December 11, 1998 - The state will receive nearly $400,000 in restitution and overpayments from two Tacoma dentists who were sentenced yesterday in Pierce County Superior Court for submitting false bills to the state's Medicaid program.
Dr. Randall Nozawa and Dr. Kuzi Hsue each pleaded guilty to one count of attempted Medicaid false statement which is a gross misdemeanor. Their corporation, Washington Dental Health Center, pleaded guilty to one count of Medicaid false statement, which is a Class C felony. In addition to returning $397,255 to the state, the two defendants will each serve 90 days in jail.
“These two individuals circumvented Medicaid rules and guidelines in order to receive funds from the state of Washington which they were not entitled to,” said Assistant Attorney General R. Timothy Crandell. “We hope this case serves as a reminder to other health professionals that Medicaid fraud doesn't pay in the long run.”
The Attorney General's Office, Medicaid Fraud Control Unit (MFCU), began an investigation of the defendant's billing practices in May of 1995, following a referral from the Medical Audit Division of the Department of Social and Health Services. The MFCU seized, pursuant to a search warrant, approximately 1,400 patient files at their office, along with financial and billing data.
Following a lengthy analysis of the seized materials, the MFCU determined that Doctors Hsue and Nozawa had engaged in the following fraudulent billing practices:
- Billing for a full periodontal cleaning when less had been performed;
- Billing for surgical extraction of teeth when only a simple extraction had been performed;
- Billing for emergency examinations of patients when such examinations had been included in the initial payment for the procedure as part of routine post-operative care; and
- Billing for multiple surgical procedures all performed on a single day as if the procedures had been performed on separate days in order to maximize payment for those procedures.
The entire amount of the restitution and overpayment has been collected by the MFCU and will be returned to the Medicaid program.
The case was handled by Crandell and Senior Counsel David W. Waterbury.