Anchorage Dentist Criminally Charged for Defrauding the Alaska Medicaid Program, Diverting Funds from his Prior Employers, and Unlawful Dental Acts
released on April 17, 2017
found in newsletter: April 2017
The Alaska Department of Law, Medicaid Fraud Control Unit (MFCU), announced today that 31 year-old Dr. Seth Lookhart was charged with 10 felony offenses consisting of medical assistance fraud, theft in the second degree, and scheme to defraud. The information further alleges that Dr. Lookhart committed numerous misdemeanor offenses for medical assistance fraud and unlawful dental acts. Dr. Lookhart’s office manager, thirty-two year old Shauna Cranford, was also charged with the same felony offenses and six of the seven misdemeanor offenses. Dr. Lookhart’s corporation, Lookhart Dental, LLC., D/B/A Clear Creek Dental, LLC., was also charged with the same felony offenses and three misdemeanor offenses of medical assistance fraud.
The information alleges that Dr. Lookhart, as a new dentist, was working for two established dentists in a practice called Alaska Dental Arts. Dr. Lookhart was to be paid the greater of $240,000 a year or 30% of the money he was able to generate. Dr. Lookhart was convinced by Cranford to begin offering IV sedation to Medicaid patients as an alternative to more common and less costly methods of anesthetizing a patient for a dental procedure. Dr. Lookhart and Cranford began to push IV sedation for Medicaid patients. The cost for the IV sedation is generally not included in the patient’s $1,150 annual limit for non-emergency procedures. This practice quickly became very lucrative for Dr. Lookhart resulting in his practice alone being responsible for 31% of the total Medicaid payments for IV sedation in 2016. IV sedation is governed by specific regulations that limit its approved use to a few narrow circumstances that must be properly documented.
The information further alleges that Dr. Lookhart devised a scheme to cut out his then partners by billing Medicaid under a different provider ID and sending the money directly to his home. The estimated value of the fraud towards his partners is approximately $250,000 to $350,000. Additionally, private insurance generally does not cover IV sedation, so Dr. Lookhart began offering private pay clients the option of paying a $450 flat fee when he was billing Medicaid as much as $2,049 for the same service. Medicaid regulations specifically prohibit providers from billing Medicaid more than the general public is charged for the same service. Since obtaining his IV sedation license in 2015, Dr. Lookhart has been paid by Medicaid approximately $1.9 million for IV sedation services; he has billed Medicaid approximately $2.5 million.
The felony medical assistance fraud, theft in the second degree, and scheme to defraud charges carry a possible sentence of up to 10 years in prison, a fine of up to $100,000, and restitution to the State of Alaska Medicaid program for the individual defendants and a fine of up to $2,500,000 for Lookhart Dental, LLC. The misdemeanor medical assistance fraud offenses carry a possible sentence of up to 30 days in jail, a fine of up to $25,000, and restitution to the Alaska Medicaid program for the individuals and a possible fine of up to $500,000 for Lookhart Dental, LLC. The misdemeanor unlawful dental acts offenses carry a possible sentence of up to 10 days in jail and a fine of up to $2,000.
All of the charges discussed herein are merely allegations and are not evidence of guilt. All of the defendants are presumed innocent. All of the defendants are entitled to a fair trial at which the government must prove guilt beyond a reasonable doubt.
CONTACT: Assistant Attorney General Paul Miovas at (907) 269-6314 or firstname.lastname@example.org at the Office of Special Prosecutions, Medicaid Fraud Control Unit. Copies of the information filed in this case and other matters handled by the Alaska Medicaid Fraud Control Unit can be found at http://www.law.state.ak.us/department/criminal/mfcu.html For any current providers that have questions relating to proper billing for dental services please contact: email@example.com Please contact QAPIProgramIntegrity@alaska.gov to report or self-disclose a possible overpayment or improper billing.
Original Press Release