Fluoride Action Network

Dentist Ordered to Pay $717K in Illegal Billing Case

Source: The Connecticut Law Tribune | August 20th, 2016 | By Michelle Tuccitto Sullo

A judge has ordered a retired Winsted dentist to pay $717,046 after concluding that he violated state law by improperly billing the state Medicaid program for dental cleanings and fluoride treatments.

Superior Court Judge Trial Referee A. Susan Peck issued a 41-page decision this month against the dentist, Douglas Macko. The decision entered a judgment in favor of the plaintiff, the state of Connecticut, and ordered Macko to pay $593,751 in restitution, plus a civil penalty of $123,295, for a total judgment of $717,046.

Following a seven-day hearing, Peck concluded Macko’s conduct was in violation of the Connecticut Unfair Trade Practices Act.

Attorney General George Jepsen, whose office represented the state, said in a statement, “The court’s ruling should send a clear message that Connecticut will be vigilant in protecting our taxpayer-funded healthcare programs from this type of illegal conduct.”

The state Attorney General’s Office had initiated the civil action against Macko and his practice in 2012, following a referral by the state Department of Social Services.

The state had claimed that between April 2002 and December 2009, Macko employed individuals who were not licensed dentists or dental hygienists to perform such procedures as “prophylaxis treatments,” or dental cleanings, and “fluoride applications.”

The state claimed Macko billed the state for the dental procedures, which had been performed by unlicensed individuals. State law prohibits practicing dentistry without a license.

The judge concluded the defense “failed to come forward with any sustained evidence to counter the substantial testimonial and documentary evidence that tends to prove that neither Dr. Macko nor any other licensed person actually performed prophylaxis treatments and fluoride applications as claimed by the defendants,” the decision said.

The judge concluded that unlicensed dental assistants performed the treatments in question.

Peck calculated that there were 24,659 violations subject to penalty during that seven-year time frame.

According to Peck, Macko closed his practice in May 2015 and no longer works as a dentist. The judge noted that “there is no record that any patient suffered harm relating to the prophylaxis treatment and fluoride applications performed by unlicensed employees.”

In 2010, Macko reached an agreement with DSS, the administering state agency for Medicaid, in which he agreed to suspend his participation in the Medicaid program and any other DSS program for 10 years, according to Jepsen’s office.

Susan Dixon of East Canaan, who represents Macko, said, “Obviously we take issue with the decision.”

Dixon asserted that her client was present during every single procedure. Her client can’t afford to comply with the order, according to Dixon.

“They have effectively bankrupted him, and he had to retire,” Dixon said.

According to Dixon, her client has worked to help others, such as traveling to South America to help children with their teeth. Dixon alleged that the state’s involvement and probe into her client’s practice was the result of a disgruntled former employee lodging a complaint.

“There were mistakes made, but not to the degree the state portrays,” Dixon said. “The idea of him making an illicit profit is inaccurate. He has been forced into retirement, and he doesn’t have the money to pay.”

DSS Commissioner Roderick L. Bremby said in a statement, “Overall, dental and medical providers in Connecticut’s Medicaid program are dedicated practitioners whose treatment services and reimbursement billings are conducted in a professional, above-board manner. Unfortunately, there are some outliers who cause the need for vigilant quality assurance and ­anti-fraud ­enforcement.”