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Borrego Health: Fraud Charges

 

Last updated 10/20/2024 at 8am



California Attorney General Rob Bonta has filed criminal charges against San Diego Dentist Husam Aldairi, along with five employees of his dental practice, for their allegedly fraudulent billing scheme that allegedly defrauded the state Medi-Cal program of nearly $900,000. The charges were filed October 17, 2024. The announcement was made via a press release from the AG’s office.

Ironically, it was October 20, 2020, when the FBI, prompted by investigative reporting by the Borrego Sun, raided the Offices of Borrego Community Healthcare Foundation (Borrego Health), in Borrego Springs, and Aldairi’s dental offices. Prompted by disclosures in the Borrego Healthcare Foundation’s IRS reporting, Nikki Symington began to research the relationship between Borrego Health and Aldairi’s practice as a contractor.

From 2018 to 2020, the Borrego Sun reported what appeared to be illegal dental contracting practices in Aldairi’s office and IRS reporting income of over $8 million in one year. The newspaper was assisted by a witness, who had first hand knowledge of the fake accounting and scheduling practices.

“The Sun originally became interested in Borrego Health finances in its role as the parent of the Borrego Springs clinic, which was seriously underfunded and understaffed, despite the organization’s steadily increasing income. The raid was four years after the Sun began raising red flags about questionable financial transactions and IRS reporting, undertaken by Borrego Health and dental contractors.”

“We are pleased the state is finally filing charges,” stated Patrick Meehan, publisher. Meehan offered congratulations to the FBI and the AGs office for protecting public health care assets by pursuing unethical dental and medical practitioners. People, who abuse the public trust by stealing money intended for clinics, like the Borrego Springs clinic; and clients, whose primary health care resources are Medicare and Medi-Cal, are the worst type of predators.

They say justice moves slow, but steady. In this case, justice appears to move at a glacial rate. We are hopeful that this is the start of charges directed at 13 other dental offices, as well as administration and management officials of Borrego Health named in Borrego Health’s RICO lawsuit.

According to the AG’s press release, charges are that between Aug. 29, 2016 and Oct. 20, 2020, Aldairi and his five employees allegedly fraudulently billed more than $847,000 from patients. Aldairi’s clinics contracted with Borrego Community Health Foundation, a federally qualified health center which serves Medi-Cal patients that are from underserved populations or communities. Aldairi was entitled to get reimbursed for each patient visit rather than specific services, the release stated.

However, he allegedly fraudulently billed patients for services that were either not rendered or not rendered over multiple days as they were claimed, according to the attorney general’s office.

“When providers defraud Medi-Cal, it not only undermines the integrity of the program, but it also poses a significant threat to the patients who rely on its critical services for their health and well-being,” said Attorney General Bonta.

“At the California Department of Justice, we will continue to hold accountable those who perpetuate Medi-Cal fraud. We must ensure that the program remains reliable and accessible in providing quality healthcare to those who need it most.”

Aldairi’s clinics contracted with Borrego Community Health Foundation, a Federally Qualified Health Center (FQHC) that serves Medi-Cal patients, to provide dental services to underserved populations and communities. Aldairi was entitled to reimbursement for each patient visit, rather than the specific services performed. However, Aldairi allegedly fraudulently billed for services that were either not rendered, or not rendered over multiple days, as was claimed to maximize profit from Medi-Cal reimbursements. Aldairi and his employees allegedly fraudulently billed more than $847,000 between 2016 and 2020.

Borrego Community Health Foundation’s assets, which included clinics in San Diego and Riverside Counties, were sold to DAP Health on August 1, 2023, for $50 million. The sale was finalized by the official approval of both the bankruptcy court and the Health Resources and Services Administration (HRSA).

A copy of the criminal complaint is available here: https://oag.ca.gov/system/files/attachments/press-docs/Complaint%20-%20Aldairi%20-%20Redacted.pdf.

 
 
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