Four Arrested in Dental Fraud Probe

A widespread probe of Medi-Cal abuses stretched to the dentistry program Wednesday with the arrest in Los Angeles of three women and one man accused of operating a $1-million fraud ring that used San Joaquin Valley farm workers and other low-income people to make phony claims.

Shortly after the arrests, law enforcement officials raided the Pico Cosmetic Dental clinic in South Gate, which they said is one of the facilities suspected of being involved in the operation.

Law enforcement officers said the arrests and the raid were the first in an ongoing investigation of dental clinics throughout the Los Angeles area. The clinics used recruiters called “cappers” to comb farm worker and other low-income communities for poor laborers who qualified for Medi-Cal, the state’s medical poverty program, according to the officers.

“[This] marks the beginning of a concerted effort by the attorney general and the Los Angeles County Health Authority to control the rapid proliferation of dentists fraudulently billing the Medi-Cal program for unnecessary and oftentimes unperformed dental work,” said Collin Wong, director of the state attorney general’s Bureau of Medi-Cal Fraud and Elder Abuse.

The arrests show that the state believes that massive, organized fraud has spread beyond the few sectors of Medi-Cal that have been the focus of an FBI investigation, and into unrelated areas such as Denti-Cal, which provides dental services to the poor.

The newest fraud revelations follow earlier discoveries by the FBI of false billings to Medi-Cal by medical supply businesses, laboratories and pharmacies. The FBI estimates that fraud in the Medi-Cal program exceeds $1 billion.

In the latest scam, law enforcement officials said, farm workers were offered a fee to travel to Los Angeles and visit certain clinics for dental services. Those who accepted were loaded into vans and transported in groups.

The clinics, law enforcement officials said, often performed services, particularly fillings, that were not needed and then billed Medi-Cal for them. In other instances, they said, the clinics billed Medi-Cal for expensive procedures that were never performed.

“It’s a vast network of people and it seems to be occurring all over Los Angeles,” said Don Ashton, the environmental health specialist on the Health Authority’s law enforcement task force. “You have cappers that drive for all these different doctors. They go into low-income areas and say, ‘We’ll give you $20 if you’ll come in and let us do a checkup and any dental work for free.’ ”

The downside, he said, is that some of the work performed is unnecessary, and in some cases the “patients” ended up with a mouthful of fillings they didn’t need.

Wong said that sometimes even children were recruited, with an offer of new shoes or trinkets.

State records show that the clinic raided Wednesday had filed claims with Medi-Cal totaling more than $2.5 million from January 1998 until June 1999. Law enforcement officials estimate that nearly $1 million of the claims are fraudulent.

“We’ve found some patients with severe permanent damage to their teeth because of the unnecessary treatment,” Ashton said.

Law enforcement officials said the four people arrested--Maria Aura Espinosa, Thelma A. Espinosa, Rolando Jose Ruiz and Reyna Isabel Ruiz, all of Los Angeles--operated as cappers. Each was charged with conspiracy to defraud the Denti-Cal program and with participating in kickback schemes for patient referrals.

The arrests were made jointly by the California attorney general’s office and the health authority task force, which includes three deputies from the Los Angeles County Sheriff’s Department and two officers from the Los Angeles Police Department.

Ashton said the investigation, which started nine months ago, is expected to produce many more arrests for dental fraud later this year. He said two licensed dentists in the Pico clinic were not arrested but are under investigation.

He said the involvement of multiple agencies allows law enforcement to cross jurisdictional lines and to attack all parts of the operation at once. He said the California Dental Examiners Board, for example, has been called in to investigate the licenses of dentists suspected of participating in fraudulent activities.

He said dental experts performed key roles in the investigation, such as scrutinizing X-rays to determine if fillings or other procedures were really needed. In some instances, he said, they actually examined patients and were able to determine that fillings were too shallow for a cavity to have existed.