WILMINGTON, N.C. (WECT) – The North Carolina State Board of Dental Examiners is investigating the unusual billing trends of Dr. Michael Hasson, the same Wilmington oral surgeon already facing dozens of criminal charges for allegedly sexually assaulting his female patients while they were sedated.
Records provided by the NC Department of Health and Human Services show that Hasson received nearly $5 million in Medicaid reimbursements between 2014 and 2019. That’s more than almost any other oral surgeon in the state, and about five times more than average compared with other oral surgeons providing care to Medicaid patients over the same time period.*
Significantly, Hasson’s billing data indicates he was frequently charging Medicaid to keep patients under sedation for extended periods of time. That is generally only necessary for more complicated dental procedures, and likely nets a more generous reimbursement from Medicaid. Compared with another New Hanover County oral surgeon who sees Medicaid patients and performs extractions, Hasson’s lengthy sedation habits were high.
Determining whether Hasson was keeping patients under lengthy sedation for reasons that were not medically necessary, or if he was upcoding to get more money from Medicaid after a standard length sedation, is a very involved process. Dental Board officials were clear that having above-average Medicaid billing reimbursements is not in and of itself evidence of fraud.
“Fraud cases require extensive investigation because, of course, you have to prove there was intent to defraud,” NC Dental Board CEO Bobby White explained to WECT. “Of course, the dentist will say, ‘Oh, it was an accident. I missed—my staff coded that incorrectly, the billing was done incorrectly; let me fix that.”
Dental board investigators have to go through hundreds of patient records to try to establish a pattern of improper billing. Then, they have to convince patients to let dental investigators literally look inside their mouths to prove the services Medicaid reimbursed the dentist for were not actually performed. While White was unable to comment on the details of the Hasson investigation, he did provide examples of cases where Medicaid fraud has been substantiated against other dentists.
The 50-page Final Agency Decision for Carlos Privette, a Cary dentist the board took action against in 2018, helps demonstrate how investigators are able to prove fraud. Investigators submitted more than 100 patient files into evidence in Prevatte’s case. They showed how Prevatte billed Medicaid for surgical extraction of patients’ teeth when X-rays of the patients showed the teeth in question were baby teeth not attached to the bone and close to falling out on their own.
Other times, Privette took unwarranted X-rays, exposing pediatric patients to unnecessary radiation. He took dental X-rays four times in 18 months on one two-year-old patient, and five times in two years on another preschooler. Dental investigators found Privette also billed Medicaid for X-rays that were never taken, and dental procedures that were never performed. When services were performed, Privette often billed Medicaid for more complicated (and more lucrative) dental procedures.
The Dental Board ultimately revoked Prevette’s license, and he reached a settlement with the NC Attorney General’s office to pay the state nearly half a million dollars in restitution.
“[Fraud] cases are very time consuming because we generally have to have the patient evaluated. And sometimes the patients don’t know anything is going on, and they’re a little skittish. ‘Hey, here’s a state agency calling me to go in and have my mouth examined by a third party dentist. What’s going on here?’” White said of the challenges of these cases, which can take two years to investigate.
In addition to protecting patients from harm inflicted by incompetent dental providers, the NC Board of Dental Examiners seeks to protect the public’s confidence in the practice of dentistry, and protect taxpayers from providers who are seeking to enrich themselves by fraudulently billing Medicaid.
“I’m a taxpayer too, and I don’t want my tax dollars to go to someone who is stealing from the government,” White said. “That’s kind of basically it. It is theft. Call it fraud or whatever you want. You’ve got to be competent, thoroughly trained, and you have to be of good moral character. And, if you can’t survive the test of good moral character—if you are a thief, if you are stealing, that is evidence of unfit moral character.”
The Department of Health and Human Services conducts its own investigations into concerns about Medicaid fraud, and a DHHS official indicated to WECT that concerns about Hasson’s billing trends have been forwarded to the appropriate people for further review.
We attempted to reach Hasson for comment on concerns about his billing practices, but he had not returned our call by the time of this publication. In addition to the investigation into his Medicaid reimbursements, Hasson faces criminal charges involving 23 female patients ranging in age from 12 to 69 years old, who claim he sexually assaulted them while they were in his care. His dental license has been suspended while the case proceeds to trial.
In January, a judge awarded a $4 million default judgment to one of Hasson’s accusers who had sued him in civil court after she says he sexually assaulted her after putting her under sedation to take her wisdom teeth out.
*Editors note: Medicaid providers who received less than $10,000 in reimbursement were not included on the list provided by the state.
Copyright 2021 WECT. All rights reserved.