Georgia Dentist Convicted of Misuse of Medicaid Funds
On June 5, 2015, Attorney General Sam Olens announced the conclusion of a multi-part investigation into Dr. Dennis B. Jaffe’s Atlanta-based dentistry practice. After a joint investigation conducted by the Georgia Medicaid Fraud Control Unit and federal partners, Dr. Jaffe, D.M.D., pled guilty to criminal charges and civilly settled allegations of fraud for $324,327.05.
The criminal plea focused on allegations that Dr. Jaffe knowingly billed for services provided on certain days when Dr. Jaffe was not in the office. On those days, unqualified staff performed services and Dr. Jaffe then billed as if he had performed the services. Dr. Jaffe pled guilty to one count of Misuse of Healthcare Funds, 18 U.S.C. § 669, and received a sentence of one year of probation, 50 hours of community service and restitution of $3,368.10. In connection with his plea, Dr. Jaffe also surrendered his license to practice dentistry.
The civil agreement, in which Dr. Jaffe will pay over $324,000, settles further allegations that Dr. Jaffe submitted claims for reimbursement to the Georgia Medicaid program that (1) exaggerated the complexity of surgical tooth extractions, resulting in inappropriately high compensation, and (2) improperly billed for services rendered by dental assistants when Jaffe was not present in the office. The settlement resolves these allegations, but does not involve an admission of guilt. As part of the settlement, Dr. Jaffe agreed to a five-year exclusion from all federally-funded healthcare programs, including Georgia Medicaid.
As a condition of receiving payment for services rendered, Georgia Medicaid requires that procedures are billed accurately. Furthermore, Medicaid also requires that enrolled providers personally perform the services billed or properly supervise them. The Georgia False Medicaid Claims Act, O.C.G.A. § 49-4-168 et seq, makes it illegal to knowingly submit false or fraudulent claims to the State of Georgia for payment. For each false claim, the Act allows the state to recover triple damages and a penalty from $5,500 to $11,000.
“Dr. Jaffe’s actions are inexcusable and clearly warranted the administrative, civil, and criminal actions taken,” said Georgia Attorney General Sam Olens. “My office, through the State Medicaid Fraud Unit, continues to combat Medicaid fraud, waste, and abuse through prosecutions like these.”
“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.”
“Health care providers who choose to cut costs and increase profits by using unlicensed and unqualified 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 unscrupulous providers who choose to put profits above patient care.”
Of the $324,327.05 paid under the settlement, the State’s Department of Community Health will receive $133,691.38. The remainder will be paid to the federal government, which contributes federal funds to help finance the Medicaid program. The whistleblower who initiated the investigation will also receive a share of the civil recovery.
The civil settlement was reached by Georgia Assistant Attorney General Kevin D. Bradberry and Assistant U.S. Attorney David A. O’Neal. The criminal case was prosecuted by Georgia Assistant Attorney General James P. Mooney and Assistant U.S. Attorney Nathan Kitchens. Georgia Medicaid Fraud Investigator Tonia Medlin, Nurse-Investigator Nancy Goddard, and Investigative Auditor Kim Smith investigated the case in conjunction with agents from the United States Department of Health and Human Services, the Federal Bureau of Investigation, and the United States Attorney’s Office for the Northern District of Georgia.
Those wishing to report suspected Medicaid fraud may contact the Georgia Medicaid Fraud Control Unit (MFCU) by phone at 404-656-5400 or by email at email@example.com.