For Immediate Release:
Tuesday, September 24, 2019
(RALEIGH) Attorney General Josh Stein today announced that he reached a $567,125 settlement with High Point dentist Dr. Stefan J. Simoncic and his Triad Oral Surgery practice to resolve allegations involving the submission of false claims to the North Carolina Medicaid program. This action is part of Operation Root Canal, an ongoing effort by the NCDOJ’s Medicaid Investigations Division (MID) to find and stop fraud among dental providers.
“Our efforts to stop fraud among dental providers have gotten back more than $6 million for our state’s Medicaid program,” said Attorney General Josh Stein. “My office will hold providers accountable when they cheat taxpayers and people who need health care.”
According to the settlement, between Jan. 1, 2015, and Aug. 31, 2019, Dr. Simoncic and his practice submitted claims involving detailed oral evaluations and anesthesia services performed on Medicaid recipients. The services were not medically necessary, had no supporting clinical documentation, or were performed in violation of Medicaid policy. Dr. Simoncic has agreed to pay back $567,125 to the Medicaid program.
Operation Root Canal involves a wide variety of dental services, including dental cleanings, use of nitrous oxide, repetitive restorations on the same tooth, palliative care, and upcoding of patient examinations. Through this effort, MID has reached settlements with 10 dental providers, resulting in more than $6.3 million being paid back to the Medicaid program.
This settlement was obtained with the assistance of MID and the North Carolina Department of Health and Human Services’ Division of Medical Assistance – Clinical Policy and Program Integrity.
About the Medicaid Investigations Division (MID)
The Attorney General’s MID investigates fraud and abuse by healthcare companies and providers, as well as patient abuse and neglect in facilities that are funded by Medicaid. Medicaid is a joint federal-state program that helps provide medical care for people with limited income. To date, the MID has recovered more than $850 million in restitution and penalties for North Carolina.
To report Medicaid fraud in North Carolina, call the North Carolina Medicaid Investigations Division at 919-881-2320.
Laura Brewer (919) 716-6484