By SDCN Editor
San Diego, CA–An Imperial County dentist was sentenced in federal court to 37 months in prison for defrauding Medicare and then covering it up, federal authorities said.
The dentist, 50-year-old Javad Aghaloo of Indio, CA, and his former billing manager, 42-year-old Melissa Rosas of Calexico, CA, 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. 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.
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 for $8,476,466.23.
“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.”
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 2017 and October 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 March 8.
