State Settles Joint State-Federal False Claims Act
Investigation with Pediatric Dental Provider
A pediatric dental provider with practices in Milford and West Haven will pay more than $1.3 million to the state and federal government to resolve allegations that he submitted false claims to Connecticut's Medicaid program for x-ray services that did not comply with state law, Attorney General George Jepsen said today. The investigation was conducted jointly with the Connecticut U.S. Attorney's Office, federal agents with the U.S. Health and Human Services Office of Inspector General/Office of Investigations (OIG/OI) and the Connecticut Department of Social Services Office of Quality Assurance.
Dr. Jesus Villegas and his pediatric dental practices – Fairfield Pediatric Dentistry, LLC, in Milford and Haven Pediatric Dentistry, LLC, in West Haven – will pay $1,367,466 to resolve allegations that he authorized certain of his dental assistants who were not certified by the Dental Assisting National Board (DANB) to take dental x-rays of his Medicaid patients.
Connecticut law requires DANB certification of dental assistants before they are allowed to take dental x-rays. The certification demonstrates that the dental assistant successfully completed a course of instruction on the protocols and operating procedures that must be followed to ensure the safe administration of x-rays.
The state and federal government alleged that from June 2010 through March 2014, Dr. Villegas – who has been enrolled as a provider in the Connecticut Medical Assistance Program (CMAP) since 1995 – submitted false claims to Medicaid for x-ray services knowing that they were taken by uncertified dental assistants.
The settlement funds – of which the state's share is 60 percent, or approximately $820,479 – will be used to reimburse the Medicaid program. The state Department of Social Services (DSS) is the administering state agency for Medicaid.
In addition to the settlement funds, Dr. Villegas and his practices have agreed to implement a compliance program designed to ensure compliance with all applicable state and federal healthcare laws and must provide to the Attorney General certifications of adherence to the compliance program for the next three years. Dr. Villegas and his practices will also enter into a separate Integrity Agreement with the Office of the Inspector General of the U. S. Department of Health and Human Services.
"Medicaid providers have a legal responsibility to ensure that they are in compliance with all material laws and regulations when they submit claims for services to the Medicaid program, and Medicaid patients are entitled to the highest standard of care for their dental services," said Attorney General Jepsen. "The state requires dental assistants to be DANB certified in order to take x-rays to make certain they are done safely, which protects both the patient and the dental assistant. I'm pleased that we have reached an agreement in this case, and that we are also putting in place compliance requirements that will ensure this provider adheres to appropriate billing processes going forward to protect the integrity of our Medicaid program. I am grateful to our partners in this investigation, especially the Connecticut U.S. Attorney's Office, the federal agents of the OIG/OI and the state Department of Social Services Office of Quality Assurance, for their coordination and work in this case, and for the continued cooperation between agencies, both state and federal, as we work to protect our public healthcare programs."
Department of Social Services Commissioner Roderick L. Bremby said, "This case involves an extremely important area of health care quality in our dental coverage program. Quite simply, standards of safety for patients and staff must be fulfilled meticulously and conscientiously by enrolled providers. This includes the critical area of medical necessity in determining the need for x-rays. Overall, Connecticut's enrolled dental providers are among the finest in the nation, but this case illustrates the need for oversight to ensure that quality standards are met and financial integrity of the program is protected. I am pleased to acknowledge and thank the Attorney General's Office, the U.S. Attorney's Office and U.S. Department of Health and Human Services' Office of Inspector General/Office of Investigations for their outstanding work with DSS Quality Assurance investigators in this area."
Today's action is part of a larger effort 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. For more information, please visit www.fightfraud.ct.gov.
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 to email@example.com.
Assistant Attorneys General Karen Haabestad, Natasha Freismuth and Michael Cole, chief of the Antitrust and Government Program Fraud Department; and Forensic Fraud Examiners Lawrence Marini, Kevin Jeffko and David Boucher assisted the Attorney General with this matter.