A dentist and a billing manager in California were sentenced for their roles in collecting more than $8 million from Medicare for procedures that were not performed, uncovered, and unnecessary and for then trying to cover up the fraud, according to the U.S. Department of Justice.
Dr. Javad Aghaloo of Southwest Dental Group was sentenced in U.S. court to 37 months in prison, ordered to pay nearly $8.5 million in restitution, and forfeit more than $1 million in property purchased with money obtained from the fraud. He pleaded guilty in October to conspiracy to healthcare fraud, according to a press release dated January 26 from the U.S. Attorney’s Office for the Southern District of California.
Melissa Rosas, a billing manager who pleaded guilty in October 2023 to obstructing a U.S. audit, was sentenced to three years of probation and one year of home confinement, according to the release.
Aghaloo, 50, and Rosas, 42, along with others, reportedly recruited Medicare beneficiaries for dental work done at his offices. To recruit patients, Aghaloo and his employees allegedly advertised their dental services as being covered by Medicare though they knew the program would not cover them. Aghaloo would reportedly perform procedures, typically tooth extractions, on patients and submit a false claim for procedures like bone grafts that were never performed, according to the release.
Between 2016 and 2018, Aghaloo’s dental offices purportedly submitted more than 7,000 false claims totaling over $18 million to Medicare. His offices received $8,476,466 for these claims.
Between April of 2017 and October of 2018, Rosas and Theresa Flores, Aghaloo’s office manager, reportedly submitted false documents to Noridian Healthcare Solutions, a U.S. auditor for the Medicare program, to conceal the fraud.
Flores has pleaded guilty to obstructing an audit and is scheduled to be sentenced in March.