How a dentist's license suspension for Medicare fraud works in Massachusetts
When the Massachusetts Board of Registration in Dentistry suspends a dentist's license due to Medicare fraud, that dentist cannot legally practice dentistry in the state until the suspension is lifted. The suspension is a disciplinary action separate from any criminal charges — it happens through the state licensing board, not through the courts. The board can suspend a license when ready if it finds that a dentist's continued practice poses an when ready threat to public health or safety, or it can schedule a hearing first and then decide whether to suspend.
Medicare fraud in dentistry typically means billing Medicare for services that were not provided, billing for more expensive procedures than what was actually done, or submitting claims for patients who were not may be able to access for coverage. The board learns about suspected fraud through complaints, through investigations by the federal Office of Inspector General, or through reports from Medicare itself. Once the board has evidence, it can move to suspend the license without waiting for a criminal conviction.
A suspension is different from a revocation. A suspension is temporary — the dentist can petition to have the license restored after a set period or after meeting certain conditions. A revocation is permanent and much harder to overturn. The board decides which penalty fits the violation.
Key Takeaways
- The Massachusetts Board of Registration in Dentistry can suspend a license based on Medicare fraud findings alone, without waiting for criminal charges or a court conviction.
- An when ready suspension can happen if the board believes the dentist's practice poses a direct threat to patients, but the dentist has the right to request a hearing.
- A suspended dentist cannot legally practice dentistry in Massachusetts, but the suspension can be lifted if the dentist meets conditions set by the board or after a certain time passes.
- The dentist can appeal the board's decision to the Massachusetts Superior Court, which will review whether the board followed proper procedure and had enough evidence.
The difference between when ready suspension and suspension after a hearing
The Board of Registration in Dentistry can suspend a license in two ways. An when ready suspension (also called an emergency suspension) happens without a hearing first. The board must show that the dentist's continued practice poses an when ready threat to public health or safety. For Medicare fraud, this might mean the board found evidence that the dentist was systematically overbilling or performing unnecessary procedures that harmed patients. The dentist is notified of the suspension and the reasons for it.
Once an when ready suspension is in place, the dentist has the right to request a hearing within a set timeframe — usually 10 to 30 days, depending on the board's rules. At that hearing, the dentist can present evidence and argue against the suspension. The board must then decide whether to keep the suspension in place, lift it, or modify it.
A suspension after a hearing is the more common route. The board notifies the dentist of the allegations, schedules a formal hearing, and the dentist can bring a lawyer, present witnesses, and cross-examine the board's evidence. After the hearing, the board decides whether to suspend, revoke, or take no action. This process typically takes several months.
What the dentist must do during a suspension
During a suspension, the dentist cannot see patients, perform any dental procedures, or hold themselves out as a practicing dentist in Massachusetts. This includes working in a dental office, even in a non-clinical role if the role involves patient care decisions. The dentist cannot supervise dental hygienists or dental assistants. Violating a suspension by practicing anyway can result in criminal charges and a permanent revocation of the license.
The dentist must notify all current patients that their care will be transferred to another provider. Patients have the right to their dental records, and the suspended dentist must make those records available within a reasonable time. The dentist should also notify any dental practices, hospitals, or clinics where they held privileges that the license has been suspended.
The dentist may be required to post notice of the suspension in any office space they still occupy, or to notify the public in other ways. The board's order will specify what notifications are required.
How to appeal a suspension decision
A dentist who disagrees with the board's decision to suspend can file an appeal to the Massachusetts Superior Court. The appeal must be filed within 30 days of the board's decision. The court will not retry the case or hear new evidence — instead, it will review the record of the board's hearing to determine whether the board followed the correct legal procedure and whether there was enough evidence to support the suspension.
The dentist will need a lawyer for this appeal. The lawyer will argue that the board either did not follow proper procedure, did not have enough evidence, or imposed a penalty that was too harsh for the violation. If the court agrees, it can overturn the suspension, send the case back to the board for a new hearing, or reduce the penalty.
While the appeal is pending, the suspension usually stays in effect. The dentist can ask the court for a stay (a temporary halt to the suspension) while the appeal is being decided, but the court will only grant this if the dentist shows a strong likelihood of winning the appeal and that the suspension is causing serious hardship.
Conditions for restoring a suspended license
The board's suspension order will state what the dentist must do to have the license restored. Common conditions include completing a course on dental ethics or Medicare billing rules, paying a fine, submitting to monitoring or supervision for a period of time, or passing a new examination. Some suspensions are lifted automatically after a set period — for example, after one year — if no new violations occur.
The dentist must request restoration of the license in writing, showing that all conditions have been met. The board will review the request and may grant it, deny it, or require additional conditions. If the board denies restoration, the dentist can request another hearing or appeal to the Superior Court.
If the suspension was based on Medicare fraud, the dentist may also need to resolve the fraud case itself — either by repaying overbilled amounts, entering into a settlement with Medicare, or being cleared of the charges. The board often will not restore a license until the underlying fraud matter is resolved.
Criminal charges versus license suspension
A license suspension and a criminal prosecution for Medicare fraud are separate processes. The board can suspend the license based on its own investigation, even if no criminal charges have been filed. Conversely, a criminal conviction is not required for the board to suspend — the board only needs to find that the dentist violated state dental practice laws or Medicare rules.
If the dentist is charged criminally, the criminal case happens in court and is handled by prosecutors and a judge or jury. The license suspension happens in an administrative proceeding before the board. Both can happen at the same time, and a conviction in criminal court will almost certainly lead to license revocation (permanent loss of the license), not just suspension.
A dentist facing both criminal charges and a board investigation should consult a lawyer who has experience with both criminal defense and professional licensing. The two cases can affect each other, and statements made in one proceeding might be used in the other.
How Medicare fraud investigations begin
Medicare fraud investigations into a dentist typically start when the Centers for Medicare & Medicaid Services (CMS) or the Office of Inspector General (OIG) notices a pattern of unusual billing. Red flags include billing for procedures that are not medically necessary, billing for more expensive procedures than what was documented in patient records, or billing for patients who were not may be able to access for Medicare coverage.
Patients, other dentists, or dental staff can also file complaints with the board or with CMS. Once an investigation begins, federal investigators may subpoena patient records, billing records, and testimony from the dentist and staff members. The investigation can take months or years.
If the investigation finds evidence of fraud, the OIG may refer the case to the U.S. Attorney's Office for criminal prosecution, to CMS for civil recovery of overbilled amounts, or to the state licensing board for disciplinary action. Often all three happen. The state board does not wait for the federal case to finish — it can move forward with its own investigation and suspension.
Frequently Asked Questions
Can a dentist practice in another state if their Massachusetts license is suspended?
No. A suspension in Massachusetts only affects the right to practice in Massachusetts. However, if the suspension was based on Medicare fraud or patient harm, other states may learn about it through the National Practitioner Data Bank or through background checks, and they may deny a license process or suspend a license in their own state. Each state makes its own decision.
What happens to patients' dental records during a suspension?
Patients have the right to their records, and the suspended dentist must provide them within a reasonable time, usually 10 to 30 days. If the dentist refuses, patients can file a complaint with the board. The dentist cannot charge an unreasonable fee for copying records — typically $1 to $2 per page is considered reasonable.
Can a dentist work as a dental hygienist or assistant while suspended?
No. A suspension of a dental license means the person cannot work in any capacity that requires a dental license. However, a dentist might be able to work in a non-clinical role, such as office management or billing, if that role does not involve patient care or clinical decisions. The board's order will specify what work is prohibited.
How long does a suspension typically last?
Suspension length varies widely depending on the severity of the fraud and the dentist's history. Some suspensions last six months to one year, while others last several years. The board's order will state the length or the conditions for restoration. If no length is stated, the dentist can petition for restoration after a reasonable time has passed.
Does a suspension appear on public records?
Yes. The Massachusetts Board of Registration in Dentistry maintains a public database of licensed dentists, and suspensions and revocations are listed there. Anyone can search the database to see whether a dentist's license is active, suspended, or revoked. This information is also reported to the National Practitioner Data Bank, which hospitals and other healthcare organizations can access.