Dental Provider to Pay Over $500,000 to Resolve False Claims Act Allegations

Red Dirt Orthodontics has agreed to pay $583,090 to settle allegations of fraudulent billing practices involving Oklahoma’s Medicaid program, according to an announcement by the state’s Attorney General’s office on Monday.

The settlement addresses claims that the dental provider knowingly submitted false claims to SoonerCare, Oklahoma’s Medicaid program, over a two-year period from March 2022 to March 2024. Investigators found that Red Dirt Orthodontics had been falsely identifying an Oklahoma Health Care Authority (OHCA) credentialed orthodontist as the provider of services that were actually performed by an uncredentialed practitioner.

“My investigative team worked carefully and extensively to recover these funds, and I’m grateful for their efforts,” Oklahoma Attorney General Gentner Drummond said in a statement. “I take all claims of fraud seriously and will hold accountable anyone who exploits the system.”

The case highlights a growing concern within healthcare systems nationwide about provider credential misrepresentation, a practice that undermines the integrity of state Medicaid programs. In Oklahoma, orthodontists must obtain specific credentials through the OHCA before they can legally bill SoonerCare for patient services.

Healthcare fraud involving Medicaid has become an increasing focus for state attorneys general across the country. According to recent federal data, Medicaid fraud investigations recovered more than $1.9 billion in improperly obtained funds nationwide in the last fiscal year.

The settlement with Red Dirt Orthodontics represents one of the larger Medicaid fraud recoveries in Oklahoma in recent years. The practice, which operates multiple locations throughout central Oklahoma, provides orthodontic services to thousands of patients, including many who rely on SoonerCare coverage.

For patients covered by SoonerCare, this type of fraud can have direct consequences, potentially disrupting continuity of care and creating questions about treatment legitimacy. State officials have not disclosed whether any patients received substandard care as a result of the credentialing deception.

The investigation was conducted by the Oklahoma Attorney General’s Medicaid Fraud Control Unit, specifically led by Assistant Attorney General Jamie Bloyd and Agent Daniel Shcolnik. The specialized unit is primarily funded through federal grants, receiving 75 percent of its $6.35 million budget from the U.S. Department of Health and Human Services.

This case demonstrates the increasing sophistication of state fraud investigation units, which are utilizing advanced data analytics and auditing techniques to identify suspicious billing patterns. The Oklahoma unit has steadily increased its recovery figures over the past five years, returning millions to the state’s Medicaid program.

The settlement does not include any admission of liability by Red Dirt Orthodontics, which is common in such agreements. The practice will be permitted to continue treating Medicaid patients, though likely under heightened scrutiny from state regulators.

Healthcare providers who bill Medicaid programs face stringent requirements, including proper credentialing, accurate service documentation, and adherence to specific billing protocols. Violations can result in significant financial penalties, exclusion from government healthcare programs, and in severe cases, criminal charges.

The Oklahoma Health Care Authority, which administers the SoonerCare program, serves approximately 1.2 million low-income residents, or nearly one-third of the state’s population. The agency has emphasized the importance of program integrity measures to ensure taxpayer funds are properly used for legitimate healthcare services.

Representatives from Red Dirt Orthodontics have not yet issued a public statement regarding the settlement.