A dentist who was previously excluded from Medicaid has pleaded guilty in federal court to health care fraud allegedly involving $20 million in false claims submitted to Medicaid. The dentist was excluded from Medicaid and Medicare after a 1997 conviction for submitting false claims. Despite his exclusion from Medicaid, the government alleged that the dentist owned and operated several dental clinics in Connecticut by using a licensed dentist to act as the nominal head of the clinics. The clinics included Landmark Dental, Dental Group of Connecticut, and Dental Group of Stamford. When applying to enroll as Medicaid providers, the excluded dentist and the nominal head of the clinics did not disclose the excluded dentist’s controlling interest in the clinics. An individual who is excluded from Medicaid may not participate directly or indirectly in any services provided to Medicaid beneficiaries. The involvement of an excluded individual as an owner of the clinics meant that all claims for reimbursement to Medicaid submitted by the clinics were considered false claims. The excluded dentist pleaded guilty in federal court to one count of health care fraud, which carries a maximum term of imprisonment of 10 years, and one count of tax evasion, which carries a maximum term of imprisonment of five years. He also agreed to pay $9.9 million to the State of Connecticut to settle related state law false claims allegations. If you have questions about exclusion or the employment of an individual who is excluded from Medicare or Medicaid, then you should consult with an experienced Medicare and medicaid fraud attorney. Contact John Howley, Esq. at (212) 601-2728 or click here to reach our office via email. John Howley, Esq. The information you obtain at this site is not, nor is it intended to be, legal advice. You should consult an attorney for advice regarding your individual situation. I invite you to contact our law offices and welcome your calls, letters and electronic mail. Contacting us does not create an attorney-client relationship. Please do not send any confidential information to us until such time as an attorney-client relationship has been established. I practice law and offer legal services only in jurisdictions where I am properly authorized to do so. I do not seek to represent anyone in any jurisdiction where this web site does not comply with applicable laws and bar rules.
0 Comments
The New York Medicaid program paid dentists for fillings and root canals supposedly performed on 465 patients who had no teeth. This is just one of three types of dental fraud identified by the New York State Office of Medicaid Inspector General in a recent report. The New York Medicaid fraud investigation also uncovered double billing for dental services provided to patients who live in skilled nursing facilities. Medicaid pays nursing homes a set fee for the dental care of patients in skilled nursing facilities, and the nursing homes are supposed to pay the dentists. The report found, however, that dentists had billed Medicaid directly for services provided to almost 2,000 residents of skilled nursing facilities. This resulted in Medicaid paying twice for the same services – once when the nursing home was paid, and again when the dentist was paid directly. The third type of dental fraud identified in the report involved referrals. All patient referrals must be documented properly to avoid situations where dentists are referring patients to themselves. The investigation found, however, that 75,392 patient referrals took place without the necessary documentation. New York and other states are becoming increasingly sophisticated when it comes to identifying and prosecuting dental fraud. For example, the New York Medicaid Inspector General is now using a sophisticated data matching review across data sets to identify possible instances of fraud. In other words, claims submitted by dentists are being compared to beneficiary and other records. The Medicaid Inspector General also coordinates with two other agencies devoted to investigating and prosecuting Medicaid fraud. The Medicaid Fraud Control Unit in the Attorney General’s office has teams of auditors, investigators, and lawyers in offices throughout the state. New York City has its own Office of Medicaid Provider Fraud and Abuse Investigations at 250 Church Street in Manhattan. If you are contacted by any of these offices, then you should consult an experienced Medicaid fraud attorney immediately. Medicaid fraud penalties can be severe. You could be ordered to pay three times the amount Medicaid paid plus a penalty of up to $11,000 for each claim. You could be excluded from participating in Medicare and Medicaid. You could even lose your license and go to prison. When you receive a call, letter, or visit from one of these investigative agencies, it means that the investigators have already gathered evidence against you. Anything you say or do will be used against you in their investigation and, possibly, in court. Do not try to handle this on your own. Get an experienced Medicaid fraud attorney on your side. To arrange a consultation with an experienced Medicaid fraud attorney, call John Howley, Esq. at (212) 601-2728 or click here to reach our office via email. John Howley, Esq. The information you obtain at this site is not, nor is it intended to be, legal advice. You should consult an attorney for advice regarding your individual situation. I invite you to contact our law offices and welcome your calls, letters and electronic mail. Contacting us does not create an attorney-client relationship. Please do not send any confidential information to us until such time as an attorney-client relationship has been established. I practice law and offer legal services only in jurisdictions where I am properly authorized to do so. I do not seek to represent anyone in any jurisdiction where this web site does not comply with applicable laws and bar rules. A dentist was sentenced to three years probation and a $1,000 fine after pleading guilty to submitting false claims to Medicaid. He was also ordered to pay $7,300 in restitution to Medicaid and $2,700 to reimburse the Attorney General’s office for investigative costs. The Medicaid fraud investigation began when an employee in the dentist’s office contacted the Medicaid Fraud Control Unit at the Attorney General’s office. According to the government, the investigation revealed that the dentist was engaged in dental fraud by submitting several different types of false claims to Medicaid, including:
The dentist agreed to settle the charges of dental fraud by pleading guilty to one felony count of billing Medicaid for services not provided. In his plea, the dentist admitted that he billed Medicaid claims for surgical extractions or post-surgical complications when the procedure was only a simple tooth removal with no complications. Medicaid fraud penalties can be harsh. While this dentist was sentenced only to probation, a small fine, and restitution, his ability to practice as a dentist is now at risk. Because he pleaded guilty to a felony, he faces exclusion from Medicare and Medicaid programs, as well as professional disciplinary charges that could include suspension or revocation of his professional license. New York Medicaid fraud investigations often begin with a request for records or other documents from an investigator. If you practice in New York City, that request often comes from an investigator located at 250 Church Street in Manhattan. A request for records means that the government has already commenced its investigation, gathered evidence against you, and suspects that you have done something wrong. Anything you say or do at this point will be used against you. If you are under investigation or have been charged with Medicaid fraud, then you should consult with an experienced Medicaid fraud attorney immediately. How you handle the investigation can mean the difference between retaining or losing your rights, your livelihood, and your professional license. To arrange a consultation with an experienced Medicaid fraud attorney, call John Howley, Esq. at (212) 601-2728 or click here to reach us via email. John Howley, Esq. The information you obtain at this site is not, nor is it intended to be, legal advice. You should consult an attorney for advice regarding your individual situation. I invite you to contact our law offices and welcome your calls, letters and electronic mail. Contacting us does not create an attorney-client relationship. Please do not send any confidential information to us until such time as an attorney-client relationship has been established. I practice law and offer legal services only in jurisdictions where I am properly authorized to do so. I do not seek to represent anyone in any jurisdiction where this web site does not comply with applicable laws and bar rules. A dentist has been charged with Medicaid fraud and grand theft for allegedly billing Medicaid for services provided by an unlicensed dental hygienist. The government’s Medicaid Fraud Control Unit (MFCU) investigated the dentist after parents of young patients complained that he mistreated them. The investigation allegedly uncovered evidence that the dentist employed an unlicensed dental hygienist to perform periodontal root cleaning and scaling on dozens of children. Under state law, only a licensed dentist or licensed dental hygienist may perform this procedure. Employing an unlicensed individual to perform services that can only be performed by a licensed professional is, by itself, a crime under state licensing laws. When claims for reimbursement are submitted to Medicaid for those services, the conduct becomes Medicaid fraud as well. The penalties for dental fraud can be severe. If convicted, this dentist faces up to 15 years in prison and more than $30,000 in fines. He may be excluded from participating in Medicare, Medicaid, or other government programs. He could also lose his professional license. If you are under investigation or have been charged with dental Medicaid fraud, then you should consult with an experienced Medicaid fraud attorney immediately. To arrange a free and confidential consultation, call John Howley, Esq. at (212) 601-2728 or click here to reach our office via email. John Howley, Esq. The information you obtain at this site is not, nor is it intended to be, legal advice. You should consult an attorney for advice regarding your individual situation. I invite you to contact our law offices and welcome your calls, letters and electronic mail. Contacting us does not create an attorney-client relationship. Please do not send any confidential information to us until such time as an attorney-client relationship has been established. I practice law and offer legal services only in jurisdictions where I am properly authorized to do so. I do not seek to represent anyone in any jurisdiction where this web site does not comply with applicable laws and bar rules. When prosecutors indicted the owner of a dental practice for Medicaid fraud, they also indicted his office manager, billing manager, and four dentists employed by the practice as co-conspirators in the fraud. Stephen Beukas is a dentist and former owner of New Jersey Mobile Dental Practice, P.A. (”NJ Mobile”). Dentists working for NJ Mobile provided on-site dental treatment to patients at nursing homes, assisted living facilities, adult day care facilities, and private homes. The government alleges that NJ Mobile submitted more than $5 million in false claims to Medicaid by:
As is typical in dental fraud cases, the government did not just arrest the dentist who owned the practice. The government also indicted the office manager, billing manager, and other employees as co-conspirators for going along with the fraud. These employees now face felony fraud charges that could result in long prison sentences and hefty financial penalties. It is too early to tell whether the dental office employees were innocent rubes or willing co-conspirators. But if they knew that false claims were being submitted to Medicaid, they had a number of options that might have avoided the criminal charges they now face. One option was to consult with an experienced whistleblower attorney about the rewards and legal protections available under the state and federal False Claims Acts. Under the federal False Claims Act, an individual citizen may bring a qui tam lawsuit on behalf of the government and share in any recovery. The lawsuit is initially filed “under seal” (in secret), and the evidence is provided only to the prosecutor. The prosecutor then investigates the case and decides whether to take it on. The whistleblower who brings the case is entitled to a reward of between 15% and 30% of the amount recovered. They are also entitled to legal protections against retaliation. The amount of the whistleblower reward depends on the amount actually recovered by the government. In this case, if the government recovered $5 million, then the whistleblower reward would be between $750,000 and $1.5 million. Do not go to prison for your employer’s fraud. If you know that false claims are being submitted to Medicare or Medicaid, consult with an experienced whistleblower attorney immediately to protect your rights, your livelihood, and your freedom. The consultation is free and confidential. No attorneys’ fees are charged unless you win. To arrange a free consultation with an experienced whistleblower attorney, call John Howley, Esq. at (212) 601-2728 or click here to reach us via email. We will listen to you, explain how whistleblower rewards work, advise you on your rights, and explain your options. John Howley, Esq. The information you obtain at this site is not, nor is it intended to be, legal advice. You should consult an attorney for advice regarding your individual situation. I invite you to contact our law offices and welcome your calls, letters and electronic mail. Contacting us does not create an attorney-client relationship. Please do not send any confidential information to us until such time as an attorney-client relationship has been established. I practice law and offer legal services only in jurisdictions where I am properly authorized to do so. I do not seek to represent anyone in any jurisdiction where this web site does not comply with applicable laws and bar rules. The New York Attorney General's Office recovered more than $335 million last year from companies and individuals who engaged in Medicaid fraud and abuse. New York has one of the most aggressive Medicaid Fraud Control Units (MFCU), with a staff of more than 315 people across the state. They work closely with the Medicaid Inspector General in the NYS Health Department to detect and prevent Medicaid fraud. The most common forms of Medicaid fraud in New York last year included:
The largest Medicaid fraud recoveries came from pharmaceutical companies. Abbott Labs, Boehringer-Ingelheim, Dava Pharmaceuticals, GlaxoSmithKline, K-V Pharmaceutical, McKesson, Merck, and other pharmaceutical companies paid more than $250 million to settle allegations that they submitted false price reports to Medicaid and/or promoted their products for uses not approved by the federal Food and Drug Administration (off-label marketing). Other significant recoveries involved pharmacists, hospitals, and dental clinics. Pharmacy Fraud: Four pharmacists and a pharmacy owner agreed to pay $9.9 million in restitution after pleading guilty to billing Medicaid for drugs that they never dispensed to their patients. Stark Law Violations: Cayuga Medical Center paid $3.1 million to settle a whistleblower or qui tam lawsuit alleging that the hospital billed Medicaid and Medicare for patients referred by physicians who had financial relationships with the hospital. The Stark Act prohibits a physician from referring patients to a hospital if the physician has a financial relationship with the hospital, unless an exception applies. The whistleblower in this case, a physician at the hospital, received 18% of the settlement (approximately $560,000) as his whistleblower reward. Dental Fraud: Kaleida Health repaid $1.6 million to Medicaid after an internal audit revealed that it had billed Medicaid for patients who received teeth cleanings more often than once in six months, which violated Medicaid reimbursement rules. The audit also revealed that the dental clinic had billed Medicaid for multiple visits to complete exams, x-rays, and cleanings. Medicaid regulations require dental clinics to perform and bill these tasks in one office visit. If you are under investigation or have been charged with Medicaid fraud, then you should consult with an experienced Medicaid fraud attorney immediately, before you speak with government investigators. Anything you say to the investigators can and will be used against you. To arrange a free and confidential consultation, call John Howley, Esq. at (212) 601-2728 or click here to reach our office via email. You should also consult with an experienced Medicaid and Medicare fraud lawyer if you know that your employer is submitting false claims to the government. You may be entitled to a substantial whistleblower reward and legal protections if you help the government recover money paid on false and fraudulent claims. Call our office today to schedule a free and confidential consultation. John Howley, Esq. The information you obtain at this site is not, nor is it intended to be, legal advice. You should consult an attorney for advice regarding your individual situation. I invite you to contact our law offices and welcome your calls, letters and electronic mail. Contacting us does not create an attorney-client relationship. Please do not send any confidential information to us until such time as an attorney-client relationship has been established. I practice law and offer legal services only in jurisdictions where I am properly authorized to do so. I do not seek to represent anyone in any jurisdiction where this web site does not comply with applicable laws and bar rules. A dentist entered into a consent order agreeing to pay $30,000 to Medicaid after investigators discovered billing irregularities and documentation problems. According to the consent order, Peter J. D'Allessandro "failed to maintain adequate records to support and justify treatments." The consent order also provides for a public reprimand and a two-year probation period. During the probation period, Medicaid officials will randomly examine patient charts during unannounced visits to the dentist's practice to "insure compliance with minimum requirements for record-keeping and billing." Failing to maintain adequate records to support and justify treatments creates serious problems. Any claim that is not adequately supported by contemporaneous records may be considered a "false claim." Submitting false claims to Medicaid can result in heavy financial penalties, exclusion from Medicare, Medicaid and other government healthcare programs, and even a criminal conviction resulting in the suspension or loss of a professional license. By cooperating with the investigation and agreeing to the terms of the consent order, the dentist avoided the possibility of more serious proceedings and consequences. The government aggressively investigates and prosecutes cases of dental Medicaid fraud. If you are contacted by a Medicaid investigator, then you should consult with an experienced Medicaid fraud attorney immediately to protect your rights. How you respond to the investigation can mean the difference between an inconvenience and a career-destroying catastrophe. To arrange a free and confidential consultation, call John Howley, Esq. at (917) 652-6504 or click here to reach our office via email. John Howley, Esq. The information you obtain at this site is not, nor is it intended to be, legal advice. You should consult an attorney for advice regarding your individual situation. I invite you to contact our law offices and welcome your calls, letters and electronic mail. Contacting us does not create an attorney-client relationship. Please do not send any confidential information to us until such time as an attorney-client relationship has been established. I practice law and offer legal services only in jurisdictions where I am properly authorized to do so. I do not seek to represent anyone in any jurisdiction where this web site does not comply with applicable laws and bar rules. Spencer Brown will spend the next year in jail after pleading guilty to one count of Medicaid fraud. The charges resulted from the submission of Medicaid claims for dental services that were never provided. According to the government, Mr. Brown submitted the false and fraudulent claims to Medicaid in his capacity as an employee of a dental practice operated by his wife, Lisa Valentine, D.D.S. Mr. Brown allegedly billed the Medicaid program $156,918 for services that were never rendered. After completing his jail term, Mr. Brown will be placed on supervised probation for five years. He must also complete 150 hours of community service and pay $156,918 in restitution to the Medicaid program. The government aggressively prosecutes anyone who submits false claims to Medicaid or Medicare. If you are under investigation for Medicaid fraud or have been charged with a crime, then you should consult with an experienced Medicaid fraud attorney immediately to protect your rights. For a free and confidential consultation, call John Howley, Esq. at (917) 652-6504 or click here to reach his office via email. John Howley, Esq. The information you obtain at this site is not, nor is it intended to be, legal advice. You should consult an attorney for advice regarding your individual situation. I invite you to contact our law offices and welcome your calls, letters and electronic mail. Contacting us does not create an attorney-client relationship. Please do not send any confidential information to us until such time as an attorney-client relationship has been established. I practice law and offer legal services only in jurisdictions where I am properly authorized to do so. I do not seek to represent anyone in any jurisdiction where this web site does not comply with applicable laws and bar rules. |
John Howley, Esq.
350 Fifth Avenue 59FL New York, NY 10118 (212) 601-2728 |