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Dentist Pleads Guilty to Medicaid Fraud Scheme
SPRINGFIELD, Mo. — James R. Dye, 66, of Independence, waived his right to a grand jury and pleaded guilty in federal court to his role in a conspiracy to collect more than $167,000 in fraudulent Medicaid payments for child patients of the clinics.
Dye pleaded guilty to health care fraud in the United States District Court for the Western District of Missouri. The crime was committed between October 6, 2010, and August 19, 2015.
According to the plea agreement, Dye and his co-conspirators purchased orthodontic appliances, known as Ortho-Tain, for approximately $50 each. They billed each appliance to Medicaid as a speech aid prosthesis for approximately $695, the maximum allowed.
Over the nearly five-year period, Dye and his co-conspirators submitted 241 claims, for which they received reimbursement of $675 to $695 per claim, for a total of $167,090. The vast majority of the orthodontic appliances that Dye and co-conspirators billed as speech aid prostheses were Ortho-Tain orthodontic appliances.
Under federal statutes, Dye is subject to a sentence of up to 10 years in federal prison without parole. He must forfeit $167,090, which was derived from the proceeds of the health care fraud scheme, to the government. A sentencing hearing will be scheduled after the completion of a presentence investigation by the United States Probation Office.
Dye’s co-conspirators operated clinics under the name All About Smiles and contracted with Dye to work at the All About Smiles dental clinics in Springfield and Mountain Grove. All About Smiles, which has now closed all of its clinics, also paid for the services of three other dentists.
The Ortho-Tain orthodontic appliance is not a speech aid prosthesis, according to today’s plea agreement, and therefore should have been pre-certified by Medicaid and billed using a different orthodontic code.
Key Facts
- State: Missouri
- Category: White Collar Crime
- Source: DOJ Press Release â†â€â€
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