JEFFERSON CITY, MO (KFVS) - Attorney General Chris Koster announces that an Independence dentist who formerly practiced at clinics in southern Missouri pleaded guilty Thursday in federal court to his role in a nearly five-year conspiracy to collect $167,090 in fraudulent Medicaid payments.
The Attorney General's Office assisted the U.S. Attorney's Office, U.S. Department of Health and Human Services, and the U.S. Internal Revenue Service in the investigation.
James R. Dye, 66, pleaded guilty to healthcare fraud.
In his plea, Dye admitted to conspiring with two others who operated clinics under the name All About Smiles and contracted with Dye to work at their clinics in Springfield and Mountain Grove.
Dye admitted in his plea that he and his co-conspirators provided orthodontic devices including Ortho-Tain—designed to straighten teeth without braces—purchasing the devices for approximately $50 each.
Dye and his co-conspirators then billed each device to Medicaid as a speech aid prosthesis—designed to replace a missing part of a patient's palate or hole in the roof of the mouth— for approximately $695, the maximum amount allowed for a speech aid prosthesis.
From October 2010 to August 2015, Dye and his co-conspirators submitted 241 claims, receiving reimbursement of $675 to $695 per claim, for a total of $167,090.
Dye admitted that he and his co-conspirators knew Medicaid did not cover orthodontic services unless a Medicaid-employed dentist or orthodontist pre-approved the request upon review.
In contrast, Medicaid did not require providers to obtain prior authorization for speech aid prostheses provided to eligible beneficiaries.
In order to bypass the pre-certification for orthodontics, Dye and his co-conspirators billed Ortho-Tain as a speech aid prosthesis instead.
As a result of his guilty plea, Dye must forfeit to the government the $167,090 derived from the fraudulent claims.
Under federal law, he is subject to a sentence of up to 10 years in federal prison without parole, but his ultimate sentence will be determined by a federal judge.
His sentencing hearing will be scheduled after the completion of a pre-sentence investigation by the U.S. Probation Office.