Local dentist, ex-office manager plead guilty to Medicare fraud.
01/10/2024

SAN DIEGO — An Imperial County dentist and his office manager admitted Tuesday in federal court to conspiring to defraud Medicare and covering it up, prosecutors said.

Dr. Javad Aghaloo pleaded guilty to conspiring to commit health care fraud by billing Medicare for procedures that were not covered, not performed, or otherwise not necessary, Cindy Cipriani with the Office of the United States Attorney Southern District of California said in a news release Wednesday. His office manager, Theresa Flores, entered a guilty plea to obstructing a Medicare audit.

 

Aghaloo and Flores, knowing Medicare does not cover dental services, recruited Medicare patients by marketing the dental services to two individuals in Imperial County as being covered by Medicare, according to court records.

"Once a Medicare beneficiary was in one of Aghaloo's offices, Aghaloo and others performed some type of procedure (usually a tooth extraction) and submitted false claims to Medicare using the person's Medicare beneficiary number," Cipirani said. "Since tooth extractions are not covered by Medicare, Aghaloo's offices instead submitted false claims for procedures like bone grafts that were never performed."

Over 7,000 false claims, worth over $18 million, were submitted by Aghaloo's dental offices between March 1, 2016, and Oct. 18, 2018, for which they received $8,476,466.23 by Medicare, prosecutors said.

Between April 2017 and October 2018, Flores and Rosas concealed the fraud by causing false documents to be submitted to Lowridian Healthcare Solutions, LLC. ("NHS"), a federal auditor for the Medicare program, per officials.

 

Aghaloo agreed to forfeit more than $1 million in property and pay restitution to Medicare in the amount of $8,476,466.23 as part of his plea, Cipriani said.

Aghaloo and Flores' sentencing is set for Jan. 12, 2024, at 9 a.m.