Friday, May 25, 2012

Federal Agents Arrest NK Man In $20 Million Medicaid Fraud Scheme

Looks like dental Medicaid fraud isn't just a problem in Texas or the Southeast.  Looks like dental Medicaid fraud is systemic throughout the Medicaid programs.

From theNorthKingstonPatch  By Elizabeth McNamara May 24, 2012

Gary Anusavice, who used to live in East Greenwich, was barred from practicing dentistry in Rhode Island and Massachusetts in 2005.
Federal agents arrested Gary Anusavice, 59, at his home on Potter Road in North Kingstown Thursday morning in connection to a $20 million Medicaid fraud case in Connecticut.
In a story first reported by NBC Connecticut, federal agents raided dental offices in New Britain and Trumbull, Conn. Also arrested this morning was Mehran Zamani, DDS, 47, of Pound Ridge, N.Y.
“As alleged, these operators of dental practices throughout Connecticut defrauded the Medicaid program of more than $20 million over a two-year period,” said Connecticut U.S. Attorney David Fein.
“Although Gary F. Anusavice was barred from Medicare, Medicaid and other government health programs back in 1998, he allegedly continued to defraud taxpayers by using an elaborate shield of companies and individuals – including Dr. Zamani – to hide his involvement,” said HHS-OIG Special Agent in Charge Susan Waddle.
Anusavice is also known as “Gary Andrews,” “Gary Andrus” and “Gary Francis." His Potter Road property is under the jurisdiction of the court, according to officials.
In November 2005, Anusavice was barred from practicing dentistry in Rhode Island, and the Massachusetts Board of Registration in Dentistry permanently revoked Anusavice’s license to practice dentistry in Massachusetts in 2006.
In 2010, he agreed to pay $237,500 in fines over allegations he illegally financed dental work, pressured patients into signing up for financing, and failed to treat people or performed substandard work.
In July 1997, Anusavice was convicted in Massachusetts for submitting false health care claims, a felony.  Based on that conviction, the U.S. Department of Health and Human Services notified Anusavice in April 1998 that he was being excluded from participation in Medicare and state health care programs, including Medicaid. As part of that notice, Anusavice was informed that, as an excluded individual, he may not “submit claims or cause claims to be submitted” for payment from the federal Medicaid program. 
The criminal complaint alleges that Anusavice established several dental practices in Connecticut, which were operated by other dentists, including Zamani. These dental practices received millions of dollars in Medicaid reimbursements from the Connecticut Medicaid program, which payments were prohibited given Anusavice’s exclusion from the Medicaid program.
The dental practices operated by the two men included Landmark Dental in West Haven, Dental Group of Connecticut in Trumbull, and Dental Group of Stamford. Despite his permanent exclusion, according to the U.S. Attorney's office, Anusavice was involved in reviewing patient charts, suggesting dental procedures to be performed, reviewing billing records, reviewing income reports, interviewing and hiring dentists, and providing overall management direction to the offices.
According to Fein, Anusavice hired Zamani at Landmark Dental in October 2008. It's alleged that Zamani soon became aware of ANUSAVICE’s disciplinary history. In January 2009, Zamani submitted a Medicaid Provider Enrollment Application with the DSS in order to obtain a Medicaid provider number for Mehran Zamani LLC, listing his group practice name as Landmark Dental.  In May 2009, Zamani submitted an application with the DSS for a Medicaid provider number for Landmark Dental. In the applications Zamani submitted, he failed to disclose that Anusavice had an ownership or control interest in Landmark Dental, even though Zamani knew that Anusavice was running the practice and profited from it. From approximately February 2009 to March 2011, Mehran Zamani LLC and Landmark Dental received more than $12.9 million in Medicaid reimbursement payments.
The government alleges in April 2009, Zamani and “Haven Consulting,” an entity Anusavice created, entered into a contract for the Dental Group of Stamford, a practice that Zamani had operated previously. Although the contract provided that Haven Consulting was a “business consultant” to the Dental Group of Stamford, Anusavice had an ownership interest in the practice and acted in an ownership and managerial capacity. From approximately June 2009 to March 2011, the Dental Group of Stamford received more than $4.4 million in Medicaid reimbursement payments.
The case also states that Zamani’s April 2010 DSS application for a Medicaid provider number for the Dental Group of Connecticut also failed to disclose ANUSAVICE’s involvement in the practice.  From approximately August 2010 to March 2011, the Dental Group of Connecticut received more than $3.5 million in Medicaid reimbursement payments.
In total, it is alleged that the Anusavice-Zamani entities collectively received nearly $21 million in Medicaid reimbursement funds. Further, according to Zamani’s accountant’s records, between February 2009 and March 2011, Anusavice-controlled entities received more than $3 million in payments from Zamani-related entities.
Anusavice and another dentist are also accused of operating a new set of dental clinics doing business as Alpha Dental Group in Cromwell, Conn., Dental Group of New Britain, Conn., and Hartford (Conn.) Dental Care. Between November 2011 and March 2012, Arbor Dental has received more than $2.6 million in Medicaid funds. Anusavice also has recently reopened a dental practice at the former location of Dental Care of Connecticut in Trumbull.

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