State Reaches Settlements with Three Defendants in
Alleged Fraudulent Medicaid Billing Lawsuit
The state has executed settlement agreements with three defendants that resolve civil fraud allegations and claims stemming from an illegal Medicaid dental billing scheme, Attorney General George Jepsen said today.
David Wu of Cheshire, Conn. and his companies, Arbor Dental Association LLC and Alpha Dental Group PC; Paul Anusavice of North Grafton, Mass.; and John Gallagher of Manchester, Mass. were among 28 individuals, dental practices and corporations named in a civil lawsuit filed by the state in May 2012 that alleged participation in an elaborate and illegal scheme that resulted in the submission of fraudulent Medicaid dental claims over two years in violation of the Connecticut False Claims Act and the Connecticut Unfair Trade Practices Act.
"False or fraudulent claims to our Medicaid programs will not be tolerated," said Attorney General Jepsen. "The settlement with Dr. Wu provides restitution to the Connecticut Medical Assistance Program and bars Dr. Wu from participating in our Medicaid program for one year. The additional settlements with Mr. Anusavice and Mr. Gallagher permanently prohibit them from taking part in our state Medicaid program or in other programs administered by the Department of Social Services. I appreciate the continued coordination and partnership with our client agency and our law enforcement partners in this ongoing case."
Under the terms of his settlement agreement, Dr. Wu will pay $100,000 into the Connecticut Medical Assistance Program and forfeit any right or legal interest in an additional $179,286 in Medicaid payments that had been suspended and held by the state Department of Social Services during the pendency of the investigation and litigation. He will be suspended and excluded from participation in the Connecticut Medical Assistance Program and any other federal health care program for one year.
In consideration of the foregoing payment and suspension, claims previously pending against Dr. Wu, Arbor Dental Association LLC and Alpha Dental Group PC have been withdrawn in the state's civil lawsuit. According to the settlement agreement, Dr. Wu denied liability of wrongdoing.
Under the terms of their respective settlement agreements, Mr. Anusavice and Mr. Gallagher will be permanently excluded and suspended from participation in the Connecticut Medical Assistance Program and any and all other programs administered by the state Department of Social Services or any other federal health care programs. They have agreed not to operate, have or acquire ownership interest in, share in profits of, receive any payments from, loan any money to or be employed by any person or entity that applies for reimbursements from the DSS.
The Attorney General thanked the U.S. Department of Health and Human Services, Office of the Inspector General – Office of Investigations; the U.S. Attorney's Office for the District of Connecticut; the Internal Revenue Service – Criminal Investigation Division; the Federal Bureau of Investigation; and the DSS, Office of Quality Assurance for their close coordination on this case.
“This case underscores the need for Connecticut’s aggressive anti-fraud enforcement program,” said Department of Social Services Commissioner Roderick L. Bremby. “While the great majority of Medicaid-enrolled medical and dental providers are highly professional and above-board, the exceptions require aggressive efforts to counter fraudulent activity and take strong action on behalf of taxpayers. As always, we thank the Attorney General’s Office and our federal partners and law enforcement agencies for their outstanding work with us in support of Medicaid program integrity.”
The state reached a $9.9 million settlement with defendant Gary Anusavice of North Kingston, R.I., and his companies in June 2013, as well as a $2.1 million settlement with defendant Mehran Zamani of Pound Ridge, N.Y., and his companies in April 2015.
The settlements do not resolve the state's civil claims against the final defendants, Alphonso Mack of Bloomfield, Conn., and his company, Wintonbury Dental Associates PC, and the state's civil lawsuit against Dr. Mack and Wintonbury Dental Associates continues.
Today's law enforcement actions are part of efforts underway by the State of Connecticut's Interagency Fraud Task Force, which was created in July 2013 to wage a coordinated and proactive effort to investigate and prosecute healthcare fraud directed at state healthcare and human service programs. The task force includes a number of Connecticut agencies and works with federal counterparts in the U. S. Attorney's Office and the U.S. Health and Human Services, Office of Inspector General – Office of Investigations.
Anyone with knowledge of suspected fraud or abuse in the healthcare system is asked to contact the Medicaid Fraud Control Unit in the Office of the Chief State’s Attorney at 860-258-5986 or by email at email@example.com
; the Attorney General’s Antitrust and Government Program Fraud Department at 860-808-5040 or by email at firstname.lastname@example.org
; or the DSS fraud reporting hotline at 1-800-842-2155 or by email at email@example.com
Assistant Attorney General Joshua Jackson, with Forensic Fraud Examiners Lawrence Marini and David Boucher and Assistant Attorney General Michael Cole, chief of the Antitrust and Government Program Fraud Department, are assisting the Attorney General with this matter.
Jaclyn M. Falkowski