A Connecticut pediatric dentist, Dr. Jesus Villegas, and his Milford and West Haven dental practices have agreed to pay over $1.3 million to resolve allegations that they submitted false claims to Connecticut's Medicaid program for x-ray services that did not comply with state law, Attorney General George Jepsen announced Tuesday.
Dr. Villegas and his two practices allegedly violated federal and state False Claims Acts when they submitted claims for payment of x-ray services to the Connecticut Medical Assistance Program (CMAP) knowing that x-ray personnel were not properly certified. Over $820,000 of the $1.3 million settlement will go toward CMAP reimbursement.
Connecticut Medicaid Requires Proper Dental Assistant Certification for X-Ray Procedures
Connecticut law requires that dental assistants obtain Dental Assisting National Board (DANB) certification before receiving authorization to take dental x-rays. DANB certification ensures that the dental assistant has successfully completed a course on the safety protocols and operating procedures required for the safe administration of x-rays.
In this case, the federal and Connecticut State governments alleged that the majority of x-rays taken in Dr. Villegas’ two dental clinics between June 1, 2010 and March 17, 2014 were by uncertified assistants. Submitting claims for payment of dental x-ray services to Connecticut Medicaid when those services do not comply with state law violates federal and state False Claims Acts.
“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.”
Villegas’ Dental Practices Enter Integrity Agreements, Reimburse Connecticut Medicaid $821K
Dr. Villegas, Milford-based Fairfield Pediatric Dentistry, LLC, and West Haven’s Haven Pediatric Dentistry, LLC, agreed to pay $1,367,466 to federal and Connecticut State governments. Connecticut Medicaid will collect 60% of the total settlement amount, or $820,479, in reimbursement. As part of the settlement, Dr. Villegas and his practices have agreed to implement a program to ensure compliance with state and federal health care laws. The defendants must provide certifications of adherence to the compliance program to the Attorney General for the next three years. Dr. Villegas and the two practices have also entered into a three-year billing integrity agreement with the U.S. Department of Health and Human Services designed to ensure future compliance with the requirements of federal healthcare programs.
“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. Attorney for the District of Connecticut, 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.”
Reporting Connecticut Medicaid Fraud Pays Cash Awards
Medicaid fraud costs Connecticut taxpayers millions of dollars each year. Dental assistants, nurses, technicians, bookkeepers and other health care professionals with inside knowledge of fraud are the most valuable tool our government has to detect misconduct and recover Medicaid dollars lost to fraud, waste and abuse.
Federal and state False Claims Acts offer large cash awards to whistleblowers who report their inside knowledge and act to protect patients from receiving medically unnecessary or dangerous care. Health care professionals who suspect fraud is occurring within their place of employment must be the first to report the fraud to qualify for the cash whistleblower award.