A dentist in Charleston, WV, who falsely billed West Virginia Medicaid and West Virginia Medicaid Managed Care Organizations (MCOs) for more than $700,000 pleaded guilty to healthcare fraud on Monday, August 21. Antoine Skaff, 58, also entered into a civil settlement with the US Attorney’s Office and other federal and state agencies in which he agreed to pay treble damages of $2.2 million, or 3 times the loss suffered by West Virginia Medicaid.
Skaff, DDS, admitted that he fraudulently billed West Virginia Medicaid and Medicaid MCOs for dental procedures that he did not actually perform on Medicaid recipients. His scheme to defraud Medicaid and its MCOs lasted more than 5 years and involved falsely inflating his billings, commonly known as upcoding, and double billing.
First, Skaff admitted that he upcoded by falsely claiming reimbursement for procedures involving impacted teeth. Typically, only wisdom teeth are impacted. But Skaff admitted that he upcoded billings for tooth extractions by falsely informing Medicaid and its MCOs that he performed more complex procedures such as extractions of impacted teeth when he had actually performed simple extractions.
Because Skaff upcoded these extractions, Medicaid and its MCOs paid him $172 per extraction of each tooth, rather than $80 per tooth for a simple extraction. He also admitted he falsely upcoded at least 7,490 extractions, billing more than $1.3 million. Further, he admitted that if those extractions were medically necessary and if he had actually performed the procedures he claimed, he should have been paid only $599,200.
Next, Skaff admitted he submitted false bills and received payment twice for removing the same teeth from the same patients. He first billed and received payments from Medicaid for the extraction of patients’ specific teeth. Then, he falsely billed and received payment again from Medicaid MCOs for extraction of the same teeth. Skaff admitted that he received $56,930 from his false double billings.
Skaff faces up to 10 years in federal prison when he is sentenced on November 13, 2017. As part of his plea agreement, he agreed to pay $738,067 in restitution. In addition to the civil settlement of $2.2 million, he agreed to be excluded from Medicare and Medicaid programs for 13 years, which means he will not be able to bill them.
“This case demonstrates the good that comes when federal and state agencies work together to identify, investigate, and prosecute healthcare fraud,” said US Attorney Carol Casto. “Through the civil, criminal, and administrative processes brought to bear, the Medicaid program will be made whole, Dr. Skaff will be punished, and we will protect federal healthcare dollars in the future by securing his exclusion from these programs.”
“Collaboration between agencies is the key to continued reduction and prevention of healthcare fraud and abuse in the state,” said Bill J. Crouch, West Virginia Department of Health and Human Resources (DHHR) Cabinet Secretary. “DHHR and its specially trained, nationally recognized Medicaid Fraud Control Unit work daily with our federal and state partners to resolve these issues for the benefit of our citizens and the Medicaid program.”
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