Civil action against dentist stayed pending criminal investigation
EL CENTRO — A federal judge has granted a stay of forfeiture of assets of a local dentist pending the outcome of an ongoing criminal investigation.
Back in April, the U.S. Attorney’s Office filed a civil complaint in U.S. District Court for the Southern District of California to seize assets of Southwest Dental Clinic and its owner, Dr. Javar Aghaloo, over alleged Medicare fraud and other offenses.
At the time the complaint was filed, the U.S. Attorney’s Office had already seized a 2017 BMW M6 belonging to Aghaloo and more than $1.5 million held in two of his bank accounts.
Further plans at the time called for inspections and inventories of Aghaloo’s clinic at 1502 S. LaBrucherie Ave., and his residences in El Centro, Indio and San Diego.
On Aug. 5, a judge granted the parties’ joint motion to stay the civil case until the criminal investigation is complete.
Assistant U.S. Attorney Leah Bussell would not provide specifics about what charges might be filed, but referred back to April’s civil complaint as containing the substance of the crimes being investigated.
Southwest Dental Group in El Centro was still in operation as of Monday afternoon
According to the original civil complaint, Aghaloo is accused of a defrauding Medicare “by, among other things, executing high volumes dental procedures, including tooth extractions, on patients who do not have conditions falling under the Medicare Dental Exceptions, and subsequently billing Medicare for those procedures.”
Except in rare instances Medicare does not pay for dental procedures, the complaint reads.
When viewed on a patient-by-patient basis, the vast bulk of Medicare claims submitted by Aghaloo through his professional corporation, were submitted under codes not covered by Medicare, the U.S. Attorney’s Office alleges.
Those included repair of nasal or cheek bone with bone graft, repair of lower jaw bone with bone graft, incision and repair of bony defect of cheek bone with repositioning of bony segment, removal of lower jaw, removal of facial bones, and procedure impression and custom preparation of temporary oral prosthesis.
Aghaloo could only bill Medicare for these codes if the patients receiving the procedures had a condition that qualified under the Dental Medicare Exceptions, the complaint reads.
According to the complaint, many of the patients, when interviewed by law enforcement, indicated that they had received teeth extractions at Southwest Dental. At the time of the extractions, the patients stated that they were not suffering from any serious illnesses such as cancer or traumatic injury.
None of the interviewed patients indicated they had any conditions that would have permitted their treatment to fall under the Medicare Dental Exceptions, court documents said.
According to Medicare data, between the dates of March 1, 2016, and Oct. 18, 2018, Aghaloo DDS submitted almost $21.43 million in claims to Medicare, consisting of 7,224 individual claim lines.
Of the $21.43 million billed, Medicare has reimbursed to Aghaloo DDS $9.49 million. Of the money paid by Medicare, $6.6 million represents reimbursements for services associated with two Medicare codes.
Aghaloo’s Medicare billings for Current Terminology Codes 21210 and 21215 services — $15.71 million — represent 13 percent of the national total, the U.S. Attorney said.
The Current Procedural Terminology code is a medical code set and maintained by the American Medical Association.