Exclusion Violation by Dentist "Sends a Strong Warning"

February 1, 2017

By Paul Weidenfeld

The Office of the Inspector General's (OIG) announced last week that it had reached a settlement in excess of a million dollars with an excluded dentist for violations of the provisions of the regulations denying participation in federal health care programs by an excluded individual. The terms of the settlement require the excluded dentist to pay $1.134 Million in Civil Money Penalties and to agree to be excluded from participation in Federal Health care Programs for a period of 50 years!

Excluded Dentist Assumes the Identity of a Dead Colleague

An investigation lead by the OIG found that a New Jersey dentist who had lost his license and been excluded from participating in federal health care programs managed to avoid these professional sanctions for almost seven (7) years.   The dentist was excluded from participation in federal health care programs in 2000 as a result of licensure issues (he was suspended from practicing dentistry in 1999 and had his license revoked in 2004), but he was able to circumvent these sanctions by assuming the identity of a colleague in and maintaining that identity even after the colleague's death.  In this way, the excluded dentist was able to re-start practicing in 2005 and to continue until 2012 during which time he owned, controlled, and managed a large New Jersey dental practice with multiple locations.   

An "Appropriate Resolution" for his Fraud and Putting Patients at Risk

To resolve the case, the dentist agreed to pay $1,134,000 in Civil Money Penalties (CMP) and, in addition, he agreed to be excluded from participation in Federal health care programs for a period of fifty years.  The federal exclusion will, as is made clear in the recent revisions to the OIG's exclusion authority we previously reported on, include Medicaid in addition to Medicare, TRICARE, and the Children's Health Insurance Programs known as CHIPS.  The OIG alleged that the individual owned, controlled, and managed a dental practice with multiple locations,

In a strongly worded news release issued by the OIG, Gregory E. Demske, chief counsel to the Inspector General said: "This case sends a strong warning that individuals who intentionally circumvent exclusion to defraud Federal health care programs face substantial consequences.”   Noting that “[F]ifty years is one of the longest exclusion periods ever imposed by our office,” Demske went on to say that “[T]his period of exclusion, coupled with the significant monetary recovery, is an appropriate resolution for an individual who went to such great lengths to defraud a Federal health care program and put patients at risk.”

Interesting Aspects to the OIG's Investigation

Though the case deals almost entirely with issues related the Medicaid Program (Medicaid reimbursements, Medicaid losses and Medicaid Regulations), there is no mention in the press release of involvement by the New Jersey Medicaid Fraud Control Unit.  Typically, one would expect that unit to be involved in such a large and significant "Medicaid Case," but the OIG press release only credits special agents from OIG's New York Regional Office and Senior Attorneys and paralegals from the OIG's Office of Counsel with running the investigation and there is no press release from its State counterpart. And the penalties being imposed are for federal exclusion violations as opposed to state violations.

It is also interesting to note that while the dentist had his license suspended by the State in 1999 and then revoked in 2004, and that he was excluded by the OIG in 2000 — he was only "suspended" from New Jersey Medicaid until 2015 at which time he was "disqualified." Regardless of whether the suspension and disqualification had the same legal effect, the differences in terminology and in the timelines serve to highlight the lack of consistency and lack of information sharing endemic in exclusion enforcement.

Conclusion

With the increase of OIG exclusion settlements and larger settlement amounts, screening employees, vendors and contractors against the List of Excluded Individuals and Entities (LEIE), the System for Award Management (GSA/SAM), and all 38 state lists every month is critical. To eliminate the risk of having to self-disclose a possible exclusion violation or undergo an OIG investigation, contact the Exclusion Experts 1-800-294-0952 or online https://www.exclusionscreening.com/assessment-of-needs-and-costs/) for a free consultation.