Fraud and Abuse in Medicaid Clinics

I have previously discussed on this blog how students graduating from medical school have an average debt of around $158,000 and the average debt of those graduating from undergraduate college is around $27,000 in the U.S.  In fact, the video called College Conspiracy http://blog.teethremoval.com/college-conspiracy-and-united-states-hyperinflation/ profiles a dentist who is stuck with with high loans from school  (around the 11 minute mark). One quote appearing in this video is “…as soon as you get out of school you are indentured for life.”

This figure below showing the inflation cost of college tuition (in blue), medical care (in red), and general inflation (in black) from http://www.leftbusinessobserver.com/College.html pretty much tells more of the story. In fact I would argue that college tuition costs and medical costs are correlated with each other and you should be able to calculate some sort of correlation coefficient.

An interesting article titled “Our Junior Colleagues and Interstate Medicaid Clinics” written by Michael W. Davis DDS appears in the New Mexico Dental Journal, Fall 2011, vol. 62, no. 4, pages 24-28, helps further show the major problems with increasing college tuition and how this directly impacts and increases medical care costs.

The article is available over at http://dentistthemenace.com/documents/M%20Davis%20NMDA%20Fall%202011.pdf

The article discusses how often dentists are stuck with high loans after graduating from dental school and may end up working as transient laborers in Medicaid clinics. This lends itself readily towards fraud, criminal activities, and abuse.

The end of the article says:

“…many of our junior professionals are facing hard times and hard choices. Some face the prospect of either not paying bills, or working and contributing to the abuse of disadvantaged children. Medicaid fraud and abuse is big business, and played out on a vast interstate corporate stage. State government may collude with these large dental corporations in abusing poor children for profit. We either address these problems, or face wholesale collapse of Medicaid programs, and a sellout of large segments of our junior colleagues.”

In fact the business model of these Medicaid clinics accounts for fines, penalties, and legal settlements within it. Dentists are deemed as expendable as new dentists can just be hired to replace the one who got caught.

The article discusses several scams and how they play out. In brief

1. Billing for services never rendered
2. Restraining children in a papoose board. (I discuss how pediatric patients in a restraint can contribute towards the unfortunate occurance of death at the dentist office http://www.teethremoval.com/dental_deaths.html)
3. Unbundling of charges
4. Upcoding of services
5. Overtreatment and basing care on what pays more Medicaid dollars particularly with pedodontic crowns and pulpotomies

What is even more shocking is a discussion of “Pay-to-Play” politics between state government and Medicaid providers.

The article further states:

“Eventually taxpayers with their limited resources will demand an accounting of the Medicaid money-pit. Their frustrations will certainly be vented at corporate creeps who scammed the system, and government regulators, who gave these crooks a pass.

Ultimately the first step in fixing the medical crisis where profits seem to trump ethics has to be dealt with by substantially lowering the cost of medical education. Having a large amount of debt for a long time is not a comfortable prospect for most and leads to a lot of stress and worrying and seems to lead some young dentists to pursue aggressive and excessive medical treatments that should not be performed.