On Tuesday, August 30, 2016, the Department of Justice along with Connecticut Attorney General George Jepson and the U.S. Department of Health and Human Services announced that Jesus Villegas, DDS, and his two pediatric dental clinics in Milford and West Haven, Connecticut have entered to a civil settlement to pay $1,367,466 to resolve allegations that they violated the federal and Connecticut False Claims Acts.
The allegations revolve around the taking of pediatric dental x-rays at the two dental clinics. Under Connecticut law, a licensed dentist may delegate the taking of dental x-rays to dental assistants if the dental assistant has completed the dental radiography portion of an examination prescribed by the Dental Assisting National Board (DANB). The federal and state cases alleged that the majority of x-rays taken at Dr. Villegas dental clinics were taken by dental assistants who were not DANB certified. This practice was alleged to have violated the federal and state False Claims Act because X-rays taken by uncertified dental assistants are not payable by the Medicaid program yet the defendants billed Medicaid for these X-rays. The conduct covered under the settlement occurred from June 1, 2010 through March 17, 2014.
As part of the settlement, Villegas and the two clinics have entered into a three-year billing Integrity Agreement with the U.S. Department of Health and Human Services. The agreement is designed to ensure future compliance with federal healthcare programs.
The case was investigated by the Office of Inspector General for the Department of Health and Human Services and is being prosecuted by Assistant U.S. Attorney Richard M. Molot and Auditor Kevin Saunders, and by Assistants Attorney General Karen S. Haabestad and Natasha Freismuth of the Connecticut Office of the Attorney General.
Under the qui tam provisions of the False Claims Act, whistleblowers with information about similar fraud against the government may bring a civil case on behalf of the United States. If successful, the government can recover three times the amount the defendants fraudulently billed the government. The whistleblower, who originally filed the qui tam case, is entitled to 15-30% of the government’s recovery as well as their attorney’s fees.
To report fraud, contact Frohsin, Barger & Walthall.