MIAMI (CBSMiami) — A dentist in South Florida faces fraud charges for billing patients for work already covered under Medicaid.
Dr. Fadi Yousef Qablawi, 39, targeted elderly patients with Medicaid by telling them their procedure would have to be paid out-of-pocket, despite knowing that Medicaid would actually cover the work, according to the Medicaid Fraud Control Unit under the Office of Attorney General in Florida.
Dentures, for example, require only a 5 percent co-pay from the insured individual aged 21 and older, per the Florida Medicaid Dental Services Coverage and Limitations Handbook.
Investigators said Qablawi would instead charge the patient the full cost for the procedure, roughly between $300 and $600, and then bill Medicaid for a reimbursement, as well.
The investigation stemmed from a complaint in November 2013 after a woman was told she would need to pay $400 for a set of upper and lower dentures. She made the payment to Dr. Qablawi’s office and then on her follow-up visit, according to authorities, was told she would need to pay an additional $200 because the price was actually $300 for each set of dentures, totaling $600. The woman checked with Medicaid, who informed her that she only needed to pay the 5 percent co-pay and not the full amount. When she complained to Dr. Qablawi, she was told to take her business elsewhere.
Further investigation revealed 20 victims who stated they were charged a co-payment prior to the delivery of their dentures.
Findings indicated Qablawi billed Medicaid for $16,138 and was reimbursed $13,737. He also billed his patients another $10,260.
Qablawi was enrolled as a Medicaid provider in 2006 and operated out of two dental offices, “Mecca Dental” located at 27501 S. Dixie Hwy, Ste 300 in Homestead, and “Madina Dental” at 888 N.E. 126th Street, Ste 203 in North Miami.
Qablawi was charged with Medicaid Fraud, Organized Fraud and Trafficking Medicaid Property.