True to their word in several recent public statements, the Chief and Deputy Chief of the Medicaid Fraud Division of the Massachusetts Attorney General's Office have brought several recent criminal cases against dentists for fraudulent billing and unlicensed practice of dentistry. The individuals and practices indicted were:

• A 55-year-old Worcester dentist and her practice for allegedly defrauding MassHealth of over $2 million for services not performed and other illegal practices;
• A 69-year-old Boston dental practice manager and the practice for allegedly defrauding MassHealth for services not provided as well as assault and battery for services, including a tooth extraction, performed by the defendant who was not a licensed dentist; and
• A 49-year-old Falmouth dentist for defrauding MassHealth and billing for services that were not performed by a licensed dentist, as required.

The Deputy Division Chief, Kevin Lownds, has also recently indicated that there has been a huge uptick in claims to MassHealth for autism-related services and, similar to the dentist cases, the AG’s Office has concerns about patient harm and substandard care from unlicensed providers as well as fraudulent billing for those services.

Lownds also stressed the AG’s Office’s continued focus on the patient wellbeing areas that have been a mainstay for the office: home health, skilled nursing facilities and the rise of telemedicine fraud, waste and abuse.

Like its federal counterpart at the Department of Justice, Attorneys General are utilizing more sophisticated data analytics tools to identify outliers in billing data and more previously routine MAC and UPIC audits are ripening into enforcement actions.