Charleston dentist sentenced to five years in federal prison for health care fraud
Dentist overcharged and falsely billed Medicaid and managed care organizations for more than $700k; agrees to pay over $2.2 million in civil settlement
CHARLESTON, W.Va. – A Charleston dentist who falsely billed West Virginia Medicaid and West Virginia Medicaid Managed Care Organizations (MCOs) for more than $700,000 was sentenced today to five years in federal prison, announced United States Attorney Carol Casto. Antoine Skaff, 58, previously pleaded guilty to health care fraud. Skaff also previously entered into a civil settlement with the U.S. Attorney’s Office, the Office of Inspector General for the U.S. Department of Health and Human Services, the West Virginia Department of Health and Human Resources (DHHR), DHHR’s Bureau for Medical Services, and the West Virginia Medicaid Fraud Control Unit, in which he agreed to pay treble damages of $2.2 million, or three times the loss suffered by West Virginia Medicaid.
Skaff, a dentist, fraudulently billed West Virginia Medicaid and Medicaid MCOs for dental procedures that he did not actually perform on Medicaid recipients. Skaff’s scheme to defraud Medicaid and its MCOs lasted more than five years and involved upcoding and double billing.
Skaff admitted that he falsely inflated his billings, a practice commonly known as upcoding, often by falsely claiming reimbursement for procedures involving impacted teeth. Typically, only wisdom teeth are impacted. However, Skaff admitted that he upcoded billings for tooth extractions by falsely informing Medicaid and its MCOs that he performed more complex procedures, such as extractions of impacted teeth, when he had actually performed simple extractions. Because Skaff upcoded these extractions, Medicaid and its MCOs paid Skaff $172 per extraction of each tooth, rather than $80 per tooth for a simple extraction. Skaff additionally admitted that he falsely upcoded at least 7,490 tooth extractions, billing more than $1.3 million for those procedures. He further admitted that if those extractions were medically necessary, and if had actually performed the procedures he claimed, then he should have been paid only $599,200.
Skaff also admitted that he submitted false bills and received payment twice for removing the same teeth from the same patients. Skaff first billed and received payments from Medicaid for the extraction of patients’ specific teeth. He then falsely billed and received payment again from Medicaid MCOs for extraction of the same teeth. Skaff admitted that he received $56,930 from his false double billings.
The West Virginia Medicaid Fraud Control Unit, the FBI, the Office of Inspector General for the U.S. Department of Health and Human Services, and the Affirmative Civil Enforcement investigator from the U.S. Attorney’s Office conducted the investigation. Assistant United States Attorney Meredith George Thomas is in charge of the criminal prosecution. Assistant United States Attorney Jennifer Mankins is responsible for the civil settlement. United States District Judge Joseph R. Goodwin imposed the sentence.
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