California Dentist Sentenced for Filing False Claims with Insurance Companies

May 19, 2014 — Dental Medicaid fraud places a horrible drain on the federal coffers. Many inside employees at dental clinics may be aware of fraudulent billing practices, but they may not realize that they have the power to stop billing fraud schemes against the government. When whistleblowers bring a lawsuit under the qui tam provisions of the federal False Claims Act, they may receive a significant share of the government’s recovery.

Of course, not all billing fraud is directed at government healthcare programs like Medicaid. Sometimes unethical dentists target private insurers. A California dentist who pleaded no contest in April to insurance fraud has now paid $786,000 in restitution. Tom K. Kalili, of Beverly Hills, was also sentenced to one year in county jail and five years of formal probation.

Kalili and his Beverly Hills Medical Suites had been investigated for several years by the California Dental Board, the California Department of Insurance and the California Franchise Tax Board. Kalili’s fraudulent practices resulted in a loss to the insurance carriers of $439,000, the investigation revealed.

Kalili reportedly pleaded no contest to one felony count of insurance fraud and admitted to allegations of excessive taking amounting to more than $150,000. Kalili’s former office manager, Claudia Ventura, who handled insurance billing for the practice, also pleaded no contest to two felony counts of insurance fraud.

State Medicaid programs across the nation have been plagued with fraudulent billing scams like the one targeting private insurers in this California case. With offices in Los Angeles, where the fraud in this case occurred, and in Dallas and the Washington D.C. area, Waters & Kraus knows how to work with whistleblowers to put a stop to fraudulent billing scams against Medicaid. Contact us by email or call 855.784.0268 to speak with a qui tam lawyer about your role in saving Medicaid for those who need it.