Two charged in $6M pediatric dental Medicaid fraud/kickback scheme
HOUSTON – An operator and manager at a dental clinic have been charged for their roles in a health care fraud scheme involving $6 million in claims to Medicaid, announced U.S. Attorney Jennifer B. Lowery.
Authorities took Ifeanyi Ndubisi Ozoh, 51, Houston, into custody today. He is expected to make his initial appearance tomorrow before U.S. Magistrate Judge Sam Sheldon at 2 p.m. Also charged is Rene Fernandez Gaviola, 65, also of Houston. He had been previously arrested on similar charges Aug. 1. He is expected to appear on the new charges in the indictment in the near future.
On Aug. 16, a federal grand jury returned the 13-count indictment which was unsealed upon Ozoh’s arrest today.
According to the charges, Gaviola was the operator, while Ozoh was the manager of Floss Family Dental Care clinic located in Houston.
The indictment alleges Gaviola and other employees submitted false and fraudulent claims to Medicaid for dental services such as cavity fillings that were never provided as billed. Gaviola and Ozoh also allegedly paid kickbacks to marketers and caregivers of children Medicare insures to bring them to Floss for dental services.
Gaviola also employed at least one individual to practice pediatric dentistry without a license and billed Medicaid for their services, according to the charges.
The indictment further alleges Gaviola laundered Medicaid monies from the Floss business bank account to his personal bank account in several transactions exceeding $100,000.
From 2019 to 2021, the dental company allegedly billed Medicaid for nearly $6.9 million for which Medicaid paid approximately $4.9 million. Many of the dental services were not provided or that unlicensed and non-enrolled individuals had administered.
If convicted, Ozoh and Gaviola face up to five years in federal for conspiracy to pay and receive kickbacks. Gaviola also faces up to 10 years for conspiracy to commit health care fraud and each count of health care fraud and money laundering. All charges also carry a possible $250,000 maximum fine.
The FBI, Texas Attorney General’s Medicaid Fraud Control Unit and the Department of Health and Human Services - Office of Inspector General conducted the investigation with assistance of Customs and Border Protection. Special Assistant U.S. Attorney Kathryn Olson is prosecuting the case.
An indictment is a formal accusation of criminal conduct, not evidence.
A defendant is presumed innocent unless convicted through due process of law.