X-ing Out Fraud

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The Connecticut State Dental Association is quite clear about the requirement for all state dental assistants to pass the dental radiography portion of the Dental Assistant National Board’s exam before being allowed to take x-rays in any dental office.A Connecticut dentist who operated two practices skipped that important requirement and let his uncertified dental assistants take x-rays of his Medicaid patients. His offices also billed the government health care program for more than $1.3 million in dental claims despite the infraction.

In order to be a provider under the Connecticut Medical Assistance Program, health care professionals must follow the rules and regulations set forth under the Medicaid program. This protects both the Medicaid patients as well as the provider and their employees. (Dentists should provide quality care through certified employees. Would you want someone who doesn’t know what they are doing to point an x-ray beam at you?) The dentist in this particular case submitted false claims for x-rays knowing that they had been taken by uncertified dental assistants for approximately four years. (I guess he thought the government would be numb to his illegal acts.)

The dentist agreed to pay $1,367,466, of which 60 percent or $820,479 will go to reimburse the Connecticut Department of Social Services. He also agreed to adhere to a compliance program that meets state and federal healthcare laws over the next three years. In addition, the dentist will comply with a separate Integrity Agreement with the Office of the Inspector General of the Department of Health and Human Services

Medicaid beneficiaries have a right to receive a high standard of care. This dentist tried to cut corners and put the safety of his patients and employees at risk, not to mention the integrity of the Medicaid program. Let’s hope that the parameters put in place will be successful in x-ing out any more x-ray fraud from occurring in this dentist’s offices in the future.

Source: Today’s ”Fraud of the Day” is based on an article entitled, ”Milford Dentist to Pay $1.3M in Medicaid Fraud Case,” published by The Milford Patch on September 14, 2016.

MILFORD, CT — A pediatric dentist with practices in Milford and West Haven, has agreed to pay more than $1.3 million to the state and federal government to resolve allegations that uncertified assistants took X-rays of patients.

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 they violated the federal and state False Claims Acts by authorizing certain dental assistants who were not certified by the Dental Assisting National Board (DANB) to take dental X-rays of his Medicaid patients, according to authorities.

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Larry Benson, Senior Director of Strategic Alliances, LexisNexis Risk Solutions - Government

Larry Benson is responsible for developing strategic partnerships and solutions for the government vertical. His expertise focuses on how government programs are defrauded by criminal groups, and the approaches necessary to prevent them from succeeding.

Mr. Benson has 30 years of experience in sales and business development. Before joining LexisNexis® Risk Solutions, he spent 12 years founding and managing two software technology startups. During the 1990s he spent 10 years as a Regional Director helping to grow a New England-based technology company from 300 employees to 7,000. He started his career with Martin Marietta Aerospace working on laser guided weapons and day/night vision systems.

A sought-after speaker and accomplished writer, Mr. Benson is the principal author of “Fraud of the Day,” a website dedicated to educating government officials about how criminals are defrauding government programs. He has co-authored WTF? Where’s the Fraud? How to Unmask and Stop Identity Fraud’s Drain on Our Government, and Data Personified, How Fraud is Changing the Meaning of Identity.

Benson holds a Bachelor of Science in Physics from Albright College, and earned two graduate degrees – a Master of Business Administration from Florida Institute of Technology, and a Master of Science in Engineering from Lehigh University.