What Happens When a Dentist Is Accused of Medicare Fraud
When a dentist in Massachusetts is accused of submitting false claims to Medicare or Medicaid, the state dental board can suspend their license before any criminal case is resolved. This is called an emergency suspension or summary suspension, and it happens because the board views the conduct as an when ready threat to public safety or the integrity of the healthcare system.
The suspension is not a conviction. It is an administrative action taken by the Massachusetts Board of Registration in Dentistry, separate from any federal investigation or criminal charges. A dentist can face suspension even if they have not yet been charged with a crime, and even if they are eventually found not guilty in court.
Medicare fraud in dentistry typically means billing for services that were not performed, billing for more expensive procedures than what was actually done, submitting duplicate claims, or billing for procedures on patients who were not may be able to access for coverage. Medicaid fraud follows the same pattern but involves state insurance funds.
Key Takeaways
- The Massachusetts Board of Registration in Dentistry can suspend a dentist's license when ready if there is probable cause that Medicare or Medicaid fraud occurred, without waiting for a criminal trial.
- A suspension hearing must be held within 10 days, where the dentist can present evidence and challenge the board's findings before the suspension becomes permanent.
- The dentist has the right to legal representation at the hearing and can request a continuance if they need time to prepare a defense.
- A suspended license prevents all dental practice in Massachusetts, including treating patients, supervising hygienists, or operating a dental practice of any kind.
- The suspension remains in effect until the board votes to lift it, which may happen after a hearing, after criminal charges are dropped, or after a not-guilty verdict in court.
The Emergency Suspension Process in Massachusetts
When the Board of Registration in Dentistry receives a report of suspected Medicare or Medicaid fraud—usually from the federal Office of Inspector General, state Medicaid investigators, or a whistleblower—the board's executive director can issue an emergency suspension order without a hearing. This order takes effect when ready and notifies the dentist that their license is suspended as of that date.
The dentist must receive written notice of the suspension and the reason for it. The notice also informs them of their right to request a hearing within 10 days. If the dentist does not request a hearing, the suspension remains in place indefinitely until the board decides to lift it or until the underlying case is resolved.
If the dentist requests a hearing, it must be scheduled within 10 days of the request. At this hearing, the board presents evidence of the suspected fraud, and the dentist can present a defense, call witnesses, and cross-examine the board's witnesses. The hearing is conducted by a hearing officer or an administrative law judge, not by the full board.
What the Dentist Must Prove at a Suspension Hearing
At the hearing, the board must show that there is probable cause to believe the dentist committed fraud. Probable cause is a lower standard than "beyond a reasonable doubt"—it means the board must show enough evidence that a reasonable person would believe fraud likely occurred. The dentist does not have to prove innocence; they can challenge the board's evidence and present their own.
Common defenses include showing that services were actually performed as billed, that billing codes were correct, that the dentist had a reasonable interpretation of coverage rules, or that any errors were unintentional and have been corrected. If the dentist can show that the board's evidence is weak or that there is a legitimate explanation for the billing pattern, the hearing officer may recommend that the suspension be lifted.
The hearing officer then makes a recommendation to the full board, which votes on whether to uphold, modify, or reverse the suspension. The dentist receives a written decision explaining the board's findings and their right to appeal to the Superior Court.
How Long a Suspension Lasts
An emergency suspension can last weeks, months, or years depending on how the underlying case progresses. If criminal charges are filed, the suspension typically remains in place until the case is resolved—either by conviction, acquittal, or dismissal. If the dentist is acquitted or the charges are dropped, the board usually lifts the suspension, though it may conduct its own investigation before doing so.
If the board's own investigation concludes that fraud did occur, even if criminal charges were never filed or resulted in acquittal, the board can move to a formal disciplinary hearing to determine whether to revoke the license permanently, suspend it for a set period, or impose other penalties. This disciplinary process is separate from the emergency suspension and can take many months.
Some dentists request that the suspension be lifted while the criminal case is pending, arguing that the emergency suspension has already served its purpose of protecting the public. The board may agree if circumstances change—for example, if new evidence emerges that undermines the fraud allegation, or if the dentist demonstrates that they have corrected their billing practices and implemented oversight.
The Difference Between Suspension and Revocation
A suspension is temporary; it removes the dentist's right to practice for a defined period or until certain conditions are met. A revocation is permanent; it ends the dentist's license entirely and prevents them from ever practicing dentistry in Massachusetts again without going through the full licensure process from the beginning.
An emergency suspension is almost always temporary, even though it can last a long time. The board uses emergency suspension to protect the public while the fraud investigation is ongoing. If the board later determines that the dentist committed fraud and should never practice again, it holds a formal disciplinary hearing and votes on revocation as a separate action.
A dentist whose license is revoked can petition for reinstatement after a waiting period (usually at least five years), but reinstatement is difficult and requires showing that the dentist has been rehabilitated and poses no further risk.
What Happens to the Dentist's Practice During Suspension
Once the license is suspended, the dentist cannot see patients, perform any dental procedures, prescribe medications, or supervise dental hygienists or assistants. The dental office must close or be run by another licensed dentist. If the dentist owns the practice, they cannot work there in any capacity related to patient care.
The dentist's name is added to the Board of Registration's public list of suspended practitioners, which patients and other healthcare providers can search online. This public notice is required by law and cannot be removed while the suspension is in effect.
If the dentist has pending patient cases—root canals in progress, orthodontic treatment, or other ongoing care—those patients must be notified and referred to another dentist. The suspended dentist must transfer patient records to the new provider or to the patient upon request.
How to Challenge a Suspension or Seek Reinstatement
The dentist's first opportunity to challenge the suspension is the hearing within 10 days of the emergency suspension order. If the hearing officer or board upholds the suspension, the dentist can appeal to the Massachusetts Superior Court within 30 days. The court will review whether the board had probable cause and whether the suspension was issued according to proper procedures.
If the dentist wants to challenge the suspension while a criminal case is pending, they can file a motion asking the board to lift the suspension pending the outcome of the criminal case. This motion must argue that the emergency suspension is no longer necessary or that new evidence has emerged that undermines the fraud allegation.
Once the criminal case is resolved, the dentist should notify the board when ready and request that the suspension be lifted. If the charges were dropped or the dentist was acquitted, the board will usually lift the suspension within a few weeks, though it may require the dentist to submit to a new background check or compliance review first.
Frequently Asked Questions
Can a dentist practice while their license is suspended?
No. A suspended license prohibits all dental practice, including treating patients, performing procedures, prescribing medications, and supervising staff. Practicing while suspended is a separate crime and can result in additional criminal charges and permanent license revocation.
Does a suspension mean the dentist is guilty of fraud?
No. A suspension is based on probable cause, which is a lower standard than guilt. The dentist has not been convicted of anything. They may be found not guilty in criminal court, or charges may be dropped, and the suspension can still remain in effect until the board votes to lift it.
What if the dentist was billing incorrectly by mistake, not on purpose?
Intent matters in criminal fraud cases, but the board can suspend a license based on billing errors alone if they are systematic and result in overpayment. At the suspension hearing, the dentist can argue that errors were unintentional and have been corrected, which may persuade the board to lift the suspension or reduce the penalty.
How long does it usually take to get a suspended license back?
It depends on the case. If criminal charges are dropped quickly, the suspension may be lifted within weeks. If the case goes to trial, the suspension typically lasts until the verdict. If the board conducts its own disciplinary hearing, the process can take six months to a year or longer.
Can a suspended dentist work as a consultant or in a non-clinical role?
Not in Massachusetts. A suspended license prohibits any work that requires a dental license, including consulting, teaching, or supervising. The dentist can work in an unrelated field, but cannot hold any position in dentistry or dental practice.