Southington Dentist Will Pay Settlement In Medicaid Fraud Case

A dentist will pay $55,000 to settle claims he defrauded the state’s Medicaid program, Attorney General George Jepsen announced Monday. Dr. Thomas DeRienzo, a licensed practicing dentist in Southington, will pay the money to settle civil healthcare fraud allegations that he submitted fake claims for Medicaid payments. Jepsen alleged that DeRienzo carried out a “long-term scheme” in which he submitted claims to the state Department of Social Services, which administers Connecticut’s Medicaid program, for dental services he did not provide to patients enrolled in the Connecticut Medical Assistance Program (CMAP).  CMAP, run by DSS, includes family, children’s and low-income Husky programs.

Jepsen accused DeRienzo of submitting claims to DSS for resin-based composite fillings that he never gave to CMAP patients. In addition to agreeing to pay $55,000 to resolve those allegations, DeRienzo has entered a separate agreement with DSS in which he is permanently barred from participating as a dentist in the CMAP, according to Jepsen.

Reached at his practice Monday, DeRienzo denied any wrongdoing.

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Drug Company Tied To Connecticut Nurse Settles Kickback Case In Oregon

The company alleged to have paid kickbacks to a Derby nurse in exchange for her prescribing of a potent pain medication has agreed to pay $1.1 million to settle a case brought by the state of Oregon, which accused the firm of deceptive marketing and kickback payments involving the same drug. In a notice of unlawful trade practices filed against the Arizona-based drug maker Insys, the Oregon attorney general’s office charged that the company used an “unconscionable tactic by making payments to doctors that you intended to be a kickback to incentivize the doctor to prescribe Subsys.” The attorney general also charged Insys with using “unconscionable, false and deceptive sales tactics” designed to increase the “off-label” use of Subsys, which is approved only to treat breakthrough cancer pain. The case in Oregon comes as Connecticut nurse practitioner Heather Alfonso, formerly with the Comprehensive Pain and Headache Treatment Center in Derby, awaits sentencing on charges she received $83,000 in kickbacks from Insys from 2013 to 2015. In pleading guilty, Alfonso, 42, admitted that the money she was paid for attending “dinner programs” as a speaker — many of them sham dinners, with just an Insys sales representative or her friends or co-workers — influenced her prescribing of the drug, according to the U.S. Attorney’s Office for Connecticut. The charge of receipt of kickbacks in relation to a federal healthcare program carries a maximum term of imprisonment of five years and a fine of up to $250,000.

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Derby Pain Clinic Terminated From Medicaid Program

The state has barred practitioners at a Derby pain clinic, including a high-prescribing nurse, from participating in the Medicaid program because of improprieties in treatment and oversight. Documents from the Department of Social Services (DSS) show the physician heading the clinic, Dr. Mark Thimineur, and four nurses and assistants were notified in July that their participation in the Connecticut Medical Assistance Program, which includes Medicaid, is being terminated on Aug. 30. Those terminations came after Heather Alfonso, an advanced practice registered nurse (APRN) at the privately run Comprehensive Pain & Headache Treatment Centers, was removed from the Medicaid program in May, DSS officials said. Alfonso was identified in a February story by C-HIT as among the top 10 prescribers nationally of the most potent controlled substances in Medicare’s drug program in 2012 — Schedule II drugs, which have a high potential for addiction and abuse.

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