Oklahoma Dental Provider Agrees to $600,000 Settlement Over False Claim Allegations

Oklahoma dental provider Red Dirt Orthodontics has agreed to pay $583,090 to settle allegations of submitting false claims to the state’s Medicaid program, following an extensive investigation by the Oklahoma Attorney General’s Office.

The settlement resolves accusations that the orthodontic practice falsely billed SoonerCare, Oklahoma’s Medicaid program, over a two-year period from March 2022 to March 2024. According to investigators, Red Dirt Orthodontics submitted claims identifying an Oklahoma Health Care Authority (OHCA)-credentialed orthodontist as the provider of services that were actually performed by an unauthorized practitioner.

The investigation revealed that the orthodontist who performed the services lacked proper OHCA credentials necessary to submit claims to the state’s Medicaid program. This misrepresentation constituted a violation of state Medicaid regulations, which require all providers billing for services to maintain appropriate credentials.

Oklahoma Assistant Attorney General Jamie Bloyd and Agent Daniel Shcolnik from the state’s Medicaid Fraud Control Unit led the investigation. The case represents part of a broader effort by Oklahoma authorities to combat healthcare fraud and protect taxpayer dollars allocated for public health programs.

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

The settlement highlights ongoing challenges in Medicaid program integrity across the country. SoonerCare, which provides healthcare coverage to approximately 1 million low-income Oklahomans, relies on accurate provider credentialing to ensure quality care and proper use of public funds.

Healthcare fraud involving improper billing practices costs taxpayers billions annually nationwide. According to the U.S. Department of Health and Human Services, Medicaid fraud control units recovered over $1.8 billion in criminal and civil cases in fiscal year 2023 alone.

Dental fraud represents a significant portion of Medicaid investigations in many states. Common schemes include billing for services performed by unauthorized providers, submitting claims for unnecessary procedures, or misrepresenting the level of service provided.

For patients of Red Dirt Orthodontics who received care through SoonerCare, the settlement does not directly impact their treatment. However, it underscores the importance of provider transparency and compliance with state healthcare regulations.

The settlement amount of $583,090 represents a significant recovery for Oklahoma’s Medicaid program. Such funds are typically returned to program operations, helping maintain services for eligible residents who depend on SoonerCare for their healthcare needs.

The Red Dirt Orthodontics case serves as a reminder to all healthcare providers about the serious consequences of submitting false claims to government healthcare programs. Healthcare practices must ensure that all practitioners providing billable services maintain proper credentials with relevant state agencies.

Oklahoma’s Medicaid Fraud Control Unit operates within the Attorney General’s Office and is responsible for investigating and prosecuting healthcare provider fraud as well as abuse and neglect in healthcare facilities. The unit works in collaboration with federal authorities and other state agencies to protect the integrity of public health programs.

The settlement with Red Dirt Orthodontics was reached without an admission of liability, which is common in such cases. However, the practice has agreed to implement enhanced compliance measures to prevent similar issues in the future.