Rooting Out Fraud

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51617828 - modern dental cabinet

Many people have a great deal of anxiety when faced with a visit to the dentist. It’s hard to relax with a bright light in your face and someone else’s hands navigating your mouth with sharp instruments. One wrong move could cause a lot of pain. (Whoever came up with sedation dentistry is brilliant.) A visit to the dentist can be expensive. Some folks don’t have dental insurance, or the insurance they do have doesn’t seem cover the procedure that is needed. To add insult to injury, The Courant reports on a Connecticut dentist who performed unnecessary dental procedures on Medicaid patients in order to bill the program for $20 million in fraudulent claims. (That’s more painful than a root canal without Novocain.)

The article reports that the dentist had previously lost his license to practice and had been barred from participating in the Medicaid program in both Massachusetts and Rhode Island. Obviously in need of a job and income, the man took advantage of an incentive program offered by the State of Connecticut that encouraged the treatment of low-income patients by increasing the amount that Medicaid pays to in-state dentists. It wasn’t long before the previously convicted dentist relocated his practice to Connecticut and set up his first clinic. The 60-year-old’s practice grew and he opened clinics in areas where high concentrations of low-income residents lived.

The dentist operated ”high production” offices where dentists were paid based on filling their quotas of procedures. The clinics reportedly hired recruiters to pass out fliers in neighborhoods and commissions were paid for patients that were actually seen at the clinic. The clinics even provided transportation services for patients. (It can’t get much easier than that. We’ll give you a free ride, inflict some unnecessary pain and then steal your money. Don’t forget to floss!) While the dentist was racking in the dough – $3.3 million to be exact, he forgot to declare the income from the lucrative business. However, he did remember to hire some financially savvy employees who hid his profits by shuffling it among accounts and fake companies.

The dentist was finally caught with the assistance of an undercover dentist who happened to record the fraudster during an employment interview. The criminal, who previously had a run-in with the law for making false health care claims and filing false tax returns, served four months of home confinement for those crimes. This time around, he will be serving an eight year prison sentence. And that’s not all. He will pay more than $10 million in fines and restitution and give up his 8000-square-foot home, his boat, a Mercedes-Benz and $90,000 in cash found in his home. (Perhaps he should sell the gold fillings in his teeth.)

This fraudster’s first offense let him off easy. However, this time, he’s definitely going to need some laughing gas to get through his prison term. Let’s hope that while he is serving out his sentence that he can self examine and get to the root of the problem. Perhaps he can perform a self-extraction to get rid of the selfishness and greed that led him to commit the same crime twice.

Source: Today’s ”Fraud of the Day” is based on the article titled, ”Dentist In Massive Medicaid Fraud Case Sentenced to 8 Years,” written by Edmund H. Mahony and published in The Courant on October 9, 2013.

HARTFORD — A dentist barred from practicing elsewhere in New England was sentenced Wednesday to eight years in prison for operating assembly line-style clinics in Connecticut that targeted poor patients, performed unnecessary dental procedures and collected on more than $20 million in fraudulent claims from Medicaid.

Gary Anusavice, 60, operated networks of clinics in the south, central and western parts of the state from 2008 to 2012 and personally collected more than $3.3 million from the fraud.

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Larry Benson
Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.