Connecticut Dentist Reaches $300,000 Settlement in Overbilling Case

Dentistry Today

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Connecticut Attorney General William Tong, the United States Department of Justice, and Department of Social Services Commissioner Deidre S. Gifford have reached a $300,000 joint state and federal False Claims Act settlement with Columbia Dental PC, Columbia Oral Maxillofacial Imaging LLC, and Abbas Mohammadi, DDS, collectively “Columbia Dental,” regarding the overbilling for dental services and the use of uncertified dental assistants. Mohammadi is the owner of Columbia Dental PC and Columbia Oral Maxillofacial Imaging.

Following a complaint filed in federal court alleging violations of the federal and state false claims acts, the Office of the Attorney General conducted a joint investigation with the US Health and Human Services Office of the Inspector General/Office of Investigations and the Office of the United States Attorney. The Office of the Attorney General said that the investigation developed substantial evidence that Columbia Dental repeatedly overcharged the Connecticut Medical Assistance Program (CMAP), which includes Medicaid, for dental fillings that were either never performed or were medically unnecessary.

The office said that the investigation also uncovered substantial evidence of dental x-rays being taken by dental assistants who were not certified by the Dental Assisting National Board (DANB). Connecticut law requires DANB certification of dental assistants before they are allowed to take x-rays. The certification demonstrates that the dental assistant successfully completed a course of instruction on the protocols and operating procedures that must be followed to ensure the safe administration of x-rays.

From January 1, 2014, through November 30, 2015, Columbia Dental routinely caused claims for payment to be submitted to CMAP for x-rays taken by dental assistants who had not obtained DANB certification, the Office of the Attorney General said.

“Columbia Dental repeatedly charged the state Medicaid program for work that was never performed. Medicaid providers have an affirmative obligation to ensure that services they bill for were actually performed. Columbia Dental also routinely submitted claims for reimbursement for x-rays taken by dental assistants without DANB certification. The statutory requirement that dental assistants be DANB certified before taking x-rays is meant to ensure x-rays are done safely, which protects both the patient and the dental assistant,” said Tong.

“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. The Office of Attorney General takes seriously our obligation to safeguard our public healthcare programs, and we will take strong action against any provider who abuses the public trust,” said Tong.

“The disturbing facts of this False Claims Act settlement case underscore the need for all Medicaid-enrolled providers to scrupulously fulfill their therapeutic and legal responsibilities to patients and the taxpaying public. I join Attorney General Tong in commending his staff, state, and federal anti-fraud investigators, and the US Attorney’s Office for their outstanding work in this matter,” said Gifford.

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