Dental FWA Case Study
February is National Children’s Dental Health Month, a nationwide observance dedicated to promoting the importance of oral health and preventive care for children and families — making it a perfect time to reflect on how dental practices can impact patient safety and program integrity.
This case study examines a complex dental fraud, waste, and abuse (FWA) investigation involving an oral surgeon whose dental license had been revoked but who continued performing extensive dental procedures under a medical license. The case was identified through a prepayment review following serious patient safety concerns.
Participants will walk through the prepayment review process used to uncover aberrant billing, medically unnecessary services, unsafe clinical practices, and documentation concerns. The presentation highlights how data analysis, clinical review, and regulatory standards were applied to identify high-risk billing patterns, resulting in significant cost avoidance, postpayment recoveries, and multiple external referrals.
Through real-world examples, this session provides practical guidance for detecting dental FWA, recognizing patient safety red flags, and distinguishing between general and specialty dentistry to identify improper billing and potentially dangerous practices.
Learning Objectives
After completing this session, participants will be able to:
- Apply the prepayment review process to identify dental fraud, waste, abuse, and patient safety concerns using claims data and clinical documentation.
- Distinguish between general and specialty dentistry to recognize improper billing, scope-of-practice issues, and medically unnecessary services.
- Identify high-risk dental FWA schemes and red flags—including overutilization, upcoding, and unsafe clinical practices—that warrant escalation and external referral.
Speaker:
Janet Ellis, CFE, RDH, CPC, CPCO
Contract Supervisor, Constellation Quality Health
Robyn S. Winters, RN, QP, AHFI, BSA
Director of Payment Integrity, Constellation Quality Health
Registration Information
Employees of NHCAA Member Organizations, Government Liaisons, Supporting Members, and Individual Members can register online for NHCAA Monthly On-Demand program. A registration form is not available, you must login as a member to register. If you are having issues logging in or registering, please contact training@nhcaa.org.
Non-members, including local, state, and federal public agencies who are not NHCAA Government Liaisons, do not have access to NHCAA Monthly On-Demand programs.
REGISTRATION RATES
| February 2 – 28, 2025 | After February 28, 2026 | |
| NHCAA Member Organizations1 | Complimentary | Complimentary |
| NHCAA Government Liaisons2 | Complimentary | $50 |
| Individual Members3 | $50 | $50 |
REGISTRATION POLICIES
Complimentary registration closes on the last day of the month. Paid registration is open after the complimentary time-period ends. The registration period for complimentary registrations will end at 11:59 pm Pacific Time.
Cancellation/Substitution
All cancellations (regardless of date) will be assessed with a $10 administrative fee.
All written notice of cancellations and substitutions should be sent via email to training@nhcaa.org. Cancellations received within 5 days of the date of purchase will result in a refund minus an administrative fee if the training has not occurred. No refunds will be issued if any portion of the Monthly On-Demand program has been viewed. Registrations are non-transferrable for webinars.
Concerns
For more information regarding administrative policies such as refunds, cancellations and complaints, please email training@nhcaa.org.
Details & Frequently Asked Questions
Monthly On-Demand programs are most appropriate for beginning and mid-career analysts, investigators, consultants, and law enforcement agents working in the health care anti-fraud industry.
As a level II, or intermediate program, some investigative / health care / coding expertise is assumed. Training content is focused on the detection and investigative processes, using case examples to highlight strategy and techniques.
There are no pre-requisite requirements to attend the Monthly On-Demand programs.
All Monthly On-Demandn programs are approved by: NHCAA for 1 CPE
Participants earn 1 Continuing Professional Education (CPE) hours applicable to the training requirements for the Accredited Health Care Fraud Investigator (AHFI®) designation.Monthly On-Demand programs are delivered via NHCAA Learn. You will need a good internet connection and an up-to-date version of Chrome, Firefox, Edge, or Safari. Internet Explorer is not recommended and will not render content correctly.
Video content will open in a pop-up window. You may need to disable a pop-up blocker.
Our FAQ website will be available soon. Registration and login questions can go to training@nhcaa.org. Questions about content or NHCAA Learn functionality can be directed to learn@nhcaa.org.
