Atlanta Dentist to Pay Settlement to Resolve False Claims Act Allegations
ATLANTA—The United States Attorney’s Office for the Northern District of Georgia announced that it has reached a settlement with Dennis Jaffe and Dennis B. Jaffe D.M.D., P.C., to pay $324,327.05 to settle health fraud claims—specifically that Jaffe violated the False Claims Act by fraudulently billing Medicaid for tooth extraction procedures and for fraudulently billing for services rendered by a dental assistant when Jaffe was not present in the office. Under the terms of the settlement, Jaffe is also excluded from all federal and state healthcare programs.
In addition to the civil settlement, Jaffe also pleaded guilty to a charge of theft from a healthcare benefit program in a separate federal criminal action and was sentenced to serve one year of probation. As part of the plea, Jaffe agreed to surrender his dental license.
“Citizens rely on dentists to treat all patients in accordance with the approved standards of care,” said Acting U.S. Attorney John Horn. “Patients were placed at risk when a dental assistant, without Jaffe present to supervise, performed procedures a licensed dentist must oversee. The defendant also enriched himself at the expense of those patients by marking up the bills to Medicaid for the services he was not performing.”
“All patients should be entitled to the same level of care and providers who choose to cut costs and increase profits by using unlicensed staff bring shame upon the entire profession and more importantly jeopardizes the safety of patients,” said Derrick L. Jackson, Special Agent in Charge of the U.S. Department of Health and Human Services, Office of Inspector General in Atlanta. “Dr. Jaffe’s case should stand as a warning to those who choose to put profits above patient care.”
J. Britt Johnson, Special Agent in Charge, FBI Atlanta Field Office, stated: “The FBI, in working with Health & Human Services investigators, is proud of the role that it continues to play in ensuring that federally funded healthcare programs such as Medicaid are not abused by providers such as Mr. Jaffe. The FBI asks that anyone with information regarding such matters report it to authorities by contacting their nearest FBI field office.”
Georgia Attorney General Sam Olens stated: “The State’s Medicaid Fraud unit is pleased to work with our federal partners in attacking fraud upon vital healthcare programs. Dr. Jaffe’s actions are inexcusable and clearly warranted the administrative, civil, and criminal actions. I want to thank Assistant Attorneys General Kevin D. Bradberry and James P. Mooney for all of their hard work on the case.”
The civil settlement resolves allegations that Jaffe, a 71-year-old dentist from Atlanta, Georgia, fraudulently sought payment from Medicaid for higher and more expensive levels of service than were actually performed, a practice commonly referred to as “upcoding.” The settlement also resolves claims that Jaffe unlawfully billed for services rendered by an unsupervised dental assistant on days in which Jaffe was not present in the office. Under Medicaid regulations and Georgia law, it is unlawful for dental assistants to render any care outside of the direct supervision of a licensed dentist.
The civil settlement resolves a lawsuit filed by Michelle Smith under the qui tam, or whistleblower, provisions of the False Claims Act, which allow private citizens to bring civil actions on behalf of the United States and share in any recovery obtained. The case, pending in the Northern District of Georgia, is filed under United States ex rel. Michelle Smith v. Dennis B. Jaffe D.M.D., P.C. and Dennis B. Jaffe, Civ. 2:13-CV-1732. The Federal government will receive $190,635.67, and the State of Georgia will receive the remainder of the settlement. Ms. Smith will receive a share of the settlement payment that resolves the qui tam suit that she filed. The claims in the civil settlement are allegations only, and there has been no determination of liability.
This settlement illustrates the government’s emphasis on combating health care fraud and marks another achievement for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced in May 2009 by the Attorney General and the Secretary of Health and Human Services. The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation. One of the most powerful tools in this effort is the False Claims Act. Since January 2009, the Justice Department has recovered a total of more than $24 billion through False Claims Act cases, with more than $15.3 billion of that amount recovered in cases involving fraud against federal health care programs.
The case was investigated by Special Agents of Health & Human Services, Office of Inspector General and the Federal Bureau of Investigation as well as investigators with the Georgia Medicaid Fraud Control Unit.
The civil settlement was reached by Assistant U.S. Attorney David A. O’Neal and Georgia Assistant Attorney General Kevin D. Bradberry. The criminal case was prosecuted by Assistant U.S. Attorney Nathan Kitchens and Georgia Assistant Attorney General James P. Mooney.