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State accuses Inverness dentist of Medicaid fraud

Officials say he billed for more expensive services than he actually performed.


© St. Petersburg Times, published February 23, 2001

INVERNESS -- State authorities have accused an Inverness dentist of filing false Medicaid claims.

Thomas Sedlak, 39, faces one felony count of Medicaid fraud. He was arrested last week and released on his own recognizance. Arraignment is scheduled for March 12.

The Attorney General's Office, acting on a complaint, recently reviewed a random sample of Sedlak's Medicaid billings, according to Patrick Niemann, deputy bureau chief for the office's Medicaid fraud control unit.

Niemann said such a review is standard when complaints arise.

Niemann said experts reviewed patient files and closely examined the billings. A dentist spoke with the patients, reviewed the dental work they received and checked their X-rays, as well.

Sedlak's offense, in the state's opinion, was so-called "upcoding." In other words, he performed a particular service and then billed Medicaid for reimbursement for a different, more expensive service.

In those 20 cases, Niemann said, Sedlak filed 47 fraudulent claims worth $5,266. The state has alleged the fraud occurred between October 1996 and December 1999.

Medicaid is the state-federal program that provides health care for the poor. In Florida, the state Agency for Health Care Administration oversees the program. Sedlak submitted his claims to a private company that the state agency has hired to process such paperwork.

Sedlak's lawyer, John Fitzgibbons of Tampa, declined comment Thursday. He also said his client would have no comment.

The state said Sedlak received $54,000 from Medicaid during the period in question.

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