Dentist pays for making false claims to Medicaid
Updated: Tuesday, 11 Oct 2011, 4:42 PM EDT
Published : Tuesday, 11 Oct 2011, 4:42 PM EDT
New Haven, Conn. (WTNH) - A New Haven dentist is paying over $200,000 for making false claims for services provided at her dental office.
Kristi Rossomando, D.M.D and her dental practice, The Children's Dental Group, P.C., located at 825 Grand Avenue, have entered into a civil settlement in which they will pay $212,000 to resolve allegations that they violated the federal and state False Claims Acts.
"Dentists and other providers who fraudulently bill the Medicaid program drive up the cost of health care for all of us," said U.S. Attorney Fein. "The allegations here are particularly egregious because they involve dental services provided to children. The U.S. Attorney's office is committed to vigorously pursuing health care providers that submit fraudulent claims to government health care programs."
"It is unacceptable for a dentist to receive payment when no service is performed, or for a staff person to routinely render care that only a dentist is qualified to perform," said Attorney General Jepsen. "The state will hold providers accountable for all services billed to Medicaid."
Jepsen also thanked the state Department of Social Services for its assistance.
The allegations against Rossomando involve fraudulent billing to Medicaid for certain pediatric dental services. The services in question were "comprehensive oral evaluations."
According to the American Dental Association, the service is performed by "a general dentist and/or a specialist when evaluating a patient comprehensively." The service is provided to new patients, or to established patients who have had a significant change in their health or who have not got regular treatment in several years. It is described as a "thorough evaluation and recording of the extraoral and intraoral hard and soft tissue," which also "may include the evaluation and recording of dental caries (cavities)."
It is alleged that Rossomando often did not see a new patient on his or her first visit, yet the practice billed Medicaid for a comprehensive oral evaluation. At the first visit, the child would usually only see a hygienist. The hygienist would then recommend treatment and schedule a follow-up visit. However, Rossomando would bill Medicaid for a comprehensive oral evaluation, as if she had examined the patient and performed the service. This even happened on days when Rossomando was out of the office.
In order to settle the allegations under the federal and state False Claims Acts, Rossomando and Children's Dental Group have agreed to pay $212,000, covering the time period of February 2005 through January 2011.
Olivia Estrada, the mother of one of Rossomando's patients, was the "whistleblower" or person who brought attention to the crime and will receive a share of the proceeds of the settlement in the amount of $31,800.
Dr. Kristi Rossomando has seen the court room before:
Dr. Kristi Rossomando, Plaintiff V. Board of Regents of the University of Nebraska