Merrimack Valley dentist indicted for health care fraud
BOSTON – A Merrimack Valley dentist and two others have been indicted by a federal grand jury for their alleged participation in a scheme to defraud the Massachusetts Medicaid program, commonly known as MassHealth, according to the U.S. Attorney’s Office.
Dr. Scott Cale, 65, of Chelmsford, and Robin Cronin, 58, of Worcester, were each indicted on one count of conspiracy to commit health care fraud and one count of health care fraud. Dr. Anthony DiStefano III, 70, 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.
The defendants were arrested Thursday and were scheduled to appear Thursday afternoon in federal court.
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 allegedly recruited another dentist, Cale, to join his practice. From 2014 to 2018, dental services that DiStefano personally delivered were billed to MassHealth allegedly using Cale’s provider identification credentials. Cale then allegedly paid DiStefano a share of the money that MassHealth paid Cale.
Investigators allege 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 allegedly 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.
United States Attorney Andrew E. Lelling; Massachusetts Attorney General Maura Healey; Phillip Coyne, Special Agent in Charge of the U.S. Department of Health and Human Services, Office of the Inspector General, Office of Investigations; and Kristina O’Connell, Special Agent in Charge of the Internal Revenue Service’s Criminal Investigations in Boston made the announcement today. Assistant U.S. Attorneys Evan Panich and Chris Looney of Lelling’s Office, as well as Special Assistant U.S. Attorney Kevin Lownds, detailed from Healey Office, are prosecuting the case.
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.