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BOARD OF DENTISTRY vs. ROBERT J. SWAIN, 88-002961 (1988)

Court: Division of Administrative Hearings, Florida Number: 88-002961 Visitors: 12
Judges: DONALD D. CONN
Agency: Department of Health
Latest Update: Feb. 24, 1989
Summary: Respondent allowed fraudulent claims to be filed on a repeated basis with the medicaid program and also failing to act in legal compliance with medicaid.
88-2961.PDF

STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS


DEPARTMENT OF PROFESSIONAL ) REGULATION, BOARD OF DENTISTRY, )

)

Petitioner, )

)

vs. ) CASE NO. 88-2961

)

ROBERT J. SWAIN, D.D.S., )

)

Respondent. )

)


RECOMMENDED ORDER


The final hearing in this case was held on January 12, 1989, in St. Petersburg, Florida, before Donald D. Conn, Hearing Officer, Division of Administrative Hearings. The parties were represented as follows:


For Petitioner: Bruce D. Lamb, Esquire

730 South Sterling Street, #313

Tampa, Florida 33609-4582


For Respondent: John A. Powell, Esquire

Florida Federal Building

One Fourth Street, North, Suite 800 St. Petersburg, Florida 33701


The issue in this case is whether the Department of Professional Regulation, Board of Dentistry (Petitioner) should take license disciplinary action against Robert J. Swain, D.D.S, (Respondent) based upon matters alleged in an Amended Administrative Complaint filed herein. At the hearing, the Petitioner called ten witnesses and introduced forty-two exhibits. The Respondent testified on his own behalf, called three additional witnesses, and introduced three exhibits. The transcript of the final hearing was filed on February 9, 1989, and the parties were given ten days thereafter to file their proposed recommended orders, including proposed findings of fact. The Appendix to this Recommended Order contains a ruling on each timely filed proposed finding of fact.


FINDINGS OF FACT


  1. At all times material hereto, Respondent was licensed to practice dentistry in the State of Florida, having been issued license number DN-0000975. Respondent has been licensed to practice dentistry in this State since 1944, and there is no evidence in the record to indicate that he has previously been the subject of a complaint, investigation or license disciplinary action.


  2. Respondent was a participant in the Medicaid program, at all times material hereto. He executed a provider agreement with the Department of Health and Rehabilitative Services, under the terms of which Medicaid paid a total of

    $300 for a set of upper and lower dentures, and he was allowed to bill the

    patient for a 5% co-payment in addition to the amount paid by Medicaid. Participants in the program specifically agreed to accept the Medicaid-payment in lieu of their usual and customary charges, and not to bill or accept payments from patients, with the sole exception of the 5% co-payment for dentures.

    Billings to Medicaid could only be made after services were rendered. The Medicaid program reimbursed providers $8.00 for a single surface amalgam restoration, $16.00 for two surfaces, and $24.00 for three of more surfaces.

    The maximum allowable fee under the Medicaid program for a complete upper set of dentures was $150.00, and for a complete lower set, $150.00. Alveolectomies were reimbursed at $35.00 per quadrant.


  3. Between November 4, 1983 and December 15, 1983, Respondent rendered dental services to Geraldine Jones, for which he subsequently billed, and was paid by, Medicaid. The billings were for extracting fifteen teeth, performing three alveolectomies, and fitting the patient with complete upper and lower dentures. Respondent did not perform any of these services for Jones. Therefore, the $423 paid to him by Medicaid was an overpayment, and a payment for services not performed.


  4. Respondent billed and was subsequently paid by Medicaid for dental services rendered to Velma Mondy between May 11, 1983 and June 16, 1983. The billings were for restoration of a total of eighteen tooth surfaces. On or about June, 1985, an examination of Mondy's teeth by Dr. Charles Kekich, dental consultant with the Department of Health and Rehabilitative Services, who was accepted as an expert in dentistry, revealed that she had a total of only six surfaces restored. Therefore, Respondent billed and received an overpayment from Medicaid in the amount of $96.00 for services not rendered to this patient.


  5. Dental services which were allegedly rendered to Bridget Bryant by Respondent between September 12 and 26, 1983, were billed to Medicaid, and Respondent received payment for restoring twelve teeth, with a total of thirty surfaces. On or about June, 1985, an examination of Bryant by Dr. Kekich revealed that no more than fifteen restorations had been performed, resulting in an overpayment from Medicaid to Respondent of at least $120.00.


  6. Respondent billed and was subsequently paid by Medicaid for services rendered to Joyce Johnson between December 22, 1983 and January 1, 1984. These billings were for extracting three teeth and restoring ten, with a total of twenty surfaces. During June, 1985, Dr. Kekich examined Johnson and found that none of the work billed by Respondent had been performed. Therefore, an overpayment of $184.00 was made by Medicaid for services billed, but not rendered by the Respondent.


  7. Between January 25, 1984 and March 21, 1984, Respondent performed certain dental work on Ernest Macon, for which he billed and was paid by Medicaid for extracting two teeth and restoring nine teeth, with a total of twenty-three surfaces. Dr. Kekich's examination of Macon during June, 1985, revealed that only one tooth had been extracted and no more than four surfaces had been restored. Therefore, Respondent over billed and received payment from Medicaid for services not rendered to Macon in the amount of $159.00


  8. Respondent billed and was subsequently paid by Medicaid for dental services rendered to Derrick Ealy between March 15 and 27, 1984. These billings were for restoring four teeth, with a total of eleven surfaces. An examination of Derrick Ealy by Dr. Kekich in June, 1985, revealed that only two surfaces had been restored, resulting in an overpayment by Medicaid of $72.00 for services billed, but not rendered.

  9. An examination of Kimberly Ealy in June, 1985, revealed that none of the dental services for which Respondent had billed and been paid by Medicaid had, in fact, been performed. Respondent had billed Medicaid for extracting one tooth and restoring a total of thirteen surfaces on five teeth between March 13 and 22, 1984. Therefore, an overpayment of $114 was made by Medicaid for services billed, but not rendered to Kimberly Ealy.


  10. Respondent performed dental services for Corey Oliver between March 27, 1984 and May 6, 1984, and in connection therewith, he billed Medicaid for extracting one tooth and restoring seven teeth with a total of seventeen surfaces. An examination of Oliver by Dr. Kekich in June, 1985, revealed that roots of the tooth supposedly extracted by Respondent remained, and that eleven of the surfaces for which bills had been submitted had not been restored. Therefore, an overpayment of at least $95.00 was made by Medicaid for services billed, but not rendered to this patient.


  11. From April 16, 1984 to August 7, 1984, Respondent extracted twenty- seven teeth from Lillian Corouthers, and fitted her for a full set of dentures. He billed Medicaid for a total of $1,215 for these services, and received payment from Medicaid of $620.35. In addition thereto, he billed and received from this patient a total of $269. This co-payment exceeds the allowable 5% co- payment under the Medicaid program by $236.35. There is no evidence that Respondent ever refunded any portion of this overpayment to Corouthers.


  12. Although Respondent billed and was paid by Medicaid for services performed on Shawn Smith between July 11 and 24, 1984, which allegedly consisted of restoring eight teeth with a total of twenty-one surfaces, an examination of this patient by Dr. Kekich in May, 1985, revealed that none of this work had been performed. Therefore, an overpayment of $168 was made by Medicaid for services not rendered by Respondent.


  13. Respondent billed and was subsequently paid by Medicaid for dental services rendered to Allan Smith between July 6 and 23, 1984. The billings were for extracting two teeth and restoring a total of seventeen surfaces. Dr. Kekich's examination in May, 1985, revealed that only one extraction had been performed, and no restorations. As a result, an overpayment of $146 was made by Medicaid for services not rendered to Allan Smith.


  14. Respondent pulled one tooth and provided a complete set of dentures to Mose Tobias in July, 1984. For these services Respondent billed Medicaid for a total of $490, and received payment from Medicaid in the amount of $321.10. He also billed and received payment from this patient in the amount of $119, which exceeds the co-payment allowable under the Medicaid program by $112.11.


  15. Between July 6 and August 14, 1984, Respondent performed dental services for Angela Pleas, and in connection therewith, he billed and was subsequently paid by Medicaid for two extractions and sixteen surface restorations. During a June, 1985, examination of Pleas, it was revealed that no more than one extraction and nine restorations had been performed, resulting in an overpayment by Medicaid of $82.00 for services billed but not rendered to Pleas by the Respondent.


  16. Callie Wilson was treated by the Respondent between August 2 and 23, 1984, and in connection therewith, he billed Medicaid a total of $470.00 for an examination, x-rays, and a complete set of dentures. Respondent received payment from Medicaid in the amount of $162.45 for these services. In addition

    thereto, Respondent billed and received from Wilson an amount that exceeds the allowable 5% co-payment under the Medicaid program. The exact amount of this overpayment, however, cannot be determined, but it appears to have been an overpayment of between $45.00 and $95.00.


  17. Respondent billed and was subsequently paid by Medicaid for extracting one tooth and restoring twenty-two surfaces for Maruise Woods between September

    4 and 25, 1984. An examination of Woods by Dr. Kekich in May, 1985, revealed that no surface restorations had been performed. Therefore, an overpayment of

    $172 was made by Medicaid for services not rendered.


  18. Between September 21 and 27, 1984, Respondent claims to have performed dental services for Sharon Woods, for which he then billed and subsequently received payment from Medicaid for the restoration of four teeth, with a total of twelve surfaces. In May, 1985, Dr. Kekich examined Sharon Woods, and found that none of this work had been performed. Therefore, Respondent overbilled Medicaid $96 for services not rendered to this patient.


  19. Respondent billed and was subsequently paid by Medicaid for dental services rendered to John Aberdeen between September 27 and November 21, 1984. These billings were for extracting fifteen teeth, and providing a complete set of dentures. A June, 1985 examination of this patient by Dr. Kekich revealed that only one tooth had been extracted. Respondent received an overpayment from Medicaid in the amount of $389.85 for services not rendered to Aberdeen.


  20. Bills were submitted to Medicaid and payment received for services Respondent claims to have performed on Mercedia Lanier between October 1 and 19, 1984. These billings were for restoring seven teeth, with a total of eighteen surfaces. Dr. Kekich's examination of Lanier in May, 1985, revealed that none of the work billed by Respondent had been performed. Therefore, an overpayment of $144.00 was made by Medicaid for services not rendered to Lanier by Respondent.


  21. Respondent billed and was subsequently paid by Medicaid for dental services rendered to Patricia Hall between November 20 and December 7, 1984. These billings were for seven extractions, and the restoration of five teeth with twelve surfaces. In June, 1985, Dr. Kekich examined Hall and found that no more than four extractions, and five surface restorations had been done. Medicaid made an overpayment of $83.00 in connection with services billed, but not rendered to Hall.


  22. Claims were submitted to Medicaid by Respondent in connection with services allegedly performed on Eugenie Perry between January 17 and February 11, 1985. These billing were for the restoration of twenty-two surfaces, but Dr. Kekich found in May, 1985, that none of these restorations had been performed. As a result, Medicaid made an overpayment to Respondent of $176.00 for services not rendered.


  23. Tessie McRae was a patient of Respondent's in 1985, and claims were filed with Medicaid by Respondent for services between February 5 and March 28, 1985, consisting of ten extractions, four alveolectomies, and a complete set of dentures. When Albert Ravenna, special agent for Medicaid fraud with the Auditor General's Office interviewed McRae in June, 1985, she still had her own teeth and did not have dentures. Respondent did provide her with dentures subsequent to payment for these services by Medicaid. However, an overpayment of $401.55 was made by Medicaid since the services for which billings were

    submitted by the Respondent had not been performed prior to the filing of these claims.


  24. Respondent billed Medicaid for a total of $600 in connection with services he provided to Cora Griffin between February 3 and 11, 1985. Specifically, these bills were for an exam, x-rays and a complete set of dentures. Medicaid paid Respondent $311.60 for these services, and in addition thereto, he billed and collected from Griffin a total of $180. This amount paid by the patient exceeds the allowable co-payment under the Medicaid program.


  25. Respondent billed and subsequently received payment from Medicaid for services rendered to Kenneth Gainer between January 25 and March 22, 1985. The billings were for restoring ten teeth with a total of twenty-six surfaces. An examination of Gainer by Dr. Kekich in June, 1985, revealed that none of this work had been performed. Therefore, an overpayment of $208.00 was made by Medicaid for services not rendered.


  26. Billings were submitted to Medicaid by Respondent for services allegedly performed on Lawrence Harvey between March 14 and 19, 1985, and consisting of two extractions and eight surface restorations. Dr. Kekich found, upon examining the patient in June, 1985, that none of this work had been performed. Therefore, an overpayment of $84.00 was made by Medicaid for services not rendered.


  27. Respondent billed and was subsequently paid by Medicaid for services rendered to Brian Harvey between March 13 and 29, 1985. These billings were for restoring six teeth with a total of twelve surfaces. Respondent did not perform these services, and, therefore, the payment of $96.00 which he received for these services from Medicaid represents an overpayment for services not rendered.


  28. According to billings submitted by Respondent to Medicaid, he treated Felicia Harvey between March 21 and 29, 1985. These billings were for restoring four teeth, with a total of eight surfaces. An examination of this patient by Dr. Kekich in June, 1985, revealed that none of this work had been performed, and, therefore, an overpayment of $64.00 was made by Medicaid for services not rendered.


  29. On or about December 19, 1986, Respondent plead nolo contendere to seventeen counts of grand theft and five felony counts of public assistance fraud in violation of Sections 812.014 and 409.325, Florida Statutes, and was adjudicated guilty.


  30. The billings that Respondent signed and submitted to Medicaid, which are referenced in the above findings of fact, were prepared by his office receptionist, Ida Roundtree, who has been employed by him for twenty-two years, and who is responsible for the preparation and filing of all insurance claims based upon patient dental charts prepared by Respondent or his dental hygienist. Respondent testified that he does not consider it to be his responsibility to familiarize himself with the various requirements for insurance or Medicaid reimbursement. He relies entirely on Roundtree for this, and clearly does not consider the preparation of reimbursement or billing "paperwork" to be within the practice of dentistry.


  31. Roundtree admitted that she prepared Medicaid billings for work which was yet to be done in some cases. She would just fill in dates when the work supposedly had been done so that Medicaid would pay the claim. She testified

    she was unaware that Medicaid allowed a 5% co-payment only for dentures, and that no co-payment could be made for any other dental services under the program. Further, she admitted that she falsified billings by including services not performed so that Respondent would receive more money under the Medicaid program. The evidence does not establish that she was directed to falsify Medicaid billings by the Respondent or that she informed him of her practices, but it was established that he did not check, or in any way attempt to verify, the billings which she prepared before he signed them.


    CONCLUSIONS OF LAW


  32. The Division of Administrative Hearings has jurisdiction over the parties, and the subject matter in this cause. Section 120.57(1), Florida Statutes. Since this is a case in which the Petitioner is seeking to discipline the Respondent's license, and could thereby adversely affect the Respondent's ability to continue to practice dentistry in the State of Florida, Petitioner has the burden of establishing the basis for license disciplinary action by clear and convincing evidence. Ferris v. Turlington, 510 So.2d 292 (Fla. 1987).


  33. In pertinent part, Section 466.028(1), Florida Statutes, provides that the following acts constitute grounds for which disciplinary action may be taken:


    (c) Being convicted or found guilty, regardless of adjudication, of a crime in any jurisdiction which relates to the practice of dentistry or

    dental hygiene. Any plea of nolo contendere shall be considered a finding of guilt for purposes of this chapter.

    1. Failing to perform any statutory or legal obligation placed upon a licensee.

    2. Making or filing a report which the licensee knows to be false, intentionally or-negligently failing to file a report or record required by state or federal law, willfully impeding or obstructing such filing or inducing another person to do so . . .

    (l) Making deceptive, untrue, or fraudulent representations in the practice of dentistry.

    (n) Exercising influence on the patient or client in such a manner as to exploit the patient or client for the financial gain of the licensee . . .

    (u) Fraud, deceit, or misconduct in the practice of dentistry or dental hygiene.

    (bb) The violation, or repeated violation of this chapter, chapter 455, or any rule promulgated pursuant to chapter 455 or this chapter . . .


  34. The record in this case clearly and convincingly establishes that Respondent was adjudicated guilty of multiple counts of grand theft and public assistance fraud, and is subject to disciplinary action as a result thereof, based on Section 466.028(1)(c), as set forth above. In addition, he consistently and repeatedly failed to act in compliance with the legal requirements of the Medicaid program by being responsible for actions resulting in the filing of false claims for services which had not, in fact, been performed, and by charging and receiving from Medicaid patients co-payments

    which exceeded those allowed under the program. He, therefore, is also subject to disciplinary action under Section 466.028(1)(i) and (n), Florida Statutes.


  35. Respondent has evidenced a total disregard of the requirements of the Medicaid program by failing to verify and check claim forms which he signed prior to submitting them to Medicaid for payment. At hearing, he continued to insist that this is not his responsibility, and he should not be required to concern himself with the "paperwork" requirements of insurance or Medicaid reimbursement. However, as a result of his indifference, he allowed false, untrue and fraudulent claims to be filed on a repeated basis with the Medicaid program. Respondent's actions constitute the further violation of Section 466.028(1)(j), (1), (u), and (bb), Florida Statutes.


  36. In recommending an appropriate penalty for the violations established in this case, the disciplinary guidelines set forth in Rule 21G-13.005, Florida Administrative Code, have been considered, as well as the repeated nature of these violations, and the fact that this is the first time that Respondent has been subject to disciplinary action during his period of licensure since 1944.


RECOMMENDATION


Based upon the foregoing, it is recommended that the Petitioner enter a Final Order suspending Respondent's license for a period of THREE months, and imposing an administrative fine against Respondent in the amount of $6,000.00.


DONE AND ENTERED this 24th day of February, 1989 in Tallahassee, Florida.


DONALD D. CONN

Hearing Officer

Division of Administrative Hearings The DeSoto Building

1230 Apalachee Parkway

Tallahassee, Florida 32399-1550


Filed with the Clerk of the Division of Administrative Hearings this 24th day of February, 1989.


APPENDIX

(DOAH Case No. 88-2961)


Rulings on the Petitioner's Proposed Findings of Fact:


1. Adopted in Finding of Fact 1. 2-5. Rejected as unnecessary.

6-8 Adopted in Finding of Fact 2. 9-16. Rejected as unnecessary.

  1. Adopted in Findings of Fact 30 and 31.

  2. Rejected as unnecessary and as legal argument.

19-25. Adopted in Findings of Fact 30 and 31, but otherwise rejected as simply a summation of testimony.

26. Rejected as unnecessary.

27-30. Adopted in part in Finding of Fact 4. 31-34. Adopted in part in Finding of Fact 5.

35-39.

Adopted

in

part

in

Finding

of

Fact

3.

40-42.

Adopted

in

part

in

Finding

of

Fact

6.

43-45.

Adopted

in

part

in

Finding

of

Fact

7.

46-48.

Adopted

in

part

in

Finding

of

Fact

8.

49-51.

Adopted

in

part

in

Finding

of

Fact

9.

52-55.

Adopted

in

part

in

Finding

of

Fact

10.

56-62.

Adopted

in

part

in

Finding

of

Fact

11.

63-65.

Adopted

in

part

in

Finding

of

Fact

12.

66-68.

Adopted

in

part

in

Finding

of

Fact

13.

69-72.

Adopted

in

part

in

Finding

of

Fact

14.

73-76.

Adopted

in

part

in

Finding

of

Fact

15.

77-82.

Adopted

in

part

in

Finding

of

Fact

16.

83-86.

Adopted

in

part

in

Finding

of

Fact

17.

87-90.

Adopted

in

part

in

Finding

of

Fact

18.

91-93.

Adopted

in

part

in

Finding

of

Fact

19.

94-97.

Adopted

in

part

in

Finding

of

Fact

20

98-100.

Adopted

in

part

in

Finding

of

Fact

21.

101-103.

Adopted

in

part

in

Finding

of

Fact

22.

104-109.

Adopted

in

part

in

Finding

of

Fact

23.

110-116.

Adopted

in

part

in

Finding

of

Fact

24.

117-119.

Adopted

in

part

in

Finding

of

Fact

25.

120-122.

Adopted

in

part

in

Finding

of

Fact

26.

123-127.

Adopted

in

part

in

Finding

of

Fact

27.

128-130.

Adopted

in

part

in

Finding

of

Fact

28.

  1. Rejected as unnecessary and duplicative.

  2. Adopted in Finding of Fact 29.


(Note: In addition to adopting, in part, proposed findings of fact 27-130, as shown above, these proposed findings are otherwise rejected as unnecessary or as not based on competent substantial evidence.)


Rulings on the Respondent's Proposed Findings of Fact:


  1. Adopted in Finding of Fact 1.

  2. Rejected as irrelevant.

  3. Adopted in Finding of Fact 2.

  4. Rejected as irrelevant.

5-7. Adopted in Finding of Fact 30.

8. Rejected as irrelevant.

9-10. Adopted in Finding of Fact 30.

11-17. Adopted in Findings of Fact 30 and 31.

18-19. Rejected as not based on competent substantial evidence.

  1. Adopted in Finding of Fact 31.

  2. Rejected as not based on competent substantial evidence and otherwise as irrelevant.

22-23. Adopted in Finding of Fact 31.

24. Rejected as irrelevant.

25-28. Adopted in Finding of Fact 31.

29-30. Adopted in Finding of Fact 30 and 31.

31. Rejected as not based on competent substantial evidence and otherwise as irrelevant.

32-36. Rejected as irrelevant.

37. Adopted in Finding of Fact 29, but otherwise rejected as irrelevant.

38-47. Rejected as irrelevant.

48-49. Adopted in Finding of Fact 4, but otherwise rejected as irrelevant.

50-55. Rejected as irrelevant.

56-60. Adopted and Rejected in Finding of Fact 21, but otherwise rejected as irrelevant.

  1. Rejected as argument on the evidence, not a finding of fact.

  2. Rejected in Finding of Fact 3.

  3. Rejected in Finding of Fact 6.

  4. Rejected in Finding of Fact 9.

  5. Rejected in Finding of Fact 14.

  6. Rejected in Finding of Fact 16.


COPIES FURNISHED:


Bruce D. Lamb, Esquire

730 South Sterling Street, #313

Tampa, Florida 33609-4582


John A. Powell, Esquire Florida Federal Building One Fourth Street, North Suite 800

St. Petersburg, Florida 33701


William Buckhalt Executive Director Board of Dentistry

Department of Professional Regulation

130 North Monroe Street Tallahassee, Florida 32399-0750


=================================================================

AGENCY FINAL ORDER

=================================================================


STATE OF FLORIDA DEPARTMENT OF PROFESSIONAL REGULATION

BOARD OF DENTISTRY



DEPARTMENT OF PROFESSIONAL REGULATION,


Petitioner,

DOAH CASE NUMBER 88-2961

vs. CASE NUMBER 0079017


ROBERT J. SWAIN, D.D.S.,


Respondent.

/


FINAL ORDER


THIS MATTER was heard by the Board of Dentistry pursuant to Section 120.57(1), Florida Statutes, on April 29, 1989, in Key West, Florida, for consideration of the Hearing Officer's Recommended Order (a copy of which is attached as Exhibit A) in the case of Department of Professional Regulation v. Robert J. Swain, D.D.S., Case Number 88-2961. At the hearing, Petitioner was represented by Bruce D. Lamb, Esquire. Respondent was present and represented by John A. Powell, Jr., Esquire. At hearing, Respondent withdrew the Statement of Respondent which had been filed with his Proposed Findings of Fact, Objections and Recommendations. Accordingly, Petitioner's Motion to Strike was rendered moot. Respondent's Motion to Strike Petitioner's Motion to Increase Penalty was denied. Upon consideration of the Hearing Officer's Recommended Order, after review of the entire record and having been otherwise fully advised in its premises, the Board makes the following findings and conclusions.


FINDINGS OF FACT


  1. The Hearing Officer's Findings of Fact are approved and adore and are incorporated herein by reference.


  2. There is competent, substantial evidence to support the Boar findings.


    CONCLUSIONS OF LAW


  3. The Board has jurisdiction of the parties and subject matter of this cause pursuant to Section 120.57 and Chapter 466, Florida Statutes.


  4. The Hearing Officer's Conclusions of Law are approved and adopted and are incorporated herein by reference.


  5. There is competent, substantial evidence to support the Board's conclusions.


  6. The Board rejects the Hearing Officer's recommendation that Respondent be suspended for three months and pay a six thousand dollar fine. The Hearing Officer failed to consider the following evidence which justifies a more stringent penalty. Respondent failed to repay patients monies illegally received in excess of the five percent co-payment and has failed to make restitution. (Transcript pages 6-48, 50-55 and exhibits 18 and 39.) Respondent had been provided with information regarding his responsibilities as a provider of dental services to Medicaid patients. (Exhibits 33, HRS Manual, Medicaid Children's Dental Services.) Further, Dr. Swain was aware of the procedures in his office to bill medicaid for work not yet performed. (Transcript page 131.) The record further reflects damage to patients by virtue of work not performed which patients needed. The Board adopts paragraph two of Petitioner's Motion to increase Penalty in support of this statement.


Based upon the foregoing, it is ORDERED and ADJUDGED that Respondent violated Sections 466.028(1)(c), (i), (j), (1), (n), (y), and (bb), Florida Statutes. Respondent is hereby REPRIMANDED and shall pay an administrative fine of ten thousand dollars. The fine shall be paid during Respondent's probationary period. Respondent's license to practice dentistry is SUSPENDED for six months with the suspension beginning on the thirty first day following the effective date of this Order. However, the second three months of the

suspension shall be stayed upon Respondent having submitted proof of having made null restitution to all patients. Upon completion of Respondent's suspension, his license shall be placed on probation for five years during which time he will provide no treatment or services to patients receiving public assistance or medicaid. Respondent shall pay two thousand dollars no later than the end of each one year period of probation with the total payment of ten thousand dollars made by the end of his last probationary year.


This Order becomes effective upon being filed with the Board Clerk.


The parties are hereby notified that they may appeal this Order by filing one copy of a Notice of Appeal with the Clerk of the Department of Professional Regulation and by filing a filing fee and one copy of a Notice of Appeal with the District Court of Appeal within thirty days of the date this Order is filed.


DONE AND ORDERED this 16th day of June, 1989.


Richard J. Chicetti, D.M.D. Chairman

Board of Dentistry


CERTIFICATE OF SERVICE


I HEREBY CERTIFY that a true and correct copy of the foregoing Final Order has been forwarded by Certified United States Mail this 22nd day of June, 1989, to Dr. Robert J. Swain, 2100 9th Street South, St. Petersburg, Florida 33705 and John A. Powell, Esquire, One Fourth Street, North, Suite 806, St. Petersburg, Florida 33701, and hand delivered to Bruce D. Lamb, Esquire, 1940 North Monroe Street, Tallahassee, Florida 32399-0792.


William H. Buckhalt, C.P.M. Executive Director

Board of Dentistry

130 North Monroe Street Tallahassee, Florida 32399-0750 (904)488-6015


Docket for Case No: 88-002961
Issue Date Proceedings
Feb. 24, 1989 Recommended Order (hearing held , 2013). CASE CLOSED.

Orders for Case No: 88-002961
Issue Date Document Summary
Jun. 16, 1989 Agency Final Order
Feb. 24, 1989 Recommended Order Respondent allowed fraudulent claims to be filed on a repeated basis with the medicaid program and also failing to act in legal compliance with medicaid.
Source:  Florida - Division of Administrative Hearings

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