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Inspector General reports two Medicaid fraud-related enforcement actions

One action involves arrest of dental hygienist for allegedly illegally practicing as an unlicensed dentist to commit Medicaid fraud

March 24, 2021 The Office of Inspector General for the United States Department of Health and Human Services announced March 12 two enforcement actions along the East Coast related to Medicaid fraud in health care.

In the first enforcement action, Florida Attorney General Ashley Moody’s Medicaid Fraud Control Unit and the Miami-Dade Police Department announced arresting March 5 a dental hygienist illegally practicing as an unlicensed dentist for committing Medicaid fraud.

Julio Suarez allegedly performed unlicensed and unauthorized procedures on patients, defrauding the Medicaid program out of more than $8,000, according to the Florida attorney general’s office.

“It is utterly despicable that a health care professional would knowingly deceive trusting patients about their licenses and credentials in order to practice unlawful dental procedures,” said Ms. Moody in a statement. “To further use that deception to scam the Medicaid program out of thousands of taxpayer dollars is inexcusable and criminal. I am proud of my Medicaid Fraud Control Unit for investigating these crimes and putting an end to this illegal dental scheme.”

For more than two years, according to the attorney general, Mr. Suarez allegedly worked as an unlicensed dentist for Art Dental Service. While employed at Art Dental, he performed unlicensed dental services and procedures on unwitting and unsuspecting patients. Mr. Suarez then billed the services to the Medicaid program. By performing and billing these procedures, Mr. Suarez fraudulently caused the Medicaid program to pay more than $8,000.

He is charged with one count of Medicaid fraud, a second-degree felony, and one count of grand theft, a third-degree felony. If convicted, Mr. Suarez faces up to 15 years in prison and $10,000 in fines.

In the second enforcement action, Leonard C. Boyle, acting United States Attorney for the District of Connecticut, announced March 11 that an owner and operator of a mental treatment center pleaded guilty to one count of health care fraud.

According to court documents and statements made in court, Wali Muhammad owned and operated Happy Family Clinical Services in the Connecticut communities of East Haven, Branford and New Haven, offering mental health and social services.

From 2013 through 2019, Mr. Muhammad engaged in a scheme to defraud the Connecticut Medicaid Program by submitting fraudulent claims for psychotherapy services purportedly provided to Medicaid clients, the U.S. attorney’s office said.

The claims were for occasions and dates of service when no psychotherapy services of any kind had been provided to the Medicaid clients identified in the claims. The claims also were submitted using the names and identities of licensed clinical social workers and other licensed health care providers who purportedly worked for Happy Family, and represented that the psychotherapy services were personally rendered by the licensed providers, when, in fact, the licensed providers had not personally rendered the services, had not supervised the services that were billed, and were unaware that Mr. Muhammad was billing or causing the services to be billed as if the providers had personally rendered the services, according to the U.S. attorney’s office.

When services were provided, they were usually rendered by unlicensed individuals and billed as licensed psychotherapy.

Mr. Muhammad is scheduled to be sentenced in June and faces a maximum term of imprisonment of 10 years. As part of his plea, Mr. Muhammad agreed to pay $574,034 in restitution to Medicaid.

The U.S. Department of Health and Human Services Office of Inspector General enforces federal fraud and abuse laws enacted to protect Medicare, Medicaid and other HHS programs.