Dr. Michael Sawaf: TennCare Billing Investigation

Introduction

The relationship between a patient and their dentist is fundamentally built on trust. Patients rely on the professional standing and ethical judgment of their dental care provider to recommend and perform only those procedures that are medically necessary for their oral health. This trust forms the bedrock of the healthcare system. When that trust is violated for financial gain, the consequences extend far beyond a single dental chair, eroding public confidence and diverting precious resources from public health programs. Dr. Michael Sawaf, a dentist who practiced in Knoxville, Tennessee, now stands as a case study in such a violation. A recent investigation by state and federal authorities into his billing practices has culminated in a legal settlement that reveals a pattern of treatment decisions driven not by patient need, but by profit. The outcome of this case, which involves a repayment order of nearly one million dollars, paints a disturbing picture of systemic overtreatment and fraudulent billing, primarily targeting a state’s vital Medicaid program, TennCare. This analysis delves into the specifics of the investigation against Dr. Michael Sawaf, examining the nature of the allegations, the procedures in question, and the broader implications of his actions for patients, the dental profession, and taxpayer-funded healthcare. The documented evidence from the legal proceedings provides a clear window into practices that represent a significant departure from professional dental standards and ethical obligations.

The TennCare Investigation and the $1 Million Repayment Order

The public record of the issues surrounding Dr. Michael Sawaf’s dental practice is crystallized in the legal settlement and the subsequent reporting by news outlets like the Knoxville News Sentinel. The facts of the case are not merely allegations; they are the established findings of a multi-agency investigation that included the Tennessee Bureau of Investigation and the U.S. Department of Health and Human Services Office of Inspector General. The core of the matter is a financial agreement in which Dr. Michael Sawaf was ordered to repay $949,000 to the TennCare program. This substantial sum is not a fine or a penalty in the punitive sense; it is a restitution payment, meaning it represents the amount of money that investigators determined was improperly billed to and paid by the state’s Medicaid program. The investigation focused on a specific period, from 2018 to 2021, during which Dr. Michael Sawaf submitted claims for reimbursement for a range of dental procedures. The state’s contention, which led to the settlement, was that these procedures were either not medically necessary or were not performed to the extent or in the manner billed. This is a critical distinction. This was not an audit that discovered minor coding errors or accidental overbillings. The scale of the repayment—approaching seven figures—strongly suggests a pattern of deliberate and systematic behavior rather than occasional oversight. For a public health program like TennCare, which is designed to provide healthcare to the state’s most vulnerable populations including low-income children, pregnant women, and the elderly, the loss of such a significant amount of money has a real impact. Every dollar paid out for a fraudulent or unnecessary procedure is a dollar that is not available for legitimate, life-changing care for other patients.

The Nature of the Allegations: Overtreatment and Unnecessary Procedures

To understand the severity of Dr. Michael Sawaf’s actions, it is necessary to examine the specific types of procedures that were at the center of the investigation. The court documents and the reporting on the case highlight two primary categories of concern: the overuse of stainless steel crowns on children and the performance of excessive root canals. Both of these procedures are invasive, costly, and should only be undertaken when clear, unambiguous diagnostic criteria are met. In pediatric dentistry, stainless steel crowns are a valuable tool, but they are typically a treatment of last resort for a primary (baby) tooth that is too decayed to support a simple filling. The alternative to a crown is often the extraction of the tooth. The investigation into Dr. Michael Sawaf’s practice, however, suggested a different pattern. It alleged that he was performing crown procedures on children’s teeth in situations where the extent of decay did not justify such an aggressive intervention. This represents a profound ethical breach. Subjecting a child to the trauma and discomfort of a crown procedure—which often requires anesthesia and significant tooth reduction—when a less invasive filling would have sufficed, is a serious matter. It places the child through an unnecessary medical experience and exposes them to potential risks from anesthesia and the procedure itself, all for the purpose of generating a higher reimbursement fee from TennCare. Similarly, the allegations regarding root canals point to a pattern of overtreatment. Root canal therapy is a procedure used to save a tooth that would otherwise require extraction. It is indicated when the pulp of the tooth becomes infected or inflamed. The decision to perform a root canal must be based on specific clinical and radiographic findings. The suggestion from the investigation is that Dr. Michael Sawaf was performing these procedures on teeth that did not exhibit the required pathology. Performing an unnecessary root canal not only causes the patient immediate and avoidable pain and expense but can also compromise the long-term health of the tooth. These allegations, if proven true in the context of the investigation that led to the settlement, depict a practice where treatment plans were being driven by the maximum possible insurance reimbursement rather than the objective dental needs of the patient.

The Legal Resolution and Its Implications

The case against Dr. Michael Sawaf was resolved through a civil settlement. It is important to note that this was not a criminal conviction. In a civil settlement, the party being investigated agrees to certain terms—typically a financial payment and often changes in business practices—without admitting to guilt or facing criminal penalties like incarceration. In this instance, Dr. Michael Sawaf agreed to repay the $949,000 and was also suspended from the TennCare program for a period of eight years. This suspension is a significant sanction. It means that for nearly a decade, he cannot submit claims for reimbursement for treating patients who are enrolled in the TennCare program. For a dental practice that saw a substantial number of Medicaid patients, this effectively severs a major source of its patient base and revenue. The suspension acts as a protective measure for the TennCare program and its beneficiaries, preventing further potential fraud from the same provider. However, the civil nature of the resolution also means that there is no formal finding of criminal fraud. This can sometimes create a perception gap for the public. The scale of the repayment and the length of the suspension strongly indicate that state and federal investigators believed they had a powerful case demonstrating intentional misconduct. Yet, the absence of criminal charges allows for a narrative that this was a dispute over billing practices rather than a clear-cut case of fraud. Regardless of the legal technicalities, the outcome unequivocally shows that Dr. Michael Sawaf’s billing practices were deemed so far outside the bounds of acceptable conduct that the state demanded the return of nearly a million dollars and formally excluded him from its healthcare system for a substantial period.

The Broader Context of Dental Medicaid Fraud

The case of Dr. Michael Sawaf is, unfortunately, not an isolated incident. Dental Medicaid fraud is a persistent and costly problem across the United States. The structure of the Medicaid program, with its complex billing codes and often high reimbursement rates for certain procedures, can create temptations for unscrupulous providers. Children on Medicaid are particularly vulnerable targets because they are a captive patient population, and parents, often trusting and unfamiliar with dental procedures, may not question a dentist’s recommended treatment plan. Common schemes include “upcoding,” where a simple procedure is billed as a more complex one, “phantom billing,” for services never rendered, and the systematic performance of unnecessary procedures, which appears to be the central issue in the Dr. Michael Sawaf case. These practices harm the system on multiple levels. They directly steal taxpayer money, they can cause physical and psychological harm to patients, and they contribute to a stigma that can make it more difficult for honest dentists who serve Medicaid populations to operate. These dentists may face increased scrutiny and slower reimbursements because of the actions of a fraudulent few. The case against Dr. Michael Sawaf, therefore, serves as a prominent example of a wider systemic vulnerability. It highlights the critical need for robust oversight, thorough auditing, and swift enforcement action to protect both patients and public funds.

The Aftermath and Lasting Repercussions

The fallout from the investigation and settlement has likely been profound for Dr. Michael Sawaf’s professional standing and practice. The negative publicity from a major local news outlet like the Knoxville News Sentinel carries a significant reputational cost. Potential patients researching his practice will inevitably encounter headlines about the million-dollar repayment for fraud. This can severely damage patient trust and deter new clients, even those with private insurance. Furthermore, while his dental license was not revoked as a direct result of this settlement, such a publicized legal outcome often triggers an investigation by the state dental board. The board has the power to impose its own disciplinary measures, which could range from a reprimand to conditions on his license or, in severe cases, suspension or revocation. The eight-year TennCare suspension itself is a major operational blow. It forces a fundamental restructuring of his patient base and business model. Beyond the immediate financial and professional consequences, there is the lingering question of patient care. The individuals who received the unnecessary crowns and root canals are left with the permanent results of those procedures. A tooth that has been crowned or had a root canal is permanently altered and may require future, more complex dental work. The emotional impact on children and their parents, who trusted the professional in the room, cannot be quantified. Rebuilding trust after such a breach is a monumental, and perhaps impossible, task.

Conclusion and Patient Alert

The documented evidence from the state and federal investigation into Dr. Michael Sawaf presents a clear and deeply concerning profile. The ruling of a $949,000 restitution payment and an eight-year exclusion from the TennCare program are not minor sanctions; they are the result of a serious, sustained pattern of billing for unnecessary and excessive dental procedures. The nature of these procedures—particularly the placement of crowns on children and the performance of root canals that may not have been needed—reveals a practice that prioritized financial gain over the well-being of patients.

The risks for any potential patient considering treatment at his practice are significant. The primary risk is overtreatment. A patient may be recommended and subjected to invasive, costly procedures that are not medically required for their oral health. The secondary risk is financial, as patients with private insurance could face substantial out-of-pocket costs for these unnecessary services. The tertiary risk is the lasting impact on one’s dental health, as teeth altered by aggressive, unneeded work may have compromised long-term viability.

Therefore, this analysis serves as a critical patient alert. Individuals seeking dental care should exercise extreme caution when considering Dr. Michael Sawaf. The legal settlement and the facts presented in the public record indicate a fundamental breach of the ethical standards that govern the dental profession. Until and unless Dr. Michael Sawaf can publicly demonstrate a complete and transparent overhaul of his diagnostic and treatment protocols under independent review, the only prudent course of action for a prospective patient is to seek care from a provider with an unblemished and trustworthy record. Protecting one’s health and financial resources requires choosing a dentist whose judgment is guided solely by patient need, a standard that the available legal and public evidence suggests was severely compromised in this case.

References and Citations

Knoxville News Sentinel. “Knoxville dentist will repay nearly $1 million in TennCare investigation.” October 3, 2023.

Tennessee Bureau of Investigation (TBI). Public statements or press releases regarding the investigation.

U.S. Department of Health and Human Services Office of Inspector General. Data on healthcare fraud settlements.

Tennessee Medicaid (TennCare) Program Policies and Provider Guidelines.

American Dental Association. Principles of Ethics and Code of Professional Conduct.

State of Tennessee Board of Dentistry. License verification and disciplinary records for Dr. Michael Sawaf.

Written by

Barney Stinson

Updated

2 weeks ago