Miami Dentist Uses Unlicensed Staff
September 29, 2004 the Florida Attorney General announced that Dr. Suzanne Abergel-Nahon had used unlicenses staff to perform dental procedures for Florida Medicaid patients. The scam cost Florida Medicaid at least $260,000. From January 2000 to August 2004, Dr. Abergel-Nahon submitted claims for more than $3 million. Some of those claims were for services such as fillings, crowns, extractions, dentures, and root canals that were billed as if she provided them, when in fact, unlicensed staff performed the services.
Florida officials were probably able to find the fraud because of high billing by the provider. Data analysis algorithms can identify dentists who have such high billing it is unlikely that they could have performed all the work themselves. Once the dentist has been flagged, a simple investigation involving some phone calls and a site visit can identify who works for the dentist, what licensing they have and who actually performed the services.
Of course these algorithms only catch high billers. If a dentist bills under multiple identities, the fraud is harder to detect. Likewise, if the dentist continues his practice at normal billing levels but stops providing services himself, he’s more likely to get away with the scam.