[co-author: Stephanie Kozol]*
On May 9, Connecticut Attorney General (AG) William Tong, in collaboration with the U.S. Attorney’s Office for the District of Connecticut, announced a $495,721 false claims settlement with Advanced Dental Center PC (Advanced Dental) and its owners, Tal Yossefi and Elad Yossefi. The settlement resolves allegations that the business violated both state and federal False Claims Act (FCA) statutes by receiving so-called “recruiting fees” for each Connecticut Medicaid patient referred to the business. No liability was admitted as part of the settlement.
As a participant in the Connecticut Medical Assistance Program (CMAP), Advanced Dental received reimbursements from the government for services provided to participating patients. The government alleged that Advanced Dental collaborated on a scheme to receive kickbacks from a third-party patient recruiting company. The state and U.S. alleged that this behavior violates the federal anti-kickback statute, the CMAP provider agreement, and the Connecticut Dental Health Partnership provider manual.
Advanced Dental is alleged to have received $120 each time it treated Connecticut Medicaid patients referred by the recruiting company. Advanced Dental allegedly received the fee whenever a patient received dental services beyond a routine cleaning and examination, incentivizing the dental office to recommend and provide care beyond what was needed to secure further funds.
The anti-kickback statute at issue was prompted by concerns that the receipt of kickbacks or bribes to medical service providers would interfere with doctors’ decision-making. By prohibiting the request, receipt, offer, or payment of kickbacks meant to generate health care business, the statute protects patients from unduly expensive or medically unnecessary care.
Connecticut has been aggressive in pursuing Medicaid recruiting fees. This is the fourth instance of a company under investigation for a settlement stemming from a joint civil investigation between the Connecticut Office of the AG, the Department of Health and Human Services — Office of Inspector General, and the Federal Bureau of Investigation.
Why It Matters
The settlement between Connecticut and Advanced Dental shows that any business participating in a payment program in which the government reimburses the business with public funds must be aware of the requirements and restrictions associated with the program. Requesting payment in violation of state regulatory requirements creates potentially significant civil or criminal liability. The inclusion of Advanced Dental’s owners as a party to the suit should serve as a forewarning that owners may incur individual liability for their companies’ alleged misconduct regarding FCA violations. In these cases, the government is more than willing to look past the corporate veil and reach toward individual owners.
*Senior Government Relations Manager
