Local dentist being investigated on Medicare fraud totaling millions of dollars

UPDATE – 4/26/19 – 10:00 PM

The U.S. Attorney accused a local dentist of Medicare fraud.

Imperial Valley residents are now concerned. They said they’ve had bad experiences with dental groups in similar circumstances.

El Centro resident Martina said, “I didn’t understand why my father came into the dentist and had all of his teeth pulled when he just needed one tooth.”

She said her 80-year-old father was taken advantage of.

“Because of his age, because of his hearing and because of my father’s a diabetic and he’s also hard of hearing and I still – everywhere you go people take advantage of them,” Martina said.

The complaint filed Friday against Dr. Javad S. Aghaloo of Southwest Dental Group, known as Dr. J, said he billed for services that patients didn’t actually need or were not covered by Medicare.

Two bank accounts owned by Dr. J were seized, valued at nearly a million and half dollars, plus a BMW valued at more than a $100,000.

Lucero, another El Centro resident, said she was almost duped by a local dentist herself.

“I had some pain in my tooth. And I was, okay it’s a cavity. I need to get it filled and we fix it and we’re good to go. So, I got there…oh, you need a root canal asap! They gave me a big estimate about it and they gave me an estimate of a crown,” Lucero said.

Some patients say in the complaint they felt pressured to accept the procedures from Southwest Dental Group. They were senior citizens.

The complaint said Dr. J billed nearly 16 million dollars’ worth of services in just two years.

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The U.S. Attorney’s Office has filed a complaint against a local dentist accused of Medicare fraud.

The complaint against Dr. Javad S. Aghaloo was filed Friday morning in the Southern District of California. The federal government has seized two bank accounts tied to Dr. Aghaloo valued at almost $1.5 million. They have also seized a 2017 BMW M6 valued at more than $135,000.

According to the complaint, law enforcement officers with the FBI and the U.S. Department of Health and Human Services, Office of the Inspector General, have been investigating suspected health care fraud-related violations tied to Dr. Aghaloo.

They said he oversees several dental practices, including one located 1502 S. La Brucherie Road, in El Centro, Calif. They say in addition to treating patients, Aghaloo manages billing policies, operations of administrative staff, and dental care provided by other dentists working at Southwest Dental.

The U.S. Attorney’s Office said a review was conducted of Dr. Aghaloo’s Medicare records, where 10 patients were randomly selected. The review found that the patients did not have any preexisting medical conditions that would have authorized Aghaloo to bill Medicare under the codes used.

Several of the patients were interviewed to further build a case against Aghaloo. Several of the patients said they were not suffering from any serious illnesses like the ones listed when Aghaloo’s office filed for Medicare.

The patients also said that they felt a lot of pressure from Southwest Dental to have their teeth extracted and that they were told Medicare would cover the cost of the extractions.

The U.S. Attorney’s Office said an individual who claimed to be an employee at Southwest Dental Group created a post on her personal page, on the social media website Facebook in June 2017. The employee posted a picture of bloody extracted teeth next to dental tools. Below the image, the employee stated, partially in Spanish and partially in English, “I love these days…I [love] my job #swd #mc #drj #my little old people #toothfairy #everybody is toothless”.

Law enforcement officers inferred that “swd” referred to Southwest Dental, “mc” referred to Medicare,” and “drj”s referred to Dr. Javad Aghaloo. Additionally, the employee posted symbols commonly known as “emojis” which juxtaposed depictions of an elderly female and elderly male with a depiction of United States currency. The U.S. Attorney’s Office believes the Facebook post suggests that the employee earned money for extracting teeth from “little old people.”

According to the complaint, based on bank records, Aghaloo issued checks to the employee on multiple occasions, with “Bonus” written on the memo line (“Bonus Checks”). Aghaloo also issued many other bonus checks to a variety of other employees at Southwest Dental, including entry level support staff members.

The complaint said that during the period of March 1, 2016, and October 18, 2018, no physician or business entity in the United States (regardless of specialization) billed Medicare under CPT codes 21210 and 21215 for more money than Aghaloo billed through his professional corporation. Of the $122,088,735.34 billed to Medicare in the United States during that period for those codes, Aghaloo’s Medicare billings for CPT code 21210 and 21215 services- $15,713,800.00 — represent 13 percent of the national total.

The full complaint can be found below: