A Charleston dentist who falsely billed West Virginia Medicaid and West Virginia Medicaid Managed Care Organizations (MCOs) for more than $700,000 pleaded guilty earlier this week, announced United States Attorney Carol Casto.
Antoine Skaff, 58, entered his guilty plea to health care fraud. Skaff also entered into a civil settlement with the U.S. Attorney’s Office, the Office of Inspector General for the U.S. Department of Health and Human Services, the West Virginia Department of Health and Human Resources (DHHR), DHHR’s Bureau for Medical Services, and the West Virginia Medicaid Fraud Control Unit, in which he agreed to pay treble damages of $2.2 million, or three times the loss suffered by West Virginia Medicaid.
Skaff, a dentist, admitted that he fraudulently billed West Virginia Medicaid and Medicaid MCOs for dental procedures that he did not actually perform on Medicaid recipients. Skaff’s scheme to defraud Medicaid and its MCOs lasted more than five years and involved upcoding and double billing.
First, Skaff admitted that he falsely inflated his billings, a practice commonly known as upcoding, often by falsely claiming reimbursement for procedures involving impacted teeth. Typically, only wisdom teeth are impacted. However, Skaff admitted that he upcoded billings for tooth extractions by falsely informing Medicaid and its MCOs that he performed more complex procedures, such as extractions of impacted teeth, when he had actually performed simple extractions. Because Skaff upcoded these extractions, Medicaid and its MCOs paid Skaff $172 per extraction of each tooth, rather than $80 per tooth for a simple extraction. Skaff additionally admitted that he falsely upcoded at least 7,490 tooth extractions, billing more than $1.3 million for those procedures. He further admitted that if those extractions were medically necessary, and if had actually performed the procedures he claimed, then he should have been paid only $599,200.
Next, Skaff admitted that he submitted false bills and received payment twice for removing the same teeth from the same patients. Skaff first billed and received payments from Medicaid for the extraction of patients’ specific teeth. He then falsely billed and received payment again from Medicaid MCOs for extraction of the same teeth. Skaff admitted that he received $56,930 from his false double billings.
Skaff faces up to 10 years in federal prison when he is sentenced on November 13, 2017. As part of his plea agreement, Skaff agreed to pay $738,067 in restitution.
Skaff also entered into a civil settlement agreement today in which he agreed to pay $2.2 million as a result of his fraud. Skaff further agreed to be excluded from Medicare and Medicaid programs for 13 years, which means he will not be able to bill Medicare and Medicaid during this time period.
“This case demonstrates the good that comes when federal and state agencies work together to identify, investigate and prosecute health care fraud,” stated United States Attorney Carol Casto. “Through the civil, criminal and administrative processes brought to bear, the Medicaid program will be made whole, Dr. Skaff will be punished, and we will protect federal health care dollars in the future by securing his exclusion from these programs.”
“Collaboration between agencies is the key to continued reduction and prevention of health care fraud and abuse in the state,” said Bill J. Crouch, West Virginia Department of Health and Human Resources Cabinet Secretary. “DHHR and its specially-trained, nationally-recognized Medicaid Fraud Control Unit work daily with our federal and state partners to resolve these issues for the benefit of our citizens and the Medicaid program.”
The West Virginia Medicaid Fraud Control Unit, the FBI, the Office of Inspector General for the U.S. Department of Health and Human Services, and the Affirmative Civil Enforcement investigator from the U.S. Attorney’s Office conducted the investigation. Assistant United States Attorney Meredith George Thomas is in charge of the criminal prosecution. Assistant United States Attorney Jennifer Mankins is responsible for the civil settlement. The plea hearing was held before United States District Judge Joseph R. Goodwin.
