from the North Carolina State Bureau of Investigation, the North Carolina Division of Medical Assistance, Program Integrity Section, the North Carolina Department of Insurance, the North Carolina State Board of Dental Examiners, and the United States Department of Health and Human Services, Office of Inspector General.
“Winning guilty pleas and money back saves taxpayer funds and discourages other health care providers from cheating,” Cooper said.
North Carolina’s MID has recouped more than $500 million over the past decade and helped to convict hundreds of individuals on criminal charges including patient abuse and neglect as well as financial fraud. During the federal fiscal year that ended September 30, 2012, the MID won 33 criminal convictions and 14 civil settlements that recovered $94,390,397.85 from Medicaid abusers.
In another recent case, the MID recovered $1,280,750.90 for the state’s Medicaid program from Wyeth Pharmaceuticals, Inc. The drug company allegedly caused false claims to be submitted to the North Carolina Medicaid program by offering the kidney transplant drug, Rapamune, for uses that had not been approved by the FDA. North Carolina’s settlement is part of $491 million the company paid to settle Medicaid fraud claims nationally.
The MID investigates fraud and abuse of Medicaid benefits by hospitals, doctors, pharmaceutical companies, medical equipment companies, mental health and personal care providers, ambulance services and others. The division also investigates patient abuse and neglect in nursing homes and other facilities that receive Medicaid funds. The unit works closely with United States Attorneys, District Attorneys, and other state and federal law enforcement agencies.
Media contacts: Noelle Talley (919) 716-6413