By LINDSAY OLIVIER
NORTH KINGSTOWN – A North Kingstown resident was arrested early last Thursday morning, along with a New York man, in connection with a $20 million Medicaid fraud scheme.
Gary F. Anusavice, 59, of 229 Potter Road, North Kingstown, also known as “Gary Andrews,” “Gary Andrus” and “Gary Francis,” was arrested at his home on a federal criminal complaint charging him with conspiring to commit health care fraud and making false statements involving federal health care programs.
Mehran Zamani, DDS, 47, of Pound Ridge, N.Y., was also arrested at his home on the same charges as Anusavice. Both appeared last Thursday afternoon before U.S. Magistrate Judge Holly B. Fitzsimmons in Bridgeport, Conn.
Anusavice’s residence and dental clinics were searched by investigating agencies.
The announcement was made by David B. Fein, U.S. Attorney for the District of Connecticut; Susan J. Waddell, Special Agent in charge of the U.S. Health and Human Services, Office of Inspector General for New England; William P. Offord, Special Agent in charge of IRS Criminal Investigation in New England and Kimberly K. Mertz, Special Agent in charge of the FBI.
The government has also filed a civil forfeiture complaint against Anusavice’s property in North Kingstown, an 8,145 square foot home on 9.66 acres of land. The forfeiture complaint alleges that this property was purchased in February 2011 for $695,000 by AMZ Consulting, Inc., an entity controlled by Anusavice and that it was purchased with profits from the alleged Medicaid fraud scheme.
Anusavice and Zamani were operators of dental practices throughout Connecticut and allegedly defrauded the Medicaid program of more than $20 million over a two-year period.
“We are committed to protecting American taxpayers from health care fraud, which can increase costs and jeopardize the integrity of our health care system,” Fein said in a press release.
Anusavice had been barred from Medicare, Medicaid and other government health programs in 1998 but allegedly continued to defraud taxpayers by using an “elaborate shield” of companies and individuals, including Zamani, to hide his involvement.
“The FBI views health care fraud as a serious crime problem,” said FBI Special Agent Mertz. “It degrades the integrity of our health care system and legitimate patient care. Today's arrests send a clear message to those persons who are defrauding our federal Medicare and Medicaid and private health insurance programs."
The Medicaid program is a joint federal-state program that provides funds for medical services to lower-income individuals who qualify for benefits. The program is jointly administered by the U.S. Department of Health and Human Services and supervised by the Centers for Medicare and Medicaid Services.
According to court documents, Anusavice was previously a registered dentist in several states and, in July 1997, was involved in a felony conviction in Massachusetts for submitting false health care claims. Because of that, the U.S. Department of Health and Human Services informed him the following year that he was being “excluded” from participating in Medicare and state health care programs.
Because of that exclusion, Anusavice could not submit claims or cause claims to be submitted for payment from the Medicaid program. Further, he was advised that Medicaid reimbursement payments were prohibited to any entity in which he served as an employee, administrator, operator, or in any other capacity.
In November 2005, he surrendered his right to practice dentistry in both Rhode Island and Massachusetts. It's been alleged that, upon losing his license, he started several dental practices in Connecticut, which he operated with other dentists
“These dental practices received millions of dollars in Medicaid reimbursements from the Connecticut Medicaid program,” the press release stated. Those practices were Landmark Dental in West Haven, Dental Group of Connecticut in Trumbull and Dental Group of Stamford.
Despite being barred from associating with the federal programs, Anusavice was reportedly involved in reviewing patient charts, suggesting dental procedures to be performed, reviewing billing records, reviewing income reports, interviewing and hiring dentists, and providing overall management direction to the offices.
It’s also alleged that while Zamani was working at Landmark Dental in October 2008, he became aware of Anusavice’s history with the federal programs and that, in January 2009, Zamani submitted a Medicaid Provider Enrollment application in order to obtain a Medicaid provider number for him listing his group practice name as Landmark Dental. However, in the applications Zamani reportedly failed to disclose that Anusavice was involved in the business, even though Zamani knew Anusavice was running the practice and profited from it.
From approximately February 2009 to March 2011, Zamani and Landmark Dental received more than $12.9 million in Medicaid reimbursement payments.
It’s further alleged that in April 2009, Zamani and Haven Consulting, an entity Anusavice created, entered into a business consultant contract for the Dental Group of Stamford, a practice that Zamani previously operated. Although the contract provided that Haven Consulting was a business consultant to the Dental Group of Stamford, Anusavice had an ownership interest in the practice and acted in an ownership and managerial capacity.
Zamani’s application in May 2009 failed to disclose Anusavice’s involvement in the practice and his disciplinary history. From approximately June 2009 to March 2011, the Dental Group of Stamford received more than $4.4 million in Medicaid reimbursement payments.
Another one of Zamani's applications for a Medicaid provider number for the Dental Group of Connecticut, in April 2010, also failed to disclose Anusavice’s involvement in the practice and, from approximately August 2010 to March 2011, the Dental Group of Connecticut received more than $3.5 million in Medicaid reimbursement payments.
On April 13, 2011, Medicaid payments were suspended to Zamani, Landmark Dental, Dental Group of Stamford and Dental Group of Connecticut, based upon a pending investigation of a credible allegation of fraud.
As a result, the last Medicaid payment to any of these entities occurred on or about March 22, 2011. By that time, it is alleged that the Anusavice-Zamani entities had collectively received nearly $21 million in Medicaid reimbursement funds. Further, according to Zamani’s accountant's records, between February 2009 and March 2011, those Anusavice entities received more than $3 million in payments from Zamani-related entities.
Anusavice and another dentist are reportedly now operating a new set of dental clinics as Alpha Dental Group in Cromwell, Dental Group of New Britain and Hartford Dental Care. Between November 2011 and March 2012, Arbor Dental has received more than $2.6 million in Medicaid funds. Anusavice has also recently reopened a dental practice at the former location of Dental Care of Connecticut in Trumbull.
The matter is being investigated by the U.S. Department of Health and Human Services, Office of Inspector General, the Internal Revenue Service-Criminal Investigation, and the FBI. The Connecticut Attorney General's Office provided assistance and cooperation throughout the investigation.