Fraud with a Smile

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Calculator and stethoscope on paperwork

A Worcester, Mass., dental office manager has pleaded guilty to her participation in a scheme to defraud the Massachusetts Medicaid program, commonly known as MassHealth. Robin Cronin, 58 of Worcester, along with co-conspirators Dr. Anthony DiStefano III, 70, and Dr. Scott Cale, 65, were each indicted on one count of conspiracy to commit health care fraud and one count of health care fraud. DiStefano III  was also indicted on two counts of aggravated identity theft and one count of tax evasion.

According to the indictment in 2005, DiStefano was excluded from participation in the MassHealth program. He attempted readmission into MassHealth’s provider network twice but was denied both times due to concerns regarding the quality of dental care he delivered to patients. (There’s no doubt that there may have been pain and suffering involved.)

To circumvent his exclusion, DiStefano recruited another dentist, Dr. Cale, to join his illegitimate practice. From 2014-2018, dental services that DiStefano personally delivered were billed to MassHealth using Cale’s provider identification credentials. (That’s where the identity theft charges came in.)

DiStefano took a cut of the money that MassHealth paid to Cale. (No surprise there.) Cronin, who happened to be the office manager, was aware of the arrangement and personally billed MassHealth for claims that were false. (These three were thick as thieves, literally.) 

As if the healthcare crimes were not bad enough, DiStefano still owes substantial tax liabilities to the Internal Revenue Service (IRS) for the year 2014-2018. He evaded his outstanding tax liability by stopping the use of bank accounts and operating his business only in cash.

DiStefano and Cale have pleaded not guilty and are considered innocent until proven guilty. However, if they are found guilty, the charges of health care fraud and conspiracy to commit health care fraud provide for a sentence of up to 10 years in prison, three years of supervised release, and a fine of up to $250,000. (They may need a shot or two of Novocain to survive what’s ahead.)

Today’s Fraud of the Day comes from an article, “Dental Office Manager In Region Admits To Role In Medicare Fraud Scheme,” dated September 22, 2021.

BOSTON – A federal grand jury in Boston has indicted a Worcester dentist, a Chelmsford dentist, and a Worcester office manager for their participation in a scheme to defraud the Massachusetts Medicaid program, commonly known as MassHealth.

Dr. Anthony DiStefano III, 70, of Worcester, was indicted on one count of conspiracy to commit health care fraud, one count of health care fraud, two counts of aggravated identity theft and one count of tax evasion. Dr. Scott Cale, 65, of Chelmsford, and Robin Cronin, 58, of Worcester, were each indicted on one count of conspiracy to commit health care fraud and one count of health care fraud. The defendants were arrested this morning and will appear in federal court in Boston this afternoon.

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Larry Benson
Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.