A Charleston dentist on Monday pleaded guilty to federal charges that he falsely billed Medicaid for more than $700,000 in dental procedures he did not actually perform on his patients.
Antoine Skaff, 58, pleaded guilty to health care fraud before U.S. District Judge Joseph R. Goodwin in the Robert C. Byrd United States Courthouse in Charleston. He also entered into a civil settlement with government agencies wherein he will have to pay $2.2 million, or three times the loss suffered by West Virginia Medicaid, Assistant United States Attorney Clint Carte said in a news release.
Part of Skaff's plea deal for the criminal charges will include him paying $738,067 in restitution, which is in addition to the payments for the civil settlement, and he will face up to 10 years in prison when he is sentenced on Nov. 13.
Skaff admitted Monday to fraudulently billing West Virginia Medicaid and West Virginia Medicaid Managed Care Organizations for more than $700,000 during a span of more than five years, Carte said.
Skaff admitted he falsely inflated his billing, a practice referred to as "upcoding," which he most often did by falsely claiming reimbursement for procedures involving impacted teeth, Carte said. Skaff falsely informed Medicaid that he performed more complex procedures on his patients, such as an extraction of an impacted tooth, when he actually performed less complex procedures, like the simple extraction of a tooth. Skaff admitted to upcoding at least 7,490 tooth extractions, billing more than $1.3 million for those procedures, Carte said.
Based on the procedures he actually performed, Skaff should have billed for $599,200 in the given time frame, Carte said.
Skaff also admitted he would submit false bills and receive payment twice for completing one procedure, and he received $56,930 from the double billings, Carte said.
As part of Skaff's $2.2 million civil settlement, he also will be excluded from Medicare and Medicaid programs for 13 years, which means he won't be able to bill either entity during that time frame. Carte said.
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.