According to the indictment that was returned by a federal grand jury today, approximately 90 to 95 percent of Goodwin’s orthodontics’ patients were Medicaid beneficiaries. The Texas Medicaid program provides orthodontic services for Medicaid beneficiaries who fit the following criteria: 1) children who are 12 years old and older with severe handicapping malocclusions; 2) children who are up to 20 years old with cleft palate; or 3) other special medically necessary circumstances, including crossbite therapy and head injury involving severe traumatic deviation.
The indictment alleges that from January 2008 through March 2011, Goodwin devised a scheme to defraud the Texas Medicaid program by billing the program more than $2 million for services he claimed he provided, when in fact, as he well knew, some of the services were not medically necessary, or dental assistants provided those services when no dentist or orthodontist was present to supervise, and even when present, did not directly supervise or provide any services. As a result of this scheme, Medicaid paid more than $1.5 million for claims filed by Goodwin.
As part of his scheme, according to the indictment, Goodwin practiced orthodontic dentistry approximately two weeks each month at Goodwin Orthodontics in Amarillo and approximately two weeks each month at his Indiana office. In order to maximize the number of Medicaid patients seen, employees regularly scheduled more than 100 patients per day and intentionally scheduled large numbers of Medicaid patients for days when Goodwin was scheduled to be out of town. To accommodate the large volume of patients, Goodwin directed dental assistants to perform impermissible acts, including comprehensive examinations, diagnoses and treatment planning for Medicaid patients when he knew that only licensed dentists were permitted to perform those acts. In many cases, dental assistants installed Medicaid patients’ braces before Goodwin had ever examined the patients, yet his instructed employees and billing staff to falsely state on Medicaid claims that he was the performing provider for all services impermissibly delegated to and performed by dental assistants.
He also allegedly submitted, or had his employees submit, forms to Medicaid that falsely and fraudulently represented that beneficiaries had been examined by Goodwin and had a medical necessity for braces, when in fact the treatment was for cosmetic purposes only and did not qualify for Medicaid reimbursement. He instructed his billing staff to falsely and fraudulently represent on Medicaid claims that there was medical necessity on all claims for all services billed for Medicaid beneficiaries whose treatment was merely for cosmetic purposes and was without medical necessity.
The indictment also alleges that Goodwin hired substitute general dentists, who were not enrolled Medicaid orthodontic providers, to create the appearance of direct supervision of dental assistants when he was away from the office. These substitutes did not provide services to Medicaid beneficiaries, did not directly supervise the dental assistants who provided the services, and were not always present in the office for orthodontic procedures.
Goodwin did not furnish services to Medicaid beneficiaries to the same extent as other patients. According to the indictment, he personally examined patients who paid cash for their orthodontic treatment at virtually every scheduled appointment, while he only examined Medicaid patients every third appointment, or less.
An indictment is an accusation by a federal grand jury, and a defendant is entitled to the presumption of innocence unless proven guilty. If convicted, however, each health care fraud count carries a maximum statutory sentence of 10 years in prison and a $250,000 fine. Restitution could also be ordered.
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