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 healthcare fraud, one count of healthcare fraud, two counts of aggravated identity theft, and one count of tax evasion.
Dr. Scott Cale of Chelmsford and Robin Cronin of Worcester were each indicted on one count of conspiracy to commit healthcare fraud and one count of healthcare fraud. The defendants were arrested and appeared in federal court in Boston on January 16.
According to the indictment, in 2005, MassHealth excluded DiStefano, a dentist practicing in Worcester, from participation. DiStefano twice sought readmission into MassHealth’s provider network, but was denied both times due to concerns regarding his quality of care.
To circumvent his exclusion, the indictment says, DiStefano recruited 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.
This arrangement aimed to deceive MassHealth into paying for dental services that weren’t reimbursable because MassHealth had terminated DiStefano from the MassHealth program. Cronin, DiStefano’s office manager, was aware of the scheme and personally billed MassHealth for services that weren’t reimbursable, knowing the claims were false, the indictment says.
Also according to the indictment, DiStefano owed substantial tax liabilities to the Internal Revenue Service for 2011 to 2014. The IRS notified DiStefano of his outstanding tax liability, and he evading paying it 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, avoiding IRS levies on his bank accounts
- Using the aforementioned Medicaid scheme to conceal his income
The charges of healthcare fraud and conspiracy to commit healthcare 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 US Sentencing Guidelines and other statutory factors. The details in the indictment are allegations, and the defendants are presumed innocent unless and until proven guilty.
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