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.

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