Two dentists and office manager indicted for Medicaid fraud scheme

 

One defendant also indicted for tax evasion and aggravated identity theft

Date: January 16, 2020

Contact: newsroom@ci.irs.gov

BOSTON – A federal grand jury in Boston has indicted a Worcester dentist, a Chelmsford dentist, and a Worcester office manager for their participation in a scheme to defraud the Massachusetts Medicaid program, commonly known as MassHealth.

Dr. Anthony DiStefano III of Worcester was indicted on one count of conspiracy to commit health care fraud, one count of health care fraud, two counts of aggravated identity theft and one count of tax evasion. Dr. Scott Cale, 65 of Chelmsford, and Robin Cronin of Worcester, were each indicted on one count of conspiracy to commit health care fraud and one count of health care fraud. The defendants were arrested this morning and will appear in federal court in Boston this afternoon.

According to the indictment, in 2005, MassHealth excluded DiStefano, a dentist practicing in Worcester, from participation in the MassHealth program. DiStefano twice sought readmission into MassHealth's provider network but was denied both times in light of significant concerns regarding the quality of dental care he delivered to patients. In order to circumvent his exclusion, DiStefano recruited another dentist, Cale, to join his practice. From 2014 to 2018, dental services that DiStefano personally delivered were billed to MassHealth using Cale's provider identification credentials. Cale then paid DiStefano a share of the money that MassHealth paid Cale. The purpose of this arrangement was to deceive MassHealth into paying for dental services that were not reimbursable (because MassHealth had terminated DiStefano from the MassHealth program). Cronin, DiStefano's office manager, was aware of the arrangement and personally billed MassHealth for services that were not reimbursable, knowing that the claims were false.

In addition, according to the indictment, DiStefano owed substantial tax liabilities to the Internal Revenue Service for the years 2011-2014. The IRS notified DiStefano of his outstanding tax liability and DiStefano evaded paying his outstanding liability by, for example, ceasing the use of bank accounts and operating his business in cash; cashing Social Security checks and checks from dental insurance companies at check cashing institutions, thus avoiding IRS levies on his bank accounts; and using the aforementioned Medicaid fraud scheme to conceal his income.

The charges of health care fraud and conspiracy to commit health care fraud provide for a sentence of up to 10 years in prison, three years of supervised release and a fine of up to $250,000. The charge of tax evasion provides for a sentence of up to five years in prison, three years of supervised release and a fine of up to $250,000. The charge of aggravated identity theft provides for a sentence of two years in prison to be served consecutive to any other sentence imposed, up to one year of supervised release and a maximum fine of $250,000. Sentences are imposed by a federal district court judge based upon the U.S. Sentencing Guidelines and other statutory factors.

The details contained in the indictment are allegations. The defendants are presumed innocent unless and until proven guilty beyond a reasonable doubt in a court of law.