Lightning Strikes! How Unintended Billing Errors Helped Send Me To Prison. by Roy S. Shelburne, DDS
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n October 24th, 2003, while at the ADA convention in San Francisco, I received news that the FBI executed a search and seizure warrant on me and my practice. They battered down the back door to my office, and a team of agents carried out every patient and business record I had. I was shocked and terrified. Then things quickly moved from bad to worse. There has never been much that scares me, but one thing that scares me now is the thought of going back to prison. “Things like this don’t happen to people like me,” I told myself. After graduating from dental school in May 1981, I opened a private solo practice in my grandfather’s hardware store building in the small southwestern Virginia town where I grew up (population 1,800). There was one traffic light, and it was just down the block from my office. My grandfather was superintendent of schools, my father taught in the local high school, and my mother was a nurse in the local hospital. Growing up on a farm, I learned from an early age two important lessons: 1) how to work hard, and 2) that I wanted to do something else. Farming was too hard and paid too little. I chose dentistry and was excited to come back home to “hang my shingle.” I saw my first patient July 27, 1981. I don’t know whether my success was a result of the great people in my hometown or from being part of a family with a long-standing community presence and good reputation, but the practice grew every year. We went from two employees (my wife at the front desk plus
“ ‘Things like this don’t happen to people like me,’ I told myself” 4
Dental Explorer | Four th Quar ter 2012
one assistant) to having two business staff people, three chairside assistants, and two hygienists. We worked hard to provide excellent dental care as gently as we could. My practice was located in one of the poorest counties in Virginia. Over 85% of the children in the school system qualified for free or reduced lunches, and most had Medicaid. Oral hygiene was often neglected. Children with rampant decay were the rule not the exception. We were needed and felt appreciated. Eventually, practice management consultants helped us implement business and clinical systems that increased both our productivity and the quality of our services. I was living the dream. Everything I had worked and planned for had come to fruition. Then lightning struck, and it all came crashing in around me. The criminal investigation was not initiated by Medicaid. In fact, Medicaid conducted two audits during the course of the three-year probe and determined that they did not have a problem with me, the care provided, or the billing of the work done. But once a complaint was made, Medicaid had to investigate. My Medicaid billing records were sent to a dental consultant for review (a non-practicing dentist in Kentucky). She determined that there was possible cause for further review and offered her services for the expanding investigation. It didn’t matter that I had never had a complaint to Medicaid or the Virginia Board of Dentistry or that according to Medicaid, “I wasn’t even on their radar.” The investigation expanded. My patients were examined and then my records seized. It was like a snowball had been set into motion and was rolling downhill, gathering speed and size. It was just a matter of time before criminal prosecutors gathered enough information to construct a case that they felt would convince a jury of my guilt. My fate was sealed. The search and seizure occurred the Friday before the yearly town festival, and it was in the newspaper the following day. The news spread like wildfire, and I thought I was ruined regardless of the outcome. Amazingly, I was wrong. In spite of the investigation, patients remained loyal, and the practice continued to grow and flourish, though it was difficult and slow-going. We had to provide the FBI with our daily schedule so