Texas is again aggressively investigating and prosecuting dental and orthodontic fraud, particularly regarding Medicaid billing. In fact, in 2025 Attorney General Ken Paxton stated that the Medicaid Fraud Control Unit (MFCU) is heavily targeting pediatric dental chains that use “paper-only” visits, where the clinic bills for an exam that never actually occurred or was performed by a technician without a dentist present. While this is only one type of conduct scrutinized in these cases, increased enforcement of Texas dental and orthodontic practitioners is expected to continue. Dentists and orthodontists should also continue to be vigilant of possible enforcement actions by the federal government.
Conduct commonly investigated in these cases includes billing for services not rendered or documented, upcoding or unbundling, overutilization, providing unnecessary services, false documentation, kickbacks and improper relationships and payments, and retention of overpayments. Quality of care issues often examined include sufficiency of staffing, utilizing unlicensed personnel, inadequate supervision, medication issues such as those involving sedation and opioids, and other patient safety-related issues.
Source: Texas Dental and Orthodontic Investigations Are on the Rise / The National Law Review