According to the search warrant affidavit filed in Floyd County Superior Court, MCG Management Inc., doing business as Children’s Dentistry of Rome, billed more than $13 million in Medicaid claims since 2008, and some victims and other dentists alleged that dental work provided by the doctors and hygienists was unnecessary.
Employees from the dentist office issued the following statement on Monday evening: “The dentists operating their practice at the MCG facility care about patients and provide quality care. Dental visits are not always pleasant, but we believe that the practitioners will be able to show they exercised sound judgment and compassion when treating young patients with significant dental problems.”
Following complaints of improper use of restraints and improper or unnecessary performance of dental work on children, agents with the Department of Health and Human Services Office of the Inspector General and Rome Police Department investigators executed a warrant on Thursday and searched the office for billing and medical records pertinent to the criminal investigation.
No arrests have been made in the case and Rome police Lt. Gary Clayton declined to comment on the number of reports the detectives division has received.
The affidavit listed more than 300 patients with Medicaid whose records are being thoroughly investigated.
The affidavit, written by detective Joe Costolnick, lists 11 reports of excessive dentistry work performed on 14 children that resulted in serious medical problems and trauma. Reports recounted that children left the office traumatized, scratched and bruised.
Some children were allegedly tied down on papoose boards for unnecessary dental work, and some children needed additional medical attention for improperly done dental work they received at Children’s Dentistry of Rome.
Costolnick, who is specially trained with regard investigating criminal violations relating to cruelty and abuse to children, is working with Special
Agent Connie Murray with the Department of Health and Human Services who investigates Health Care fraud.
Murray obtained a summary of the dental office’s Medicaid claims data from January 2008 to August 2012, the affidavit reported.
The Georgia Medicaid program provides health services to beneficiaries who qualify based on financial need or other circumstances.
In providers’ contracts, the provider agrees to abide by state and federal laws when submitting claims and the Medicaid program requires that providers not bill for services not performed or delivered, and not to submit false or inaccurate claims.
Providers must maintain records to fully disclose the extent of services provided to members for a minimum of five years and the records must also explain the medical necessity for the services provided.
Since 2008, the company billed Medicaid for a total of $13,407,134.34, which breaks down to $3,146,084.38 in 2008, $3,215,831.81 in 2009, $2,908,993.61 in 2010, $2,395,811.79 in 2011 and $1,740,412.75 as of August of this year.
Unnecessary dental work?
In the affidavit, some reports by parents of children who received dental work at Children’s Dentistry of Rome claimed that children went in to the office for routine checkups but left having had more dental work performed, as well as traumatized and in tears.
According to the affidavit:
On Aug. 15 of this year, a child was taken to the dental office for a cleaning and after X-rays were taken, an unknown employee told the child’s grandmother that he would need three crowns, two fillings and two extractions. They offered to perform the services right then.
The grandmother declined and another dentist saw the child in September for a second opinion. He determined the child only needed one filling for a small cavity in his baby tooth, according to the affidavit. Ultimately, the filling was not done since the child would lose the tooth soon.
In February, the same child’s brother was treated at Children’s Dentistry of Rome and received six crowns with pulpotomies, one crown and one tooth with three fillings. The child’s mother began to wonder if all that work had been necessary, given her experience with his brother, and obtained X-rays and records.
She took them to the same dentist that gave a second opinion on her other son and he determined the child had only needed three crowns, not seven. He also advised on two of the teeth that supposedly had pulpotomies, nerves were still present, indicating the procedures had not been performed.
Another child was treated at Children’s Dentistry of Rome and an employee told the child’s mother she needed four steel crowns. She was taken for a second opinion and after an exam, the child’s mother was told the crowns weren’t needed and that there was no evidence of tooth decay.
The mother was interviewed by police in August and told investigators she had taken her daughter to get her teeth cleaned, but a front office staff worker told her that her daughter had four cavities and would need three crowns and two filings and that the cavities were large. The nurse told her that her daughter’s cavities were very small but the crowns were necessary because of where they were located. Because of the conflicting information, she got a second opinion and was told there was no evidence of tooth decay.
Costolnick wrote in the affidavit that he had probable cause to believe the owners of MCG Management, Inc., Christy McStotts, Denise Carver and Robin Guice along with Dr. Maheshvar Patel had violated O.C.G.A. Title 16, Section 16-5-70, Cruelty to Children.
“Futhermore, I have probable cause to believe that they have also violated O.C.G.A. 49-4-146.1 when they accepted payment to which they were not entitled to.”
A form is available for people who wish to file a complaint with the Rome Police Department.