Dentist with Milford, West Haven ties to pay $1.3M in Medicaid fraud case

Aug. 30--HARTFORD -- A dentist with offices in Milford and West Haven has agreed to pay more than $1.3 million to resolve allegations that he filed claims to Connecticut's Medicaid program that didn't comply with state law.

Dr. Jesus Villegas is accused of making claims for X-rays done by uncertified dental assistants at Fairfield Pediatric Dentistry, LLC, 209 Boston Post Road, Milford and Haven Pediatric Dentistry, LLC, 100 Elm St., West Haven.

Villegas knowingly submitted the false claims between June 2010 and March 2014, the state attorney general's office said Tuesday in a press release.

Connecticut law requires dental assistants to be certified by the Dental Assisting National Board before doing X-rays. The certification shows they have been trained in procedures they must follow for the safe administration of X-rays.

"The state requires dental assistants to be DANB-certified in order to take X-rays to make certain they are done safely, which protects both the patient and the dental assistant," Attorney General George Jepsen said in Tuesday's release. "I'm pleased that we have reached an agreement in this case, and that we are also putting in place compliance requirements that will ensure this provider adheres to appropriate billing processes going forward to protect the integrity of our Medicaid program."

Mary Alice Moore Leonhardt, Villegas' attorney, said Tuesday that he is still treating patients in the state's Medicaid and private insurance programs. She said the state considers Villegas to be a "highly qualified pediatric dentist."

"This was a very narrow issue and we are very pleased that it has been resolved," she said in a phone interview with The Register. "The repayment obligations arose from Dr. Villegas' mistaken belief that he could use dental assistants that he personally trained."

She said Villegas did not intend to do anything illegal and did not have reckless disregard for the law. She said it had been many years since he had read the state's laws on the issue.

"That's not an excuse," she said. "Dr. Villegas learned a lesson here. Most importantly, as soon as he recognized he made a mistake, he got the dental assistants certified. He took immediate corrective action to remedy his error" and repay the state.

She said he has "substantially" repaid the $1.3 million but still has some left to pay.

The state's Medicaid program, administered by the Department of Social Services, will get about 60 percent of the money, totaling more than $820,000.

"Overall, Connecticut's enrolled dental providers are among the finest in the nation, but this case illustrates the need for oversight to ensure that quality standards are met and financial integrity of the program is protected," DSS Commissioner Roderick L. Bremby said in Tuesday's release.

Villegas also agreed to enter a compliance agreement with the state that will ensure he follows all applicable state and federal laws over the next three years. He will also enter into a separate agreement with federal Inspector General of the U. S. Department of Health and Human Services.

Messages left for Villegas and his attorney seeking comment on the agreement were not immediately returned Tuesday.

Jepsen's office said the agreement with Villegas is part of a larger effort by the state's Interagency Fraud Task Force to investigate and prosecute health care fraud that affects state programs.

Set up in July 2013, the task force includes a number of Connecticut agencies and works with federal counterparts in the U.S. attorney's office and the U.S. Health and Human Services, Office of Inspector General -- Office of Investigations.

Anyone who knows about or suspects fraud or abuse in the public health care system is asked to contact the state attorney general's Antitrust and Government Program Fraud Department by calling 860-808-5040 or emailing [email protected]; the Medicaid Fraud Control Unit in the office of the chief state's attorney at 860-258-5986 or [email protected]; or the Department of Social Services fraud reporting hotline at 1-800-842-2155, online or by email to [email protected].

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