Court Orders Restitution, Civil Penalties against
Dentist, Dental Practice in Illegal Medicaid Billing Case
A Winsted dentist and his practice were ordered to pay $717,046 in restitution and civil penalties after a Superior Court judge found his conduct violated the Connecticut Unfair Trade Practices Act, also known as CUTPA, Attorney General George Jepsen said today.
The ruling, which followed an investigation and seven-day court hearing, finds that Dr. Douglas Macko and his dental practice – Douglas Macko, D.M.D., P.C. – devised and implemented an illegal scheme over several years to improperly bill the Connecticut Medicaid program for pediatric dental cleanings and fluoride treatments. Under state law, only licensed dentists or licensed dental hygienists can provide such services. The court determined that Dr. Macko unlawfully caused these services to be performed by unlicensed assistants – even, at times, demanding that his patients or their parents perform the services themselves.
"The court's ruling should send a clear message that Connecticut will be vigilant in protecting our taxpayer-funded healthcare programs from this type of illegal conduct," said Attorney General Jepsen. "I appreciate the continued coordination and partnership with the Department of Social Services to ensure that our most vulnerable citizens as well as our taxpayer interests are protected."
The court found that, as a dentist licensed in Connecticut for decades, Dr. Macko knew or should have known that having unlicensed personnel perform dental cleanings and fluoride treatments violated state law. In 2010, Dr. Macko entered an agreement with the state Department of Social Services (DSS), the administering state agency for Medicaid, to suspend his participation in the Medicaid program and any other DSS program for 10 years. Dr. Macko has closed his practice and is no longer practicing in Connecticut.
The Attorney General brought the lawsuit against Dr. Macko in 2012 based on a referral by DSS.
DSS Commissioner Roderick L. Bremby said, "Overall, dental and medical providers in Connecticut's Medicaid program are dedicated practitioners whose treatment services and reimbursement billings are conducted in a professional, above-board manner. Unfortunately, there are some outliers who cause the need for vigilant quality assurance and anti-fraud enforcement. I am pleased to acknowledge and thank the Attorney General's Office, the Department of Consumer Protection and our other state and federal partners for their continuing work with DSS quality assurance investigators in this crucial area."
"We want to make it clear that professionals who step over the line and take advantage of taxpayers and consumers in Connecticut will suffer the consequences," said Department of Consumer Protection Commissioner Jonathan Harris. "Ensuring public health and safety is our number one priority. We're pleased with the court's decision and commend the Attorney General, his staff and others who worked smart and hard to win this result."
Anyone with knowledge of suspected fraud or abuse in the public healthcare system is asked to contact the Attorney General’s Antitrust and Government Program Fraud Department at 860-808-5040 or by email at email@example.com; the Medicaid Fraud Control Unit in the Office of the Chief State’s Attorney at 860-258-5986 or by email at firstname.lastname@example.org; or the Department of Social Services fraud reporting hotline at 1-800-842-2155, online at www.ct.gov/dss/reportingfraud or by email at email@example.com.
Assistant Attorneys General Karen Haabestad and Gregory O'Connell, Forensic Fraud Examiner Lawrence Marini, retired Forensic Fraud Examiner David Boucher, Paralegal Specialist Holly MacDonald and Assistant Attorney General Michael Cole, chief of the Antitrust and Government Program Fraud Department, assisted the Attorney General with this case.