South Florida Children Given ‘Unnecessary’ Free Care Under Medicaid ‘Dental Scheme’

State authorities are investigating a multimillion-dollar Medicaid fraud "scheme" in South Florida in which children received "unnecessary and sometimes improper" free dental care that was then reimbursed by Medicaid, the New York Times reports. A two-year investigation by the state attorney general's Medicaid fraud unit found about a dozen dentists would provide cleanings, X-rays and "even" extractions to children "picked up from street corners, school-bus stops and, in at least one case, a day care camp," often without their parents' knowledge. Under Medicaid, beneficiaries under 21 years old are entitled to checkups and cleanings twice a year and a "limited" number of other treatments. To exploit the system, children would be "shuttled" between dentists every day for up to a month until their benefits "ran out." At each visit, new X-rays were taken, often by "untrained dental employees," and dentists would substitute X-rays and records of children ineligible for Medicaid in place of those from patients who were eligible for Medicaid but did not regularly use their benefits. Investigators found that "recruiters," who often had convictions for narcotics, child molestation and murder, would offer children $5, Pokemon cards and McDonald's food to get their cooperation. Participating dentists then paid these recruiters $25 for every child they brought in. Though some children were taken without parental knowledge, many parents gave their consent when recruiters would offer the dental services. George Fiorenza, an investigator with the fraud unit, said, "The parents initially probably thought it was a good thing. They think, 'My kid gets to go to the dentist, they get a free ride and I get a baby-sitting service for the evening and my kid gets five bucks.'"

The System
Investigators say the scheme was started by Joel Berger, a former dentist from Queens, N.Y., who had his New York license revoked for "gross negligence, incompetence and unprofessional conduct." In the late 1990s, investigators say, Berger established dental offices in Miami-Dade, Broward and Palm Beach counties, though he did not practice dentistry himself. Instead, Berger would place licensed dentists at the practices and pay them $500 a day to treat Medicaid patients. These dentists would give Berger control of the bank accounts in which Medicaid reimbursements were deposited, "the balance" of which he would keep. The Times reports that Berger, along with two alleged accomplices -- Charles Kravitz, a Pennsylvania dentist, and Gabriel Harden, a "middleman" -- made at least $10 million through the fraud. Since Florida began its investigation in 1999, South Florida's annual Medicaid dental bill has been cut in half to about $18 million. But the Times reports that despite the crackdown, the scheme continues today. Overall, investigators say the system has defrauded Medicaid of at least $20 million. Berger, however, said any money was "earned legally." He added, "I would bring patients who were Medicaid-eligible to various dentists to have services performed, that's all." The Times reports that the National Association of Attorneys General said that "no other state" had such an extensive problem, though Texas and Kansas had faced "similar schemes on a much smaller scale." According to Kim Reed, a spokeswoman for the Florida agency that administers Medicaid, the state has historically had difficulty identifying fraud because it "only recently began to limit and monitor the amount of certain benefits recipients could receive in a year" (Canedy, New York Times, 8/17).