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• Hudson dentist charged with Medicaid fraud

By Randy Hanson

rhanson@rivertowns.net

A Hudson dentist has been charged with falsely telling Medical Assistance patients that root canal therapy isn't covered by the federal program, and then requiring payment from them before he would do the work.

Dr. Anthony R. Sanchez, 35, owner of the Smile Dental clinic, made his initial appearance Aug. 12 in St. Croix County Circuit Court on six felony counts of Medicaid fraud.

He also was charged with a misdemeanor count of presenting a false claim to an insurance company. He is accused of telling the insurance company that he put a porcelain crown on a patient's tooth when it actually was a less expensive composite resin crown.

Each Class H felony Sanchez is charged with carries the maximum penalty of a $25,000 fine or six years in prison or both.

Sanchez, appearing with defense attorney Harry Hertel, told Judge Eric Lundell he understood the charges and waived his right to have them read aloud.

Lundell scheduled the preliminary hearing on the charges for Jan. 17 and allowed Sanchez to remain free on a $1,000 signature bond.

According to a criminal complaint issued by the Wisconsin Department of Justice, the alleged offenses took place between August 2005 and April 26, 2006, when investigators conducted a search of Sanchez's clinic in the Carmichael Centre building at 131 Carmichael Road.

Charles Miller, a senior auditor with the Medicaid Fraud Control Unit of the state Justice Department, was the lead investigator on the case.

Five of the felony counts Sanchez faces are for allegedly telling patients that root canals weren't covered by Medicaid. The complaint alleges that he would tell patients they would have to either pay for the root canal on their own or have the tooth pulled.

A former dental assistant of Sanchez's said he also told patients they could try to find another dentist to do the work.

In one case, a developmentally disabled man's two sisters and mother reportedly paid $4,000 for a root canal and bridge work that should have been covered by Medicaid.

The former dental assistant said Sanchez sought Medicaid reimbursement for root canals a couple of times early in his Hudson practice, but found the reimbursement rate too low.

The dental assistant told an investigator that Sanchez said he didn't make enough money on root canals for Medicaid patients to make it worth his time to perform the procedure.

She said most Medicaid patients opted to have the bad tooth pulled, and that Sanchez pulled a lot of teeth.

The sixth felony count Sanchez faces is for charging a Medicaid patient a $50 chair reservation fee.

A dental hygienist who used to work for Sanchez told investigators that he used to charge patients $50 if they missed appointments. She said the policy was more strictly enforced with Medicaid patients, and they had to pay the fee before Sanchez would see them again. Later, he dropped the missed-appointment fee and began charging Medicaid patients $50 to schedule an appointment.

Another dental assistant who used to work for Sanchez named seven patients that she said got cheaper composite resin crowns on their teeth while he reported to insurance companies that he had put porcelain crowns on their teeth.

The former assistant said Sanchez, unlike all the other dentists she had worked for, prepared and sent out insurance claims himself. He allegedly told the assistant that employees had cost dental clinics "thousands and thousands" of dollars by missing something that the dentist did.