Please E-mail suggested additions, comments and/or corrections to Kent@MoreLaw.Com.
Date: 01-24-2024
Case Style:
Case Number: 23cr0616
Judge: Jinsook Ohta
Court: The United States Court for the Southern District of California
Plaintiff's Attorney: The United States District Attorney’s Office for San Diego
Defendant's Attorney:
Description:
mperial County dentist Javad Aghaloo was sentenced in federal court today to 37 months in prison for defrauding Medicare and then covering it up. His former billing manager, Melissa Rosas, was sentenced to three years of probation with one year of home confinement for obstructing Medicare’s efforts to audit Aghaloo’s dental offices by providing false information.
The pair, along with others, conspired to commit health care fraud by billing Medicare for procedures that were not covered, not performed, or otherwise not necessary. Aghaloo pleaded guilty on October 2, 2023 to conspiracy to commit health care fraud; Rosas pleaded guilty on October 13, 2023 to obstructing a federal audit.
“Doctors should treat patients, not exploit them,” said U.S. Attorney Tara McGrath. “This office is committed to protecting vulnerable patients from doctors who take advantage of them, particularly when they do so with no regard for patient safety.”
U.S. District Judge Jinsook Ohta also ordered Aghaloo to forfeit more than $1 million in property purchased with money obtained from the fraud and pay restitution to Medicare in the amount of $8,476,466.23.
According to court records, Aghaloo and others recruited Medicare beneficiaries to get dental work done at one of Aghaloo’s two dental offices in Imperial County. To recruit Medicare patients, Aghaloo and his employees marketed their dental services as being covered by Medicare. Aghaloo and his employees knew this was untrue since Medicare does not cover dental services.
Once a Medicare beneficiary was in one of Aghaloo’s offices, Aghaloo and others performed some type of procedure (usually a tooth extraction) and submitted false claims to Medicare for the dental work using the person’s Medicare beneficiary number. Since tooth extractions are not covered by Medicare, Aghaloo’s offices submitted false claims for procedures like bone grafts that were never performed.
Between March 1, 2016 and October 18, 2018, Aghaloo’s dental offices submitted more than 7,000 false claims totaling over $18 million to Medicare, for which Aghaloo’s offices received $8,476,466.23.
To conceal the fraud, between April of 2017 and October of 2018, Rosas and Theresa Flores, Aghaloo’s office manager, submitted false documents to Noridian Healthcare Solutions, LLC., a Federal auditor for the Medicare program. Flores, who also pleaded guilty to obstructing an audit, is scheduled to be sentenced on Friday, March 8, 2024.
This case is being prosecuted by Assistant U.S. Attorney Christopher Alexander.
Outcome:
Plaintiff's Experts:
Defendant's Experts:
Comments: