Texas orthodontist charged with $1.5M Medicaid fraud

Michael David Goodwin, DDS, an orthodontist who practices in Amarillo, TX, and Crown Point, IN, has been indicted on 11 counts of healthcare fraud for allegedly defrauding the Texas Medicaid program of approximately $1.5 million.

According to the federal indictment, 90% to 95% of Dr. Goodwin's orthodontic patients were Medicaid beneficiaries. The indictment alleges that from January 2008 through March 2011, Dr. Goodwin devised a scheme to defraud the Texas Medicaid program by billing the program more than $2 million for services he claimed he provided, when in fact some of the services were not medically necessary or dental assistants provided those services when no dentist or orthodontist was present to supervise. As a result of this scheme, Medicaid paid more than $1.5 million for claims filed by Dr. Goodwin.

As part of his scheme, according to the indictment, Dr. Goodwin practiced orthodontic dentistry approximately two weeks each month at Goodwin Orthodontics in Amarillo and approximately two weeks each month at his Indiana office. To maximize the number of Medicaid patients seen, employees regularly scheduled more than 100 patients per day and intentionally scheduled large numbers of Medicaid patients for days when Dr. Goodwin was scheduled to be out of town.

To accommodate the large volume of patients, lawmakers allege that Dr. Goodwin directed dental assistants to perform impermissible acts, including comprehensive examinations, diagnoses and treatment planning for Medicaid patients when he knew that only licensed dentists were permitted to perform those acts.

He also allegedly submitted, or had his employees submit, forms to Medicaid that falsely and fraudulently represented that beneficiaries had been examined by Dr. Goodwin and had a medical necessity for braces. He allegedly instructed his billing staff to represent on Medicaid claims that there was medical necessity on all claims for all services billed for Medicaid beneficiaries whose treatment was merely for cosmetic purposes and was without medical necessity.

If Dr. Goodwin is convicted, each fraud count carries a maximum statutory sentence of 10 years in prison and a $250,000 fine. Restitution also could be ordered.

In this case, the indictment also includes a forfeiture allegation that would require Dr. Goodwin, if convicted, to forfeit a money judgment of at least $1,558,911 that represents the total amount of the gross proceeds traceable to the offenses, as well as the more than $244,000 the government seized in May and July 2011 from Goodwin's JP Morgan Chase accounts.