New York Attorney General Letitia James today announced a $753,457 agreement with pediatric dentist Dr. Barry L. Jacobson and his company HQRC Management Services LLC (HQRC), along with 13 other affiliated pediatric dentistry locations.
The dentistry group allegedly performed and billed for medically unnecessary pediatric root canals. This settlement is the result of a joint investigation between the Attorney General’s Medicaid Fraud Control Unit (MFCU), and the United States Attorney’s Office for the District of New Jersey, which is collecting $313,783 for the United States’ shares of New York and New Jersey Medicaid damages as part of this agreement.
“Dr. Jacobson and HQRC allegedly performed unnecessary and invasive dental procedures on children to line their own pockets,” said Attorney General James. “My office will not tolerate any instance of medically unnecessary procedures performed on vulnerable Medicaid beneficiaries. I am grateful to U.S. Attorney Philip Sellinger and team for their partnership as we investigated this fraudulent scheme.”
“It is unconscionable that a medical professional would create a health services business that performs unneeded dental procedures on children simply to make money,” said U.S. Attorney for the District of New Jersey Philip Sellinger. “That affiliated dentists were willing to go along with this plan to make money is especially egregious. Recovering their ill-gotten gains only begins to undo this damage. Working with Attorney General James and our partners in the New York Attorney General’s Office, we want to make it clear that this behavior is intolerable.”
The settlement resolves allegations that some HQRC dentists performed medically unnecessary pulpotomies — often referred to as “baby root canals” — on pediatric patients. A pulpotomy is a procedure to restore infected primary teeth in children whereby the dentist removes infected and damaged pulp from the upper part of the tooth and covers the remaining part of the child’s tooth with a filling or a crown. Dr. Jacobson and HQRC admit MFCU’s investigative findings that in some instances between 2011 and 2018, affiliated dentists performed and billed Medicaid for therapeutic pulpotomies not supported by the medical records maintained at the respective dental practices. The defendants also admit that in some instances between 2011 and 2014, HQRC made billing errors on claims submitted to New York and New Jersey Medicaid contractors that resulted in inaccurate servicing provider information on claims for services performed at three of its locations.
Dr. Jacobson and HQRC, now doing business as PDS Management Solutions, operate pediatric dental practices in New York, New Jersey, and Vermont. The majority of these practices are in New York, and the following are parties to the agreement: Pediatric Dentistry of Paterson, Pediatric Dentistry of Teaneck, Pediatric Dentistry of Wykoff, Pediatric Dentistry of Flushing, Pediatric Dentistry of the Bronx, Pediatric Dentistry of Valley Stream, Pediatric Dentistry of Avenue U, Pediatric Dentistry of Boro Park, Pediatric Dentistry of Monsey, Pediatric Dentistry of Kingston, Pediatric Dentistry of Albany, Pediatric Dentistry of Malone, and North Country Pediatric Dentistry.
The case against Dr. Jacobson, HQRC, and the affiliated dental practices was initiated by a former employee, who will receive a portion of the settlement. The whistleblower lawsuit was filed under the qui tam provisions of the federal and New York False Claims Acts, which allow people to file civil actions on behalf of the government and share in any recovery.
The investigation by the Attorney General’s MFCU was conducted by Senior Auditor-Investigators Songlin Mo and Matthew Tandle, under the supervision of Stacey Millis, Chief Auditor of MFCU’s Civil Enforcement Division. MFCU Lead Data Scientist Si Lok Chao provided data analytics assistance. The case is being handled by Deputy Chief Diana Elkind of MFCU’s Civil Enforcement Division, which is led by Civil Enforcement Division Chief Alee N. Scott. MFCU is led by Director Amy Held and Assistant Deputy Attorney General Paul J. Mahoney. The Division for Criminal Justice is overseen by Chief Deputy Attorney General José Maldonado and under the oversight of First Deputy Attorney General Jennifer Levy.
Reporting Medicaid Provider Fraud: MFCU defends the public by addressing Medicaid provider fraud and protecting nursing home residents from abuse and neglect. If an individual believes they have information about Medicaid provider fraud or about an incident of abuse or neglect of a nursing home resident, they can file a confidential complaint online or call the MFCU hotline at (800) 771-7755. If the situation is an emergency, please call 911.
MFCU’s total funding for federal fiscal year (FY) 2023 is $65,717,936. Of that total, 75 percent, or $49,288,452, is awarded under a grant from the U .S. Department of Health and Human Services. The remaining 25 percent, totaling $16,429,484 for FY 2023, is funded by New York state. Through MFCU’s recoveries in law enforcement actions, it regularly returns more to the state than it receives in state funding.