Dentist charged with Medicaid fraud
A St. Croix County dentist, Anthony Sanchez, appeared in front of St. Croix Circuit Court Judge Eric Lundell to face six counts of felony medical assistance fraud and one misdemeanor count of filing a fraudulent insurance claim.
Sanchez waived his right to a preliminary hearing on the felony counts. An arraignment was scheduled for Oct. 24, 2008.
According to the Department of Justice's criminal complaint, Anthony Sanchez, 35, Hudson, owns "Smi:)e Dental" at 131 Carmichael Road in Hudson.
Between April 2005 and March 2006, Sanchez allegedly advised five patients that they required root canals and that Medicaid did not cover the service.
The patients were allegedly made to pay between $400 and $775 to cover the procedures.
Another patient was allegedly charged $4,000 due to needing bridge work in addition to the root canal.
Sanchez allegedly was aware the Medicaid program does reimburse the cost of root canals and bridge work but chose not to inform the patients of this or told them that those were not covered and instead required them to pay cash.
During this same time period, Sanchez allegedly billed a private insurance carrier for providing a patient with porcelain/ceramic crowns when in fact the crown was an inferior composite resin.
Sanchez also allegedly instituted a policy requiring Medicaid recipients to pay $50 to make an appointment. If patients kept the appointment they were not charged a co-pay but were not reimbursed the balance of the $50.
If convicted, Sanchez faces up to 36 years and nine months imprisonment and $160,000 in fines. A criminal complaint is a document accusing a person of a violation of the criminal law. A defendant is presumed innocent unless and until proven guilty. The prosecution must prove its claims at trial.
The case was investigated by the Wisconsin Department of Justice's Medicaid Fraud Control Unit and is being prosecuted by Assistant Attorney General Thomas Storm.