Oklahoma Orthodontic Provider Pays $583,000 in Medicaid Settlement

Oklahoma dental provider Red Dirt Orthodontics has agreed to pay more than half a million dollars to settle allegations of improper billing practices involving the state’s Medicaid program, according to the Oklahoma Attorney General’s office.

The $583,090 settlement resolves claims that the orthodontic practice submitted false claims to SoonerCare, Oklahoma’s Medicaid program, over a two-year period from March 2022 to March 2024. The case highlights ongoing scrutiny of healthcare billing practices in state-funded programs.

According to investigators, Red Dirt Orthodontics misrepresented who was providing treatment to Medicaid patients. The practice allegedly submitted claims identifying an Oklahoma Health Care Authority (OHCA) credentialed orthodontist as the provider, when services were actually performed by an orthodontist who lacked proper credentials and authorization to bill SoonerCare.

“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 was investigated by the state’s Medicaid Fraud Control Unit, with Assistant Attorney General Jamie Bloyd and Agent Daniel Shcolnik leading the inquiry. The unit is responsible for investigating and prosecuting Medicaid provider fraud and patient abuse throughout Oklahoma.

Healthcare fraud continues to be a significant concern for state and federal authorities. Medicaid programs, which provide healthcare coverage to low-income individuals and families, are particularly vulnerable to billing irregularities and fraudulent claims. The Centers for Medicare and Medicaid Services (CMS) estimates that improper payments across all Medicaid programs nationwide total billions of dollars annually.

In Oklahoma, SoonerCare serves approximately 1.2 million residents, representing nearly one-third of the state’s population. Dental services, including orthodontic care, are covered for eligible children and some adults, making proper oversight of these programs essential for both fiscal responsibility and patient care.

Provider credentialing requirements exist to ensure that medical professionals meet established standards of education, training, and experience. When uncredentialed providers deliver services billed to Medicaid, it circumvents these quality control measures and violates program regulations.

The settlement with Red Dirt Orthodontics does not include an admission of liability, which is common in such agreements. However, the practice has agreed to the substantial financial penalty to resolve the allegations.

Healthcare compliance experts note that proper documentation and accurate billing practices are fundamental responsibilities for medical providers participating in government healthcare programs. Even when qualified professionals deliver appropriate care, misrepresenting who provided those services constitutes a violation of program requirements.

The recovery of these funds represents part of broader efforts by the Oklahoma Attorney General’s office to combat fraud across state programs. Medicaid fraud enforcement has intensified in recent years as states face increasing budget pressures and seek to ensure that limited healthcare dollars are properly spent.

For patients enrolled in SoonerCare, this case underscores the importance of maintaining awareness of who is providing their care. Beneficiaries are encouraged to report any concerns about healthcare services to the appropriate authorities.

The settlement also serves as a reminder to healthcare practices across Oklahoma about the serious consequences of improper billing practices, even when the underlying services may have been medically necessary and properly delivered.