Dr. Javad Aghaloo, an Imperial County dentist, and his former office manager, Theresa Flores, confessed to a multi-million-dollar Medicare fraud scheme on Tuesday in a federal court. The court documents showed that the pair wrongly billed Medicare for non-covered or non-delivered services and obstructed a Medicare audit to conceal their actions.
As to Dr. Aghaloo's confession, he concurred about his conspiracy to commit health care fraud by falsely billing Medicare for dental procedures that weren't covered, not executed, or not required. He also agreed to forfeit over $1 million in property and repay $8,476,466.23 to Medicare. Meanwhile, Flores pleaded guilty to obstructing a Medicare audit, the DOJ discloses.
From March 1, 2016, through October 18, 2018, Aghaloo and Flores recruited Medicare beneficiaries to their dental practice. They falsely advertised dental services that were covered by Medicare. Knowing full well Medicare does not cover dental services, they would still convince patients to undergo procedures such as tooth extractions. After the procedure, they would submit fraudulent claims to Medicare under the patient's beneficiary number, billing for non-performed procedures like bone grafts instead.
This fraudulent scheme led Aghaloo and Flores to submit over 7,000 false claims to Medicare, amounting to over $18 million. Medicare paid $8,476,466.23 to Aghaloo's dental offices for these fraudulent claims as the DOJ stated. Flores, along with another individual named Rosas, further concealed this fraud by providing false documents to Noridian Healthcare Solutions, LLC., a Medicare program auditor, between April 2017 and October 2018.
Aghaloo and Flores now face severe legal and financial repercussions. Their sentencing, set for January 12, 2024, before U.S. District Judge Jinsook Ohta, could result in a maximum five-year prison sentence and a $250,000 fine per charge according to the DOJ.
