NEW HAVEN DENTIST PAYS $212,000
TO SETTLE FALSE CLAIMS ACT ALLEGATIONS
United States Attorney David B. Fein and Connecticut Attorney General George Jepsen today announced that KRISTI ROSSOMANDO, D.M.D. and her dental practice, The CHILDREN’S DENTAL GROUP, P.C., with offices located at 825 Grand Avenue in New Haven, have entered into a civil settlement with the federal and state governments in which they will pay $212,000 to resolve allegations that they violated the federal and state False Claims Acts.
“Dentists and other providers who fraudulently bill the Medicaid program drive up the cost of health care for all of us,” said U.S. Attorney Fein. “The allegations here are particularly egregious because they involve dental services provided to children. The U.S. Attorney’s office is committed to vigorously pursuing health care providers that submit fraudulent claims to government health care programs.”
“It is unacceptable for a dentist to receive payment when no service is performed, or for a staff person to routinely render care that only a dentist is qualified to perform,” said Attorney General Jepsen. “The state will hold providers accountable for all services billed to Medicaid.” Jepsen also thanked the state Department of Social Services for its assistance.
The allegations against ROSSOMANDO involve fraudulent billing to Medicaid for certain pediatric dental services. The services in question were “comprehensive oral evaluations,” billed pursuant to the American Dental Association code D0150. According to the American Dental Association, this service is performed by “a general dentist and/or a specialist when evaluating a patient comprehensively.” The service is provided to new patients, or to established patients who have had a significant change in their health conditions or who have been absent from active treatment for three or more years. It is described as a “thorough evaluation and recording of the extraoral and intraoral hard and soft tissue,” which also “may include the evaluation and recording of dental caries (cavities).”
It is alleged that ROSSOMANDO often did not see a new patient on his or her first visit, yet the practice billed Medicaid for a comprehensive oral evaluation. At the first visit, the child would usually only see a hygienist. The hygienist would then recommend treatment and schedule a follow-up visit. However, ROSSOMANDO would bill Medicaid for a comprehensive oral evaluation, as if ROSSOMANDO had examined the patient and performed the service. Even on days when ROSSOMANDO was not in the office, Medicaid was regularly billed for comprehensive oral evaluations.
To settle allegations under the federal and state False Claims Acts, ROSSOMANDO and CHILDREN’S DENTAL GROUP agreed to pay $212,000, which covers conduct occurring from February 2005 through January 2011.
A complaint against ROSSOMANDO was filed in the United States District Court in Connecticut under the qui tam, or whistleblower, provisions of the both the federal and state False Claims Acts. The relator (whistleblower), Olivia Estrada, whose child had been treated by ROSSOMANDO, will receive a share of the proceeds of the settlement in the amount of $31,800.
The whistleblower provisions of both the federal and state False Claims Acts provide that the whistleblower is entitled to receive a percentage of the proceeds of any judgment or settlement recovered by the government.
This matter was investigated by the Office of Inspector General for the Department of Health and Human Services and the Federal Bureau of Investigation, with the assistance of the Connecticut Department of Social Services. The case was prosecuted by Assistant United States Attorneys Richard M. Molot and David J. Sheldon, and Auditor Susan Spiegel of the United States Attorney’s Office, and by Assistant Attorney General Karen S. Haabestad of the Connecticut Office of the Attorney General.
In entering into the civil settlement agreement, ROSSOMANDO and CHILDREN’S DENTAL GROUP did not admit liability.
U.S. Attorney Fein encouraged individuals who suspect health care fraud to report it by calling the Health Care Fraud Task Force at (203) 785-9270 or 1-800-HHS-TIPS.
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