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News Jun 4, 2013 - 3:35:46 PM

Attorney General Reaches $9.9 Million Settlement With Key Defendants in Medicaid Billing Lawsuit

By Attorney General George Jepsen's office

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HARTFORD, CT - Attorney General George Jepsen announced on Monday a $9.9 million settlement with Gary Anusavice of North Kingstown, R.I., and six of his management and consulting companies, settling the state’s civil fraud claims stemming from an alleged illegal Medicaid billing scheme.

Anusavice and his companies were among 28 individuals, dental practices and corporations named in the state’s civil lawsuit last May, alleging they participated in an elaborate and illegal scheme that resulted in more than $24 million in fraudulent Medicaid claims over two years in violation of the Connecticut False Claims Act and the Connecticut Unfair Trade Practices Act.

The state filed its stipulation for partial judgment, memorializing the settlement, in Hartford Superior Court today.

Anusavice, who was also indicted on federal criminal charges for his alleged involvement in the same billing scheme, pleaded guilty to those charges in U.S. District Court in Bridgeport today.

“This settlement provides restitution to the Connecticut Medical Assistance Program and permanently bars Mr. Anusavice from participating in that program,” Attorney General Jepsen said. “In addition, he has agreed to cooperate with the state’s ongoing investigation and litigation of this matter, as well as any other matter related to the alleged scheme.”

The state Department of Social Services first identified the suspected fraudulent activity and worked with the OAG and federal authorities to develop the case. The unfair trade practices complaint was brought at the request of Consumer Protection Commissioner William Rubenstein.

Jepsen noted the significant level of cooperation between his office and the U.S. Department of Health and Human Services, Office of Inspector General; the U.S. Attorney’s Office for the District of Connecticut; the Internal Revenue Service – Criminal Investigation Division; and the Federal Bureau of Investigation.

“The coordinated federal and state efforts leading to today’s announcement send a strong signal to those individuals who are intent on defrauding federal and state healthcare programs. We are focused and working as a team to preserve taxpayer funds by preventing fraud and abuse in the Connecticut Medical Assistance Program,” Jepsen said.

Social Services Commissioner Roderick L. Bremby said, “This extensive settlement once again shows how state and federal authorities collaborate in detecting and rooting out fraud in the Medicaid program. DSS anti-fraud specialists will continue to work with the Attorney General’s Office and law enforcement to do everything possible to protect taxpayer interests and the integrity of the provider networks.”

In addition to Gary Anusavice, the state’s stipulated judgment covers E.G.A. Management, Inc.; Haven Consulting, Inc.; AMZ Consulting, Inc.; Electron Marketing, Inc.; Dental Care of Connecticut, Inc.; and N.B. Dental, Inc.

Among the terms of the stipulation, Anusavice and the companies will pay the state $9.9 million, which represents treble damages under the Connecticut False Claims Act and restitution under the Connecticut Unfair Trade Practices Act. Any healthcare restitution Anusavice is ordered to make as part of his plea agreement in the federal criminal matter may be credited toward the $9.9 million award.

The agreement also bars Anusavice and the named companies from participating in any health care-related business in Connecticut, or engaging in any other business with state agencies for at least 10 years after Anusavice completes his incarceration under the federal plea agreement.

Further, Anusavice and the named companies waive all pending claims for payment by the state Department of Social Services to providers in which the defendants had a financial and/or ownership interest, including but not limited to: Dental Group of Stamford LLC, Landmark Dental; Dental Group of Connecticut; Mehran Zamani LLC; Dental Group of Waterbury; Alpha Dental Group PC; Arbor Dental Association LLC and Wintonbury Dental Associates.

Those dental practices were named in the state’s original complaint, along with Mehran Zamani of Pound Ridge, N.Y. and Stamford; Paul Anusavice of North Grafton, MA; John Gallagher of Manchester, MA; David Wu of Cheshire and Alphonso Mack of Bloomfield.

The stipulated judgment does not resolve the state’s claims against the additional defendants and the state’s civil lawsuit against them continues.

According to the state’s civil complaint, in July, 1997, Gary Anusavice, a dentist at the time, was convicted in Massachusetts of a felony for submitting false health care claims. As a result of the conviction, he was permanently excluded by the U.S. Department of Health and Human Services from participation in Medicare and state health care programs, including Medicaid, after April 1998.

The state alleges that Anusavice violated his program exclusion by setting up, through a series of corporations, a number of dental practices around Connecticut that were operated by practicing dentists who were providers, or applied to become providers in the Connecticut Medical Assistance Program, and billed Medicaid for services.

The state’s complaint alleges that Anusavice also violated his program exclusion by actively managing the practices, which received millions of dollars in Medicaid reimbursements. Although Anusavice was no longer licensed by any state to practice dentistry, he was involved in reviewing patient charts, suggesting dental procedures to be performed, reviewing billing records, reviewing income reports, interviewing and hiring dentists, and providing overall management direction to the offices.

In addition, the complaint alleges, the dental practices failed to disclose to the state Department of Social Services the ownership interest that Anusavice and/or his companies had in those practices as required by state and federal regulations. By concealing his role, the state alleges that Anusavice was able to implement a billing system that resulted in the state Medicaid program being double-billed for certain dental services, or billed for services that were not rendered.

Assistant Attorneys General Joshua Jackson and Karen Haabestad are handling this matter for the Attorney General with Forensic Fraud Examiners Lawrence Marini and David Boucher, and Assistant Attorney General Michael Cole, head of the Antitrust and Government Program Fraud Department.

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