New Jersey Company Agrees to Pay $1.89 Million to Settle Allegations that it Overbilled United States
NOTE: The quote from the U.S. Attorney in the press release below has been updated to clarify that the settlement is based on allegations.
NEWARK, N.J. – Pediatric Dentist Barry L. Jacobson and his company, HQRC Management Services LLC (HQRC), along with 13 affiliated pediatric dentistry practices, agreed to pay $753,457 to resolve allegations that they violated the False Claims Act by allegedly performing and billing for medically unnecessary therapeutic pulpotomies on pediatric patients, U.S. Attorney Philip R. Sellinger announced today.
The settlement, which is the result of a joint investigation between the U.S. Attorney’s Office for the District of New Jersey and the New York Attorney General’s Medicaid Fraud Control Unit (MFCU), also resolves allegations that defendants provided inaccurate servicing provider information on claims submitted to Medicaid managed care organizations. .
“It is unconscionable that medical professionals were allegedly willing to perform unnecessary dental procedures on children simply to make money,” U.S. Attorney Sellinger said. “Recovering their alleged ill-gotten gains only begins to undo this damage. Working with Attorney General James and our partners in the New York Attorney General’s Office, we want to make it clear that this behavior is intolerable.”
“Dr. Jacobson and HQRC allegedly performed unnecessary and invasive dental procedures on children to line their own pockets,” Attorney General Letitia James said. “My office will not tolerate any instance of medically unnecessary procedures performed on vulnerable Medicaid beneficiaries. I am grateful to U.S. Attorney Philip Sellinger and team for their partnership as we investigated this fraudulent scheme.”
According to the contentions of the United States contained in the settlement agreement:
Jacobson is the chief executive officer of HQRC, now doing business as PDS Management Solutions. He is also the founder and owner of the following New York and New Jersey based Pediatric Dentistry Practices party to the agreement: Pediatric Dentistry of Paterson, Pediatric Dentistry of Teaneck, Pediatric Dentistry of Wykoff, Pediatric Dentistry of Flushing, Pediatric Dentistry of the Bronx, Pediatric Dentistry of Valley Stream, Pediatric Dentistry of Brooklyn (Avenue U), Pediatric Dentistry of Brooklyn (Boro Park), Pediatric Dentistry of Monsey, Pediatric Dentistry of Kingston, Pediatric Dentistry of Albany, Pediatric Dentistry of Malone, and North Country Pediatric Dentistry.
The settlement resolves allegations that HQRC dentists performed medically unnecessary therapeutic pulpotomies on pediatric patients. According to the United States, certain dentists performed therapeutic pulpotomies on primary teeth even though there was no dental decay in the inner third of the dentin. The defendants also provided inaccurate servicing provider information on claims for services submitted to New York and New Jersey Medicaid Managed Care Organizations.
Jacobson and the affiliated corporate defendants admit that, in some instances between 2011 and 2018, some dentists affiliated with HQRC performed and billed Medicaid for pulpotomies not supported by the medical records maintained at the respective HQRC affiliated dental practices. The defendants also admit that in some instances, between 2011 and 2014, HQRC made billing errors to New York and New Jersey Medicaid contractors that resulted in inaccurate servicing provider information on claims for services performed at three of its locations.
The allegations were originally made in a lawsuit filed under the whistleblower provisions of the False Claims Act by Lauren Simpson. The Act permits private parties to sue for false claims on behalf of the United States and to share in any recovery. Simpson will receive a total of $135,622 from the federal and state shares of the settlement.
U.S. Attorney Sellinger credited special agents of the U.S. Department of Health and Human Services – Office of the Inspector General, under the direction of Acting Special Agent in Charge Naomi Gruchacz and civil investigator Jeffrey DeFuria of the District of New Jersey’s U.S. Attorney’s Office, with the investigation leading to the settlement.
The government is represented by Assistant U.S. Attorney Susan Pappy of the District of New Jersey’s Health Care Fraud Unit.
The lawsuit is captioned United States of America, State of New York, and State of New Jersey, ex rel. Simpson v. HQRC Management Services, LLC, et al. The claims resolved by the settlement are allegations only and there has been no determination of liability.