FWA (CT)- District of Connecticut | Somers Man Pleads Guilty to Charge Stemming from Medicaid Fraud Scheme Justice

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[MM Curator Summary]: One provider let another provider use their billing ID- for a 25% cut. You paid $338k for it.



Clipped from: https://www.justice.gov/usao-ct/pr/somers-man-pleads-guilty-charge-stemming-medicaid-fraud-scheme

Vanessa Roberts Avery, United States Attorney for the District of Connecticut, Roberto Coviello, Special Agent in Charge of the U.S. Department of Health and Human Services, and Robert Fuller, Special Agent in Charge of the New Haven Division of the Federal Bureau of Investigation, today announced that DENNIS TOMCZAK, 73, of Somers, has pleaded guilty in federal court to a false statement offense stemming from his role in a Medicaid fraud scheme.

According to court documents and statements made in court, Tomczak, a state-licensed alcohol and drug abuse counselor, offered substance abuse treatment and related counseling services through his business, Pathway to Peace, LLC.  Tomczak accepted Medicaid insurance and cash payments for his services.

In 2019, a medical provider asked Tomczak to use his own provider number to bill Medicaid for patients that the provider was allegedly seeing for psychotherapy sessions.  In exchange, Tomczak would retain 25 percent of the Medicaid claims paid and he would turn over 75 percent of the payments to the provider.  Tomczak agreed to do so, and from approximately April 2019 through October 2022, based upon a spreadsheet provided to him by the provider, Tomczak billed Medicaid for psychotherapy and related services allegedly rendered by the provider as if Tomczak had personally rendered those services himself.  Tomczak never met any of the provider’s clients and did not review records and treatment notes for any services allegedly rendered by the provider.

Through this scheme, Medicaid paid Tomczak approximately $338,427.11 for approximately 53 clients that the provider had allegedly treated.  Per his agreement with the provider, Tomczak retained approximately $84,000 of the claims money received from Medicaid.

On August 21, 2023, Tomczak waived his right to be indicted and pleaded guilty before U.S. District Judge Kari A. Dooley in Bridgeport to one count of making a false statement relating to a health care matter, an offense that carries a maximum term of imprisonment of five years.  Judge Dooley scheduled sentencing for November 13.

Tomczak is released on bond pending sentencing.

This ongoing investigation is being conducted by the Office of the Inspector General of the U.S. Department of Health and Human Services (HHS-OIG), and the Federal Bureau of Investigation.  The case is being prosecuted by Assistant U.S. Attorney Sarah P. Karwan.