$9.9 Million Settlement Reached In Connecticut Medicaid Fraud Case
Connecticut has settled claims against Gary Anusavice of North Kingstown, Rhode Island and six of Anusavice’s management and consulting companies in a civil suit revolving around an allegedly fraudulent Medicaid billing scheme. The suit, which was brought last May, alleged that Anusavice, his companies and other defendants took part in an elaborate plot covering a two year period which led to the payment of more than $24 million in fraudulent Medicaid claims. Anusavice and the companies are to pay $9.9 million to the state and Anusavice has agreed to cooperate with the state’s ongoing investigation and the continuing litigation against the other defendants who were named in the lawsuit.
Anusavice has also pled guilty to criminal charges which were brought by the United States government as a result of his involvement with the billing scheme. Any restitution which Anusavice is ordered to pay as part of his plea agreement may be credited towards the $9.9 million settlement. Under the terms of the settlement agreement, Anusavice and the companies are also barred from participating in any health care-related business in Connecticut or engaging in any other business with state agencies for at least ten years after he serves any prison time which may be imposed in connection with his conviction. Interestingly, it appears that Anusavice had previously been convicted in Massachusetts for submitting false health care claims and was excluded by the U.S. Department of Health and Human Services from participating in Medicare and state health care programs, including Medicaid. Connecticut alleged in its complaint that Anusavice violated this program exclusion by creating, through a series of corporations, a number of dental practices throughout the state that were operated by practicing dentists who billed Medicaid for services. Connecticut also claimed that Anusavice violated his program exclusion by actively managing the practices by reviewing patient charts, suggesting dental procedures, reviewing billing records, reviewing income reports, interviewing and hiring dentists and providing overall management direction to the offices. According to the state’s complaint, the dental practices failed to disclose the ownership interest Anusavice and/or his companies had in the practices as required by state and federal regulations. This allowed Anusavice to implement the billing system that resulted in Medicaid being double billed for certain services or being billed for services which were not provided.
The Connecticut Department of Social Services was the first to suspect that fraudulent activity might be taking place. That Department then worked with the state attorney general’s office and federal authorities to develop the case against Anusavice and others.