Essilor Agrees to Pay $16.4 Million to Resolve Alleged False Claims Act Liability for Paying Kickbacks
Two North Texas dentists, their dental management companies, and certain affiliated pediatric dental practices have paid the United States $3.1 million to resolve allegations that they defrauded the Texas Medicaid program and violated the False Claims Act by knowingly billing for pediatric dental services that were not rendered or that falsely identified the person who provided the service, announced Acting U.S. Attorney Prerak Shah of the Northern District of Texas.
“These defendants knowingly defrauded Medicaid, a program that provides medical coverage for more than 4 million low-income Texans,” said Acting U.S. Attorney Shah. “If they thought they could get away with this scam by targeting underprivileged populations, they were sorely mistaken.”
Drs. Gunjan Dhir, 43, and Gaurav Puri, also 43, have owned and operated dental clinics and dental management companies throughout Texas since 2009. The clinics serve primarily low-income children enrolled in the Texas Medicaid program; the dental management companies provide management and administrative services to the clinics. After opening their first dental clinic in 2009, Drs. Dhir and Puri rapidly expanded their operation to include 35 dental clinics operating statewide by 2015.
This settlement resolves allegations that between May 30, 2011 and May 30, 2017, Drs. Dhir, Puri, and their affiliated management companies and pediatric dental clinics submitted or caused the submission of false claims for payment to the Texas Medicaid Program for fillings in children that were not actually performed. The settlement also resolves allegations that they submitted or caused the submission of claims using erroneous Medicaid provider numbers misrepresenting the dentists who performed pediatric procedures.
Funded jointly by the states and the federal government, Medicaid is intended to serve low-income families and children. The State of Texas paid for part of the Medicaid claims at issue and will receive approximately half of the government’s share of the settlement amount.
Part of the allegations resolved by this settlement were originally filed under the qui tam, or whistleblower, provisions of the False Claims Act by relators Sandy Puga, Nelda Torres-Brown, and Sonia Cardoso, all former employees of the implicated dental management companies and/or pediatric dental practices, who will receive a fraction of the settlement. (The Act permits private persons with evidence of fraud to sue on behalf of the government for false claims for government funds and to receive a share of any recovery.)
The case was handled for the government by Assistant U.S. Attorneys Kenneth Coffin and Braden Civins on behalf of the Department of Health & Human Services Office of Inspector General and the State of Texas, with assistance from the Texas Attorney General’s Office, Civil Medicaid Fraud Division.
The claims resolved by the settlement are allegations only and there has been no determination of liability.