Texas Attorney General Ken Paxton has filed suit against a group of dental providers and “sham” marketers for allegedly bribing Medicaid patients and for performing medically unnecessary procedures to defraud Texas Medicaid.
According to the Office of the Attorney General, evidence shows that the provider defendants paid marketer defendants to target Medicaid beneficiaries and their families by offering gift cards in exchange for becoming a patient.
The marketer defendants would direct patients to schedule appointments with the provider defendants, and frequently circulated patients between this network of clinics to maximize Medicaid reimbursement.
After securing these patients, the providers allegedly performed unnecessary and, in some cases, high-risk dental procedures, billing Texas Medicaid for services that were not medically justified.
Paxton says those actions not only defrauded taxpayers but also exploited vulnerable Texans, including children, by subjecting them to unnecessary medical treatments and risks.
“It is malicious and unacceptable that these providers were performing dangerous, medically unnecessary procedures on patients in order to scam our Medicaid system,” said Paxton. “Our Medicaid resources are in place to serve Texans in need, and my office will continue to fight fraud and abuse within that system.”
Paxton has brought this action under the Texas Health Care Program Fraud Prevention Act, which prohibits false claims, concealment of material information, and unlawful kickback arrangements involving Medicaid-funded services.
“This case involves a barefaced kickback scheme between a group of dental providers and marketing companies to drive Medicaid patient referrals to dental providers by offering cash and gift card incentives to Texas Medicaid beneficiaries and their families,” the suit states. “In exchange for funneling Medicaid patients to their practices, the Provider Defendants paid the Marketer Defendants remuneration in the form of per-patient referral fees. The unlawful remuneration was disguised in Master Service Agreements and on invoices between the Provider and Marketer Defendants as ‘surveys’ or ‘survey services.’
“Although the MSAs and invoices indicated that the Provider Defendants paid the Marketer Defendants for providing surveys to Medicaid patients after receipt of dental services, no such surveys exist. The so-called surveys were nothing but a sham.”
The OAG is seeking full restitution, civil penalties, and all available remedies to hold the defendants accountable and recover taxpayer funds.
Northern District of Texas case No. 3-24-cv-1298-В
