Last week, Maryland-based dentist, Edward T. Buford III pleaded guilty to conspiracy to commit mail fraud and healthcare fraud. The 70 year-old will be required to pay $1,267,630 in restitution as part of his guilty plea. As reported by the District of Maryland branch of the United States Department of Justice, Buford enacted a scheme to defraud Medicaid between January 2013 and May 2018.
According to the DoJ report, Buford and a number of co-conspirators filed fraudulent Medicaid claims for dental services to Medicaid beneficiaries. As a result, the group received fraudulently obtained funds from the insurer. As part of the scheme, Buford and company recruited Medicaid beneficiaries to offer kickbacks and bribes.
Buford was a licensed dentist in Washington, D.C.
He was also the owner and Chief Executive Officer of International Dental Associates, Inc. (IDA). Before 2015, Buford was enrolled as a Medicaid provider. However, he had payments to his provider number suspended in April 2015. Following the suspension, Buford and his business partner who managed IDA (referred to as “Co-conspirator 1”) continued to submit claims to Medicaid through IDA’s provider number.
“In April 2016, Buford and Co-conspirator 1 re-enrolled IDA as a provider in Medicaid,” explains the DoJ report, “Within IDA’s application, Buford and Co-conspirator 1 failed to disclose Buford’s suspension from Medicaid. Buford and his co-conspirators caused the submission of Medicaid claims by Buford and IDA for a variety of dental services, including dentures.”
Buford and Co-conspirator 1 offered and paid kickbacks.
They were provided to another participant in the scheme, referred to as “Co-conspirator 2”. Kickbacks were also given to other patient recruiters in exchange for referring Medicaid beneficiaries to IDA for dental services. Medicaid, of course, would not have paid for any claims if it had known they were procured through the encouragement of kickbacks.
The DoJ points out that Medicaid paid substantially more for dentures than for many other dental services. As a result, Buford and Co-conspirator 1 paid Co-conspirator 2 larger cash kickbacks for recruiting beneficiaries that agreed to be fitted for dentures. The amounts were approximately $50 per beneficiary. Beneficiaries who only agreed to receive dental cleanings received less in kickbacks.
Co-conspirator 2 offered Medicaid beneficiaries cash bribes.
As directed by Buford and Co-conspirator 1, Co-conspirator 2 induced patients to visit accept dental services from IDA. They were encouraged to be fitted for dentures and not just receive cleanings in exchange for higher kickback amounts. Denture fittings required multiple visits. Meanwhile, Buford and his co-conspirators only paid the beneficiaries for their initial visits.
After those first visits, Medicaid was billed for the dentures. Many beneficiaries never returned to IDA after receiving their cash bribes. As a result, Buford and his co-conspirators stored hundreds of undelivered dentures on IDA’s premises. Medicaid had paid for most of them. Buford faces a maximum sentence of 20 years in federal prison. He may also require three years of supervised release for conspiracy to commit mail fraud and healthcare fraud.
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