Former Ozarks dentist pleads guilty to Medicaid fraud

A former Ozarks dentist yesterday admitted he was part of a Medicaid fraud conspiracy that collected $167,090 from fraudulent payments.

James Dye, 66, of Independence, pleaded guilty to health care fraud charges, according to a news release from the office of Tammy Dickinson, U.S. attorney for the Western District of Missouri.

Dye was contracted by two co-conspirators to work at All About Smiles LLC dental clinics in Springfield and Mountain Grove.

Don Ledford, spokesman for the U.S. attorney’s office, said the co-conspirators who owned the now-defunct clinics aren’t being named at this time because they haven’t been charged.

“This is an ongoing investigation,” he said via email.  

The charges involve the purchase and billing of orthodontic appliances known as Ortho-Tain. The devices were purchased for $50 each and prescribed to child patients. Though designed as an orthodontic appliance to straighten teeth with braces, Dye and his co-conspirators billed them to Medicaid as a speech-aid prosthesis for approximately $695, the maximum allowed, according to the release.

From Oct. 6, 2010, to Aug. 19, 2015, Dye and his co-conspirators submitted 241 claims of $675-$695 per device, resulting in the over $167,000 in Medicaid payouts. Dye was the performing provider on 218 of the claims totaling $151,105, with the other dentists responsible for the remainder.

For orthodontic services to be covered by Medicaid, a dentist or orthodontist employed by the health care program must provide certification. Knowing this, Dye and his co-conspirators bypassed that requirement by billing the devices as speech-aid prostheses. While the majority were Ortho-Tain, other orthodontic appliances, including retainers, were billed as speech-aid prostheses, according to the release.

Dye is required to forfeit to the government the $167,090 obtained in the scheme. Under federal statutes, he could be subject to a sentence of 10 years in federal prison without parole. A sentencing hearing will follow the U.S. Probation Office’s presentence investigation.