PA Dentist Accused of $1.5M Medicaid Fraud Scheme

A dentist from Langhorne, Penn. has been accused of perpetrating a $1.5 million scheme to defraud the federal government as well as deception and tampering public records.

Federal prosecutors allege that Dr. Ilya Babiner enriched himself and his company, General Dentistry Number One by committing Medicaid fraud from 2014 until May 2016 when the records were subpoenaed. Prosecutors hit the dentist with multiple felony charges that allege false billings for dental work never conducted were submitted to the federal government.

The dentist used an alphabetical system to organize his Medicaid fraud scheme, say prosecutors. Over a span of two years, claims for repeated dental services and crown restorations that were never performed were submitted to the Medicaid program. Prosecutors say that a high percentage of claims were submitted based on patient last names. For example, in August 2015, Dr. Babiner submitted 120 claims – 107 of those claims were for patients with a last name that started with “G.”

The Fraud Abuse Detection System helped clue investigators in to the Medicaid fraud scheme. Investigators say that a statewide investigating grand jury also helped bring criminal charges against the dentist.

The dentist and his company have waived their right to a preliminary hearing and have been ordered to stand trial on the charges.

“Medicaid fraud is a serious crime that harms taxpayers,” Attorney General Josh Shapiro announced in a statement regarding the criminal prosecution of the dentist. “When people commit Medicaid fraud, they’re stealing tax dollars from people who are in real need of these services. These charges are part of a renewed focus by my office on this kind of criminal activity. Our Medicaid Fraud Control Section is focused every day on detecting and prosecuting these kinds of cases.”

Medicaid Fraud

Some think defrauding the federal government is a victimless crime, but that isn’t true. Medicaid fraud drains much-needed funds from federal programs for the poor, needy, as well as from vulnerable children and the elderly. Ultimately, these schemes cost US taxpayers. In addition to false billing for medical services not performed, Medicaid fraud includes overbilling, and illegal kickbacks.

Federal efforts to combat Medicare and Medicaid fraud have been increased recently, putting them on par with other federal investigation efforts into terrorism. It often takes an employee of the healthcare company to report the illegal activity to federal prosecutors. These employees, known as whistleblowers, often provide critical information to investigators that allow them to initiate prosecution.

Whistleblowers are entitled to protection from retaliation for reporting fraud against the federal government under the False Claims Act. The FCA also entitles whistleblowers an award if the litigation is successful or the parties reach a settlement. Verdicts and settlement agreements can run into the millions for Medicare and Medicaid fraud. Under the FCA, whistleblowers can receive fifteen to 30 percent of that amount.

If you are a healthcare worker concerned about Medicaid fraud at your place of employment, contact the attorneys at Bradley/Grombacher for help.