On Monday, a Charleston, West Virginia dentists pleaded guilty to falsely billing Medicaid and Medicaid Management Care Organization for more than $700,000. The announcement was made by United States Attorney Carol Casto on August 21, 2017. 58-year-old Antonie Skaff pleaded guilty to health care fraud and has entered into a civil settlement with the United States Attorney’s Office, Office of Inspector General, HHS, the State’s Department of Health and Human Resources, and the West Virginia Medicaid Fraud Control Unit.
Skaff agreed to pay treble damages of $2.2 million or three times the losses sustained by West Virginia Medicaid. The Charleston dentist admitted that he had fraudulently billed Medicaid and Medicaid MCOs for dental procedures that were not actually performed on Medicaid beneficiaries. Prosecutors suspect that the scheme lasted more than five years and involved upcoding and double billing.
Skaff confessed that he frequently inflated bills, which is common referred to as upcoding. Skaff often falsely claimed reimbursement for procedures involving impacted teeth. Skaff upcoded billings for extractions by informing Medicaid and MCOs that he had performed complex procedures. In some cases, he claimed to have performed extractions of impacted teeth, when in reality, he had only performed simple extractions.
Since Skaff claimed the extractions were related to impacted teeth, he was paid $172 per extraction. For a simple extraction, he would have only been paid $80 per tooth. Over the course of the scheme, Skaff upcoded at least 7,490 tooth extractions and billed more than $1.3 million for the procedures. Skaff admits he should have only been paid $599,200 had the extractions been medically necessary and had he performed the procedures he claimed.
Also, Skaff admitted to submitting false bills and receiving payment twice for removing a single tooth in some cases. Skaff confessed to billing Medicaid for the extractions and then falsely billing Medicaid MCOs for the same procedure. Due to false double billings, Skaff received an additional $56,930.
Skaff, who faced up to 10 years in federal prison, will be sentenced on November 13, 2017. He will also be required to pay $738,067 in restitution. Skaff has also entered into a civil settlement and has agreed to pay $2.2 million. Skaff will be excluded from the Medicare and Medicaid programs for 13 years.