Milford Dentist to Pay $1.3M in Medicaid Fraud Case

MILFORD, CT — A pediatric dentist with practices in Milford and West Haven, has agreed to pay more than $1.3 million to the state and federal government to resolve allegations that uncertified assistants took X-rays of patients.

Dr. Jesus Villegas and his pediatric dental practices – Fairfield Pediatric Dentistry, LLC, in Milford and Haven Pediatric Dentistry, LLC, in West Haven – will pay $1,367,466 to resolve allegations that they violated the federal and state False Claims Acts by authorizing certain dental assistants who were not certified by the Dental Assisting National Board (DANB) to take dental X-rays of his Medicaid patients, according to authorities.

The investigation was conducted jointly with the Connecticut U.S. Attorney's Office, federal agents with the U.S. Health and Human Services Office of Inspector General/Office of Investigations (OIG/OI) and the Connecticut Department of Social Services Office of Quality Assurance.

“Medicaid providers have a legal responsibility to ensure that they are in compliance with all material laws and regulations when they submit claims for services to the Medicaid program, and Medicaid patients are entitled to the highest standard of care for their dental services," Attorney General George Jepsen said in a statement. "The state requires dental assistants to be DANB certified in order to take X-rays to make certain they are done safely, which protects both the patient and the dental assistant. I'm pleased that we have reached an agreement in this case, and that we are also putting in place compliance requirements that will ensure this provider adheres to appropriate billing processes going forward to protect the integrity of our Medicaid program.

“I am grateful to our partners in this investigation, especially the Connecticut U.S. Attorney's Office, the federal agents of the OIG/OI and the state Department of Social Services Office of Quality Assurance, for their coordination and work in this case, and for the continued cooperation between agencies, both state and federal, as we work to protect our public healthcare programs."

The state and federal government alleged that from June 2010 through March 2014, Villegas – who has been enrolled as a provider in the Connecticut Medical Assistance Program (CMAP) since 1995 – submitted false claims to Medicaid for X-ray services knowing that they were taken by uncertified dental assistants.

The settlement funds – of which the state's share is 60 percent, or approximately $820,479 – will be used to reimburse the Medicaid program, according to a press release. The state Department of Social Services (DSS) is the administering state agency for Medicaid.

In addition to the settlement funds, Villegas and his practices have agreed to implement a compliance program designed to ensure compliance with all applicable state and federal healthcare laws and must provide to the Attorney General certifications of adherence to the compliance program for the next three years. Villegas and his practices will also enter into a separate Integrity Agreement with the Office of the Inspector General of the U. S. Department of Health and Human Services.

“Health care providers must utilize properly certified individuals to treat patients, and the failure to ensure such proper care for patients will have serious consequences,” U.S. States Attorney Deirdre M. Daly said in a statement. “The U.S. Attorney’s office is committed to vigorously pursuing health care providers who submit false or fraudulent claims to federal health care programs.”

Phillip M. Coyne, Special Agent in Charge of the U.S. Department of Health and Human Services, said “dentists must ensure that only certified staff provide services to their patients.”

“Cutting corners could jeopardize the safety of patients and the integrity of the Medicaid program,” Coyne said in a statement. “Working with our law enforcement partners, our agency is dedicated to protecting patients and the government health care programs designed to serve them.”

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