AG names 28 in civil complaing alleging illegal Medicaid billing scheme
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Jun 1, 2012 - 9:25 AM
HARTFORD, CT - Attorney General George Jepsen has brought a civil action against 28 individuals, dental practices and corporations alleging an elaborate and illegal scheme, which resulted in more than $24 million in fraudulent Medicaid clams over two years in violation of the Connecticut False Claims Act and Connecticut Unfair Trade Practices Act.
The complaint seeks restitution, treble damages and civil penalties as well as a permanent injunction against the unlawful acts and practices alleged in the complaint.
The individuals named in the State’s complaint are Gary Anusavice of North Kingston, R.I., Mehran Zamani of Pound Ridge, N.Y. and Stamford; Paul Anusavice of North Grafton, MA; John Gallagher of Manchester, MA; David Wu of Cheshire and Alphonso Mack of Bloomfield.
Gary Anusavice and Zamani were arrested last week on federal criminal charges for their alleged involvement in the same billing scheme.
“This is the first case the state has initiated under the Connecticut False Claims Act,” Attorney General Jepsen said. “It gives the State the rightful ability to seek compensation for taxpayers from those who seek to abuse the system with false claims for reimbursements they are not eligible to receive.”
The Attorney General brought the unfair trade practices complaints at the request of Consumer Protection Commissioner William Rubenstein. “The allegations of the complaint are serious, and our consumer laws against unfair and deceptive practices protect state taxpayer dollars whenever medical providers make wrongful claims for reimbursement from the Medicaid program,” Rubenstein said.
Department of Social Services Commissioner Roderick L. Bremby, said “We greatly appreciate the Attorney General’s dedication of both resources and expertise to bring forward this major case of alleged provider fraud. DSS investigators first identified the suspected fraudulent activity and worked with the AG’s Office and federal authorities to develop the case. The role of the Department of Consumer Protection is also important in our collective efforts to root out fraud and abuse on behalf of taxpayers.”
The DSS administers the Connecticut Medical Assistance Program, which includes Medicaid, a joint federal-state program, which provides medical benefits for more than 500,000 low-income Connecticut residents.
The State complaint also names the dental practices and other corporations created or controlled by the various individuals. They include E.G.A. Mangement, Inc., Haven Consulting, Inc. and AMZ Consulting, Inc., Dental Care of Connecticut, Inc., and N.B. Dental, Inc.; Electron Marketing, Inc. of Fall River, MA; Dental Group of Stamford, LLC and Dentists Group of Stamford, PC.
Also named were: Mehran Zamani, LLC, and Mehran Zamani, DDS, PC; Dental Group of Connecticut, LLC, and Dentists Group of Connecticut, PC; Dental Group of Waterbury, LLC, and Dentists Group of Waterbury, PC; Dental Group of Danbury, PC; Dental Group of New Britain, PC; Dental Group of Hartford, PC; Hartford Dental Care, LLC; Hartford Dental Incorporated, PC; Arbor Dental Association, LLC; Alpha Dental Group, PC; and Wintonbury Dental Associates, PC.
According to the complaint, in July, 1997, Gary Anusavice, a dentist at the time, was convicted of a felony in Massachusetts for submitting false health care claims. As a result of the conviction, he was permanently excluded by the U.S. Department of Health and Human Services from participation in Medicare and state health care programs, including Medicaid, after April 1998.
The notification letter said the exclusion also applied to “any entity in which you are serving as an employee, administrator, operator, or in any other capacity, for any services including administrative and management services that you furnish, order or prescribe… Therefore, you cannot submit claims or cause claims to be submitted for program payment.”
The state alleges that despite the exclusion, Anusavice, through a series of corporations, set up a number of dental practices around Connecticut, which were operated by practicing dentists, who then applied to the Connecticut Medical Assistance Program to become providers or who were providers and billed Medicaid for services, in violation of the exclusion.
The complaint alleges that Anusavice continued to be actively involved in managing the practices, which received millions of dollars in Medicaid reimbursements in violation of the exclusion. Although Anusavice was no longer licensed by any state to practice dentistry, he 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.
Further, the complaint alleges that the dental providers -- Zamani, Wu and Mack – as part owners, managing members, or directors of the named dental practices, knew of Anusavice’s ownership role and/or exclusion and failed to disclose it on enrollment or reenrollment forms for the Connecticut Medical Assistance Program.
Assistant Attorneys General Joshua Jackson and Karen Haabestad are handling this matter for the Attorney General with Forensic Fraud Examiners Lawrence Marini and David Boucher, and Assistant Attorney General Arnold Menchel, head of the Health Care Fraud department.
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