Conn. dentist to pay $212K to settle Medicaid fraud case

A Connecticut dentist and her dental practice will pay $212,000 to resolve allegations that they violated the federal and state False Claims Acts by filing false Medicaid claims.

Kristi Rossomando, DMD, and her practice, Children's Dental Group in New Haven, entered into a civil settlement regarding accusations of fraudulent billing to Medicaid for pediatric services.

The services in question were "comprehensive oral evaluations" billed between February 2005 and January 2011. According to the ADA, this service is performed by "a general dentist and/or a specialist when evaluating a patient comprehensively." The service is provided to new patients or established patients who have had a significant change in their health conditions or who have been absent from active treatment for three or more years.

According to the state attorney general's office, Dr. Rossomando often did not see a new patient on his or her first visit, yet the practice billed Medicaid for a comprehensive oral evaluation. At the first visit, the child would usually only see a hygienist, who would then recommend treatment and schedule a follow-up visit. However, Dr. Rossomando would bill Medicaid for a comprehensive oral evaluation, as if she had examined the patient and performed the service. Even on days when Dr. Rossomando was not in the office, Medicaid was regularly billed for comprehensive oral evaluations, according to the attorney general's office.

"It is unacceptable for a dentist to receive payment when no service is performed, or for a staff person to routinely render care that only a dentist is qualified to perform," Connecticut Attorney General George Jepsen stated in a press release. "The state will hold providers accountable for all services billed to Medicaid."

A complaint against Dr. Rossomando was filed in the U.S. District Court in Connecticut under the whistleblower provisions of the federal and state False Claims Acts. The whistleblower, Olivia Estrada, whose child had been treated by Dr. Rossomando, will receive a share of the proceeds of the settlement in the amount of $31,800.

In entering into the civil settlement agreement, Dr. Rossamando and Children's Dental Group did not admit liability.