Insurance Fraud NEWS
Three dentists, owner charged with Medicaid fraud in Indiana
April 03, 2014, Anderson, IN
The owner of an Anderson dental center and three dentists were among nine people charged in an alleged Medicaid fraud scheme, the Indiana Attorney General’s Office said Wednesday.
Sally Metzner, owner of Anderson Dental Center Inc., and her staff are suspected of submitting false claims to Medicaid in order to receive more money from the health care provider than allowed, Attorney General Greg Zoeller said.
Metzner has served as first co-owner and then owner of the center, 1537 S. Scatterfield Road in Anderson, since the original owner, Dr. Gerald Funderburk, died in 2001, according to records.
According to court documents, one of the dentists, Dr. Thomas Dubois, provided services to Medicaid patients from 2006 to 2010 despite not being a licensed Medicaid provider. The probable cause affidavit claims Metzner and her associates billed hundreds of thousands of dollars illegally to Medicaid.
Most of the false Medicaid claims were for deep sedation services for patients. Court documents said the center ranked first in Indiana in the number of filings to Indiana Medicaid for deep sedation reimbursements despite evidence that none of the dentists had a permit to administer anesthesia.
Metzner, 57, of Chesterfield, received a cease-and-desist order in December for operating a dental clinic without a dental license of her own. Now, she has been charged with 17 total counts including two counts of corrupt business influence, also known as racketeering, a Class C felony.
She is also charged with money laundering, seven counts of Medicaid fraud, four counts of theft, two counts of forgery and one count of practicing dentistry without a license. All of the charges are felonies. Metzner appeared in court Wednesday for an initial hearing with Magistrate Stephen Clase. Metzner entered a not guilty plea and as of Wednesday night was still housed in the Madison County Jail.
Three of the dentists, including Dubois, who worked at the clinic were charged. Dr. Paul Pangallo, 73; Dr. Jeffrey Rich, 69; and Dubois, 46, each face charges of corrupt business influence, money laundering, Medicaid fraud and theft.
Five office employees at the clinic were also charged with felonies ranging from forgery to prescription drug fraud.
Jessica Worrell, 27, and Barbara Brooks, 62, were both charged with forgery and corrupt business influence. Beth Flynn-Lohrey, 45, and Chris Martin, 31, were charged with prescription drug fraud and corrupt business influence. Deborah Davis, 55, has been charged with prescription drug fraud.
The affidavit, written by Diane Hedges, an investigator with the Indiana Medicaid Fraud Control Unit, and Maureen Devlin, a deputy attorney general, alleges the defendants submitted billings to Medicaid for services they did not provide. The clinic is also accused of embellishing the services being provided to receive a larger reimbursement than is allowable.
The clinic also submitted claims for work performed by dentists who were not authorized Medicaid providers, claims for work purportedly performed by another dentist after she no longer worked at the office, and forged signatures of dentists who no longer worked at the practice onto a variety of forms submitted to the Medicaid office.
“The Medicaid program funds dental care for Indiana’s neediest citizens, but if providers intentionally over bill Medicaid causing tax dollars to be wrongly paid out then all Indiana taxpayers are the victims,” Zoeller said in a statement. “The allegation here is that these defendants defrauded Medicaid so brazenly and repeatedly in operating their practice that it cannot be attributed to mistake or paperwork errors.”
Approximately 80 percent of the patients at Anderson Dental are Medicaid recipients, court documents said.
Hedges says her investigation uncovered that Anderson Dental fraudulently billed Indiana Medicaid for more than $300,000 for a service known as deep sedation from 2006 to 2011.
Hedges said the deep sedation services were not provided, according to the patients who were supposed to have received them. The patients had been given local anesthesia, which is not billable to Medicaid.
Metzner is due in a federal court today for a sentencing hearing on charges of tax evasion. She reportedly owed more than $850,000 in unpaid federal taxes. She earned $218,777 in 2009, according to a court document that also alleges that she collected $45,920 in federal income taxes from employees but did not account for that fee with the Internal Revenue Service.
Metzner’s attorney, Dan Whitehead, who will represent her in the state case as well, said she has pleaded guilty to the charges. What Judge Tanya Pratt decides today could have an impact on the newest case, said those familiar with the case.
Whitehead said the judge could take Metzner into federal custody at the hearing, which would make scheduling court dates for the state trial difficult. Metzner could be sentenced to 24 to 30 months of prison time for the tax evasion charges.
As for the newest charges against his client, Whitehead said he was meeting with Devlin on Wednesday to go over the documents.
“I’ll have a better idea of what we’re looking at after we meet,” Whitehead said. “I don’t want to start speculating too early.”
Zoeller also declined to comment further than the statement his office released due to this being a criminal investigation.
Follow Zach Osowski on Twitter @Osowski_THB, or call 640-4847.
Source: The Herald Bulletin