Connecticut Dentist Pays Over $148K to Settle Improper Billing Allegations
U.S. Attorney John H. Durham and Connecticut Attorney General William Tong today announced that EAN JAMES, D.M.D., has entered into a civil settlement with the federal and state governments in which he will pay more than $148,000 to resolve allegations that he caused overpayments to be paid by the Connecticut Medicaid Program.
James is an oral and maxillofacial surgeon who practices at Hartford County Oral Surgery in Bristol and Rocky Hill. The government’s allegations against James arise out of billing Medicaid for sedation and anesthesia services without a valid permit to perform those services.
In order for a dentist to administer moderate or deep sedation or general anesthesia to patients during dental procedures, the State of Connecticut requires the practitioner to have an active permit to perform conscious sedation, issued by the Connecticut Department of Public Health (“DPH”). This conscious sedation permit must be renewed annually. If the annual deadline to renew the conscious sedation permit lapses, there is a 90-day grace period during which a dentist may still administer anesthesia and sedation under the expired permit and may still apply for a renewal. Once the grace period expires, the permit becomes void. The dentist may not administer anesthesia or sedation, and must apply for a new permit if he or she wishes to resume providing those services.
On April 30, 2018, James’ conscious sedation permit lapsed. He failed to renew his permit and, on August 1, 2018, the 90-day grace period expired. Despite not having an active permit, James continued to provide anesthesia and sedation services to Medicaid patients undergoing certain oral surgical procedures, and billed Medicaid for these services. The government alleges that these claims for sedation services performed without a valid permit were improper.
To resolve his liability, James will pay $148,632.23 to the federal and state governments for conduct occurring between August 1, 2018, and June 7, 2019.
This matter was investigated by the Office of the Inspector General for the Department of Health and Human Services, and the Connecticut Office of the Attorney General. This case was prosecuted by Assistant U.S. Attorney Sara Kaczmarek, and by Assistant Attorney General Michael Cole of the Connecticut Office of the Attorney General.
People who suspect health care fraud are encouraged to report it by calling 1-800-HHS-TIPS or the Health Care Task Force at (203) 777-6311.