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Pocatello Dentist Sentenced For Fraudulent Medicaid Billing

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By Paul Johnson

Boise, Idaho – Dr. Carl B. Holm, a Pocatello dentist, was sentenced Monday for felony provider fraud for submitting false dental claims to the Idaho Medicaid program. Sixth District Judge Stephen S. Dunn sentenced Holm to three years on probation and a $1,000 fine and granted a withheld judgment. Holm was also ordered to pay $7,315.55 in restitution to Medicaid and $2,701.75 to the Attorney General’s Office for investigative costs.

Holm pled guilty on January 14 to one count of provider fraud involving billing Medicaid 67 times for either surgical extractions or post-surgical complications when the procedure was actually a simple removal of a tooth without post-surgical complications. The difference between a simple extraction of a tooth and a surgical extraction at the time of the conduct was $30.87 per claim. Holm was paid $32.39 for each claim of treating post surgical complications.

In 2010, the Attorney General’s Medicaid Fraud Control Unit received a complaint from an employee of Carl Holm. The investigation revealed $7,315 in fraudulent claims to Medicaid.

As part of the plea agreement, the other counts against Holm were dismissed, although Holm agreed that the state could discuss the dismissed counts at sentencing. Those counts involved allegations of: billing for dental fillings that were not provided; billing for x-rays that were of such poor quality that they had no diagnostic value; billing for dentures and providing a fraudulent date of service for them to get around a limit of only one set of dentures every five years; and, billing for sedative fillings that were either not provided or were not medically necessary.

Holm has paid the restitution to Medicaid and reimbursed the Attorney General’s investigative costs.


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