Health care fraud is a type of white-collar crime that involves the intentional deception or misrepresentation of information. It is committed in order to receive improper financial gain or benefits from a health care program. This can include insurance fraud, Medicare or Medicaid fraud.
Some examples of health care fraud include billing for services that are not actually provided; falsifying diagnoses or medical records to justify unnecessary services; submitting claims for non-covered treatments as if they were covered; and accepting kickbacks for referrals or services. Health care fraud is illegal because it undermines the integrity of the health care system. As well, it can result in increased costs for patients and taxpayers.
Licensed hearing instrument specialist pleads guilty to health care fraud.
As reported by the District of Connecticut branch of the U.S. Attorney's Office last week, a hearing aid dealer has pleaded guilty to health care fraud. 53 year-old, Dennis Dellaghelfa owns General Hearing. The Waterbury, Connecticut-based business functions as a hearing aid provider. It has been enrolled in the Connecticut Medical Assistance Program (CTMAP) since 2013.
CTMAP is a Connecticut Department of Social Services-administered program. It provides medical assistance to low income persons. CTMAP’s benefit packages are referred to as either “HUSKY” or “Connecticut Medicaid”. They are jointly funded by the State of Connecticut and the federal government.
Dellaghelfa submitted false and fraudulent claims.
Between approximately June 2016 and April 2022, Dellaghelfa submitted, or caused to be submitted, false and fraudulent claims. They were for payment for services and equipment that were not provided or were medically unnecessary. In November 2018, for example, Dellaghelfa submitted claims to Connecticut Medicaid for services provided to six patients. The claimed services were during a period of time that Dellaghelfa was traveling outside the U.S.
“In 2019 and 2020, some of the fraudulent claims involved services that were purportedly provided by his three employees,” details the U.S. Attorney’s Office report, “However, Dellaghelfa knew that the employees performed hearing tests without having the required professional permit, and submitted paperwork for hearing tests and services that did not occur or were not medically necessary.”
Dellaghelfa paid kickbacks to patient recruiters.
Dellaghelfa didn’t just violate the CTMAP provider agreement. He also paid third-party “patient recruiters” for each Medicaid patient they brought to General Hearing for a hearing test, failed the test and received a hearing aid. In addition, he submitted false claims to Connecticut Medicaid for testing and hearing aids for five of the patient recruiters who did not need hearing aids.
Dellaghelfa pleaded guilty to one count of health care fraud. The offense carries a maximum term of imprisonment of 10 years. He is scheduled for sentencing on May 16 and is released pending sentencing. As part of his plea agreement, Dellaghelfa has agreed to make restitution of $6,141,857 to the Connecticut Medicaid program. He has also agreed to forfeit $332,675 currently held in personal and business bank accounts.
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