Two Texas dentists and their associated management companies and dental practices have agreed to pay $3.1 million to settle False Claims Act allegations of Medicaid fraud, according to a May 14 U.S. Department of Justice (DOJ) press release. Three whistleblowers originally brought the qui tam lawsuit against Drs. Gunjan Dhir and Gaurav Puri, claiming that the two doctors’ organizations billed Medicaid for services for underprivileged children that never took place, and that the medical providers “falsely identified the person who provided the service.” Although rewards for the whistleblowers have not yet been determined, they will receive a share of the total funds recovered by the government.
The lawsuit alleges that between 2011 and 2017, Drs. Dhir and Puri and their associated companies submitted or allowed the submission of false billings to Medicaid for services that in reality, the medical providers did not render. As of 2015, the doctors owed 35 clinics within the state of Texas, all of which primarily serve children who are beneficiaries of the Texas Medicaid program. As Texas’ state Medicaid program paid for around half of the procedures, the recovered funds will be split between the state and federal governments.
The whistleblowers also claim that the medical organizations allowed dentists who performed services for pediatric patients to be misidentified. The Medicaid program uses a system of Medicaid provider numbers to identify which physicians provided care to patients. The lawsuit claims that the medical organizations gave erroneous Medicaid provider numbers that misrepresented which physician provided what care.
Acting U.S. Attorney Prerak Shah of the Northern District of Texas commented: “These defendants knowingly defrauded Medicaid, a program that provides medical coverage for more than 4 million low-income Texans.” Both state and federal Medicaid programs work together to provide essential healthcare services to some of the most vulnerable people in the U.S. Medicaid fraud harms the rightful beneficiaries to the program by diverting money into the pockets of medical fraudsters.
The False Claims Act is the premier whistleblower and anti-fraud law in the U.S. and has demonstrated repeatedly that it can effectively protect and incentivize whistleblowers. The three whistleblowers, Sandy Puga, Nelda Torres-Brown, and Sonia Cardoso, are all former employees of either the dental management companies or dental practices and were able to provide valuable insider information. The whistleblowers, or relators, will share a reward of somewhere between 15 to 30% of the total amount that the government recovered from the lawsuit.