Charleston Dental Professional Pleads Guilty to Medicaid Scams in Federal Court

A Charleston dental practitioner on Monday pleaded guilty to federal charges that he incorrectly billed Medicaid for more than $700,000 in oral treatments he did not, in fact, carry out on his clients.

Antoine Skaff, 58, pleaded guilty to healthcare scams before U.S. District Judge Joseph R. Goodwin in the Robert C. Byrd United States Courthouse in Charleston. He also participated in a civil settlement with federal government firms in which he will need to pay $2.2 million, or 3 times the loss suffered by West Virginia Medicaid, Assistant United States Attorney Clint Carte stated in a press release.

Part of Skaff’s plea offer for the criminal charges will include him paying $738,067 in restitution, which remains in addition to the payments for the civil settlement, and he will confront 10 years in jail when he is sentenced on Nov. 13.

Skaff confessed Monday to fraudulently billing West Virginia Medicaid and West Virginia Medicaid Managed Care Organizations for more than $700,000 throughout a period of more than 5 years, Carte stated.

Skaff confessed he incorrectly inflated his billing, a practice described as “upcoding,” which he frequently did by incorrectly declaring repayment for treatments including affected teeth, Carte stated. Skaff wrongly notified Medicaid that he carried out more complicated treatments on his clients, such as an extraction of an affected tooth, when he, in fact, carried out less intricate treatments, like the easy extraction of a tooth. Skaff confessed to upcoding at least 7,490 tooth extractions, billing more than $1.3 million for those treatments, Carte stated.

Based upon the treatments he, in fact, carried out, Skaff needs to have billed for $599,200 in the offered time span, Carte stated.

Skaff also confessed he would send incorrect expenses and get payment two times for finishing one treatment, and he got $56,930 from the double billings, Carte stated.

As part of Skaff’s $2.2 million civil settlement, he also will be left out from Medicare and Medicaid programs for 13 years, which means he will not have the ability to costs either entity throughout that time frame. Carte stated.

The West Virginia Medicaid Fraud Control Unit, the FBI, the Office of Inspector General for the United States Department of Health and Human Services, and the Affirmative Civil Enforcement private investigator from the United States Attorney’s workplace performed the examination.

MS Medicaid Recovers $8.6 M in Fraud, Improper Payments

August 31, 2017 – The Mississippi Division of Medicaid (DOM) recuperated $8.6 million dollars from claims that were either straight deceitful or poorly submitted, the DOM revealed in a news release.

Through cooperation in between Medicaid Fraud Control Units (MFCUs) and the DOM Program Integrity Unit, the state of Mississippi had the ability to recuperate roughly $6.3 million through 3rd party liabilities, $1.6 million through program stability, and another $680,000 through monetary and performance evaluations.

7 cases of deceptive billing were described a MFCU in the Mississippi attorney general of the United States’ workplace, which recognized $3.1 million in incorrect billings.

The DOM, which is accountable for a $6 billion state Medicaid budget plan, regularly evaluates costs as a procedure to holds service providers and recipients liable for program use.

” This is federal and state money that we have a duty to recuperate, but at the very same time we put a great deal of effort into avoiding it in the very first place through policy and system modifications,” stated Dr. David J. Dzielak, executive director of the DOM.

The Attorney General’s workplace also kept in mind that securing the Medicaid program from scams makes sure the program’s future and enables it to offer services for the state’s most susceptible clients.

” Our collaboration with the Division of Medicaid, particularly the Program Integrity Unit, plays a crucial function in continuing the battle versus scams in health care advantage programs,” said Attorney General Jim Hood.

” The Medicaid Fraud Control Unit staff is dedicated to safeguarding our most susceptible residents and the resources had to serve them. Not just does our collaboration permit the prosecution of those defrauding the program and the prosecution of those abusing and overlooking clients, but it also enables court purchased restitution and charges in both criminal and civil cases.”.

Oklahoma AG Charges Mother, Daughter with Medicaid Fraud

Oklahoma City – Oklahoma’s Attorney General has charged a mom and child with Medicaid scams after authorities say they sent incorrect claims.

In a press release, Mike Hunter states his Medicaid Fraud Control workplace submitted the charges versus 43-year-old Heather Doss of Tulsa and her mom, 59-year-old Lexie Batchelor of Atoka.

Batchelor is charged with 3 counts of Medicaid scams and one count of identity theft, and Heather Doss is charged with one count of Medicaid scams and one count of identity theft.

According to court files, in between 2010 and 2016, the 2 were sending incorrect claims to the Oklahoma Health Care Authority.

The press release goes on to say Batchelor and Doss are implicated of fraudulently using customer Medicaid recognition numbers to send incorrect claims. Hunter states representatives discovered 197 customer identities fraudulently used to send claims.