Most people aren’t exactly big fans of going to the dentist. Especially as children, we often dread the idea of lying in a chair awaiting those sharp and shiny tools to enter our mouths. However, as we all know, good oral hygiene is a necessity. It doesn’t just prevent much worse visits to the dentist than those that simply involve cleanings. Taking care of our teeth also benefits our overall health.
“Research shows that regular preventive care can help stem the progression of oral and gum diseases, helping to lessen the risks associated with heart disease, diabetes, and pregnancy,” reports life insurance company, Guardian, “Good dental care can also help improve self-esteem because healthy teeth and gums are important to their feelings about themselves.”
Houston-based dental clinic operator convicted of fraud.
68 year-old, Rene Gaviola has been found to be less concerned with the oral hygiene of his clinic’s patients and more concerned with accumulating wealth. As a result, the Houston resident has been found guilty of defrauding Medicaid out of $6 million. Announced in a report by the Southern District of Texas branch of the U.S. Attorney's Office last Friday, Gaviola’s conviction followed his guilty plea to participating in the scheme.
Gaviola operated Houston’s Floss Family Dental Care clinic, informs the report. In court, he admitted that between 2018 and April 2021, he submitted fraudulent claims to Medicaid for pediatric dental services. They include several cavity fillings that the clinic never provided. Gaviola also admitted that he employed an individual to practice dentistry without a license on Medicaid-insured children.
The clinic sometimes operated without any dentists.
Even without the help of any licensed dentists, Floss Family Dental Care billed Medicaid for dental services. As part of his scheme, Gaviola paid kickbacks to marketers and caregivers of Medicaid-insured children. The objective was to get those children to visit Floss for dental services.
Gaviola also admitted to laundering Medicaid monies from the Floss Family Dental Care business bank account to his personal bank account. This took place via several transactions exceeding $100,000 each.
The clinic billed Medicaid close to $7 million for false claims.
“From 2019 to 2021, the dental clinic billed Medicaid nearly $6.9 million in claims for pediatric dental services,” details the report, “Medicaid paid approximately $4.9 million on those claims.” U.S. Attorney Alamdar S. Hamdani made the announcement about Gaviola’s guilty plea and conviction last Friday.
“These precious Medicaid funds were intended to provide necessary dental services to low-income children in our community, not line Gaviola’s pockets,” he is quoted as saying in the U.S. Attorney’s Office report, “This conviction is a reminder to all who attempt to defraud our healthcare system that we are committed to stamping out fraud and protecting the integrity of Medicaid and other federal programs.”
Are you an attorney who is currently working a healthcare fraud case?
The clinical experts at Allegiant Experts can help you! We coordinate and support courageous whistleblowers that shine lights on fraud, waste and abuse. Contact us today to schedule a complimentary consultation. Please don’t hesitate to give us a call at 407-217-5831. You may also email us at info@allegiantexperts.com.
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