Showing posts with label MassHealth. Show all posts
Showing posts with label MassHealth. Show all posts

Tuesday, August 07, 2018

Dazzling Smile Care PC and Dr. Shahrzad Haghayegh-Askarian Indicted on Medicaid Fraud Charges

August 7, 2018
BostonA Quincy-based dentist who was banned from the state’s Medicaid program has been indicted in connection with an alleged scheme to fraudulently bill MassHealth under another dentist’s name, Attorney General Maura Healey announced today.

Dr. Shahrzad Haghayegh-Askarian, age 43, of Norwell, was indicted by a Statewide Grand Jury on charges of Medicaid False Claims (2 counts) and Larceny over $1,200 (2 counts). Haghayegh-Askarian’s company, Dazzling Smile Care PC, located in Quincy, was also indicted on the same charges. 

An audit by the State Auditor’s Office uncovered Medicaid fraud committed by Dr. Haghayegh-Askarian. Following that audit, Dr. Haghayegh-Askarian agreed to a $300,000 settlement with the AG’s Office in 2015 and was terminated from participating in the MassHealth program. The settlement stipulated that she could only re-enroll with MassHealth if she met standards of compliance and instituted a monitoring program mutually agreed upon by Dr. Haghayegh-Askarian and the AG’s Medicaid Fraud Division.

The AG’s office alleges that, despite her termination from MassHealth, from April 2014 to December 2017, Dr. Haghayegh-Askarian continued to treat MassHealth patients and billed those services under the name and identification number of another dentist, without his knowledge or authorization. That dentist contacted the Office of the State Auditor to report this alleged fraudulent activity when he learned of it in September 2017. 

“I commend my staff and the staff of Attorney General Healey for their work to bring charges against Dr. Haghayegh-Askarian,” said State Auditor Suzanne Bump. “Her license should be immediately revoked, and her continued, brazen abuse of MassHealth should be punished.”

“This matter illustrates the commitment of all agencies to combat medical billing fraud which affects all citizens,” said Anthony DiPaolo, Chief of Investigations at the Insurance Fraud Bureau of Massachusetts. “The IFB places a high priority on fighting this type of insurance fraud. The collaboration in this matter is unprecedented.”

All of these charges are allegations and defendants are presumed innocent until proven guilty.
The matter was investigated by Assistant Attorneys General Jay McCormack and Kevin Lownds, Investigations Supervisor Lisa Bailey and Investigators April Waterhouse and Deborah ElMajdoubi, all of Attorney General Maura Healey’s Medicaid Fraud Division, with assistance from MassHealth, the Insurance Fraud Bureau of Massachusetts, the State Auditor’s Office, and Massachusetts State Police assigned to the AG’s Office.

Tuesday, September 05, 2017

Dental Dreams, LLC Settles with MassHealth for $1.3 Million

September 5, 2017

BOSTON – The U.S. Attorney’s Office and the Massachusetts Attorney General’s Office announced today that Dental Dreams, LLC, a national dental chain with locations in Massachusetts, has agreed to pay $1.375 million to resolve allegations that it improperly billed the Massachusetts Medicaid program (MassHealth) for unnecessary and unjustifiable dental procedures.

Dental Dreams enriched itself at taxpayer expense by improperly billing Medicaid,” said Acting U.S. Attorney William D. Weinreb. “We will continue to work with our law enforcement partners to ensure that federal and state health care dollars are spent properly.”

“This dental chain’s extensive improper billing violated state regulations and cost our state’s Medicaid program more than a million dollars,” said Massachusetts Attorney General Maura Healey. “As a result of this joint investigation, today’s settlement provides restitution to MassHealth and ensures that these funds are properly used to benefit its members.”

“Medicaid is designed to provide health care services to some of the most vulnerable members of our society and it’s our agency’s mission to ensure government health funds are spent properly,” said Special Agent in Charge Phillip M. Coyne of the U.S. Department of Health and Human Services Office of Inspector General. “Working with our Federal and State partners, we will continue to hold accountable any medical professional who, just to enrich themselves, bills Medicaid for more intensive and expensive services than those actually provided.”

“The company took advantage of a vulnerable patient population when it submitted claims to MassHealth for medically unnecessary and unreasonable dental procedures,” said Harold H. Shaw, Special Agent in Charge of the Federal Bureau of Investigation, Boston Field Division. “Today’s settlement underscores the FBI’s commitment to investigate health care providers who overbill federal and private health insurance programs to maximize profits. We urge anyone with information regarding overbilling practices to contact us.”

The settlement resolves allegations that Dental Dreams overbilled the Massachusetts Medicaid program for surgical extractions of teeth and for a specific kind of oral examination.

The settlement resolves a lawsuit filed by a former employee under the whistleblower provisions of the False Claims Act, which permits private parties to sue on behalf of the government for false claims for government funds and to receive a share of any recovery.

Acting U.S. Attorney Weinreb, Massachusetts Attorney General Healey, HHS-OIG SAC Coyne and FBI SAC Shaw made the announcement today. The case was handled by Assistant U.S. Attorneys Michelle Leung, Sonya Rao, and Kriss Basil of Weinreb’s Civil Division and Assistant Attorney General Stephany Collamore of Healey’s Medicaid Fraud Division.

Monday, August 21, 2017

Gentle Smiles, LLC and Dr. Annie Watson, DDS Settles Fraud Allegations with Masshealth

AG Healey Returns $500,000 to Masshealth in Settlement With Springfield Dentist Over Alleged Improper Billing

August  21, 2017

BOSTON – Attorney General Maura Healey announced today that her office has reached a settlement with a pediatric dentist in Springfield, returning $500,000 to the state’s Medicaid program (MassHealth) and resolving claims that the dentist improperly billed the program for services.
The settlement agreement resolves allegations that Dr. Annie Watson, DDS and her dental practice, Gentle Smiles, LLC, improperly billed MassHealth for palliative care (emergency pain treatment) between March 2010 and June 2013, and failed to comply with MassHealth rules associated with the use of that emergency treatment billing code.

The AG’s Office began an investigation into Dr. Watson and Gentle Smiles upon a referral from MassHealth, which identified Dr. Watson as the top biller of the palliative care code among all MassHealth dental providers.

Palliative care is the emergency treatment of dental pain that relieves the pain but is not curative and can include draining of an abscess or prescribing pain medication or antibiotics. In order to bill this code, the patient’s dental record must contain a description of the treatment provided and must document that the treatment was given on an emergency basis.

The AG’s investigation revealed that Dr. Watson routinely billed for palliative care without any supporting documentation, including when patients only received cleanings and x-rays.
Under the terms of the civil settlement, Dr. Watson and her business will pay MassHealth $500,000 as restitution for improper billing. The settlement also requires that Dr. Watson and her employees review and comply with all applicable state and federal statutes, and all regulations governing participation in MassHealth.

MassHealth provides healthcare products and services to eligible low-income individuals, including people with disabilities, children and senior citizens.

This matter was handled by Managing Attorney Lee Hettinger and Investigator Deborah El Majdoubi, both of the AG’s Medicaid Fraud Division. MassHealth assisted in this investigation.

Monday, September 26, 2011

The Real Cheaters

Boston Herald Monday September 26, 2011

The cheating done by food stamp recipients is peanuts compared to vendor fraud (“Life’s a beach on EBT street,” Sept. 22).

Most fraud is done by pharmacies, doctors, dentists, nursing homes, hospitals and sellers of medical equipment. The government recovered $2.5 billion in overpayments for Medicare in 2009 as the Obama administration focused attention on fraud enforcement efforts in the health industry.
Click here to read the full story
The Real Cheaters

Wednesday, June 22, 2011

Straight Smiles - Another illegal dental clinic owned and operated by Church Street Health Management opens in Worcester, MA


I hope the folks at “Straight Smiles” are paying real close attention to the Medicaid Orthodontics scams being exposed in Texas, since I’m sure that is exactly what this is as well, if not worse.

[honestly I can hardly even say “straight smiles” since I immediately think of “straight face” and how they keep one I’ll never know]

In the article below the “Lead Orthodontist” said about the patient she was examining:

“ Zulanihs had a loose tooth and small signs of a posterior cross bite. Although she was not ready for braces, interceptive treatment would widen the upper arch of her palette”

(her licenses say she is a “general dentist, searching the Dentaquest site for MA Orthodontists, there is only 2 in a 30 mile radius, and she is NOT one of them)

[she means a palatal expander as seen here and here ] hyraxmodelRPE

“If this wasn’t found or not acted upon, it could result in trauma as well as recession of her lower anterior teeth.” 

[trauma!  really? well dang good thing the child got in there in time to prevent such a trauma]

It really means we found something, ever so tiny and insignificant but I think I found something so we can bill the taxpayers of Massachusetts.

Is it legal?  Well, of course not.  However I asked a dear friend, a dentist, living in Massachusetts about having to be a “real” orthodontist and advertising as a “specialty” when you are NOT a specialist?  Here is their reply:

As for the ortho question, you are going to just love my unclear and muddled answer! In the wacky state of Massachusetts, general dentists can do ortho, provided that they can "perform to the same standards" as specialists. (If that truly is the case, then why would any Orthodontist spend the extra 2-3 years in residency?)
In medicine, that is almost like your ear/nose/throat guy deciding he'll take a swing at open heart surgery.
The regulations, as far as I'm aware mostly have prohibitions against advertising to the public as a specialist. This pretty much falls in line with the ADA position. Hope this helps.


Wednesday, April 23, 2008

Small Smiles In MassHealth Lists DeRose's Uncle-Adolph Padula

Here is a form listing all the dentist that accept Medicaid in the MassHealth (Massachusetts). You can enter "Small Smiles" or "Padula" where it says "Find" and keep searching through the documents using the down arrow beside the "Find" box.

Check out the names of all the dentist associated with Small Smiles in the different cities in the state!

See a pattern here, I sure do!

And guess what, Michael DeRose's uncle, Adolph Padula is on the list in at least one of the Small Smiles offices and this list is current 4-22-08! And DeRose says he "sold" Small Smiles... yeah, whatever!

Monday, April 21, 2008

MassHealth Small Smile/Kool Smiles Charted Increase In Claims

Sorry but this is hard to make out under these conditions but you can view it personally at this link: click here

In the following chart filed in a Remediation Monitors Report that has to do with recommendations with MassHealth and dental reimbursements. Note the number of dentist from 2003 and 2006 are 842 and 845 respectively: a difference of 3 providers.

In the second chart please note the great increase in claims! 302,469 was noted for Small Smiles/Kool Smiles in 2006. It was such an increase and large portion of the claims it was worth noting separately! That's a whole lot of unnecessary work don't you think!