Sunday, April 3, 2011

Dr. Bassiri’s dental license revoked--Medicaid fraud charged

Dr. Bassiri’s dental license revoked--Medicaid fraud charged
by Leslie Bray, News Editor
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Dr. Sassan Bassiri’s dental office, located at 226 Kirby Road in King, may soon be closing. The NC State Board of Dental Examiners revoked Dr. Bassiri’s license, which must be turned in to them by Apr. 18, 2011.
Dr. Sassan Bassiri’s dental office, located at 226 Kirby Road in King, may soon be closing. The NC State Board of Dental Examiners revoked Dr. Bassiri’s license, which must be turned in to them by Apr. 18, 2011.

Dr. Sassan Bassiri, D.D.S., has practiced dentistry at 226 Kirby Road in King for a number of years, but this will come to an end in three weeks. The North Carolina State Board of Dental Examiners handed down a decision on Thursday, Mar. 17, that Dr. Bassiri must “surrender his license and current renewal certificate to the Board at its offices no later than April 18, 2011.”

The charges against Dr. Bassiri have to do with fraudulent billing for various procedures. The Board heard the matter Nov. 5-6 and Dec. 3-5. They took into consideration that his faulty knowledge of English may have contributed to the problem.

They found out that when Dr. Bassiri immigrated to the U.S. in 1986 at age 18, he could already speak English. He then went to college for a year at Southern A&M University where he took classes in English and was fluent enough to pass calculus, chemistry and physics.

Dr. Bassiri then entered North Carolina State University in 1988. There he took additional English classes and even tutored other pupils in math and physics. As a student, he held jobs as an engineering assistant for two companies. He received a degree in electrical engineering and found employment as a test engineer.

Dr. Bassiri’s next round of schooling came at the Dental School at UNC-Chapel Hill where all of his courses were taught in English. He passed the NC Board Examination which is administered in English and was licensed to practice dentistry in NC in Sept. 2003.

The Board found that the doctor “has sufficient knowledge and understanding of the English language to be able to understand the requirements applicable to all dentists licensed in the State.”

Shortly after becoming licensed in 2003, Dr. Bassiri became an approved dental provider for the NC Division of Medical Assistance (DMA). The Board found that from Dec. 2003 to at least the end of 2009, Dr. Bassiri, or his staff acting on his orders, “knowingly and fraudulently” billed DMA for routine and recall visits under Code D0160—a code that charges a higher price than what should’ve been charged.

For the period of time that Dr. Bassiri billed DMA using this improper and higher-paying code (19,000 instances), he collected about $1 million from DMA.

Dr. Bassiri’s reply to this charge is that in Dec. 2003, an employee of Electronic Data Systems (EDS), at that time DMA’s fiscal agent, instructed him to use Code D0160 for all patient visits. The EDS representative in charge of training for Dr. Bassiri’s region of NC in 2003 denied that he advised the doctor to use Code D0160.

Dr. Bassiri’s records proved that he did not use Code D0106 for all Medicaid patient visits. He also used other codes to bill DMA.

In an interview with The Stokes News, Dr. Bassiri noted that if he had been trying to defraud Medicaid, he wouldn’t have done the same thing over and over again—19,000 times. He believes that someone committing deliberate fraud would’ve been more crafty and discreet.

He also had a dental code expert testify that doctors who are trying to cheat the system usually alter their clinical notes to match the billing. Dr. Bassiri said there was no evidence that his clinical notes had been falsified.

As far as the large sum of money he gained improperly, Dr. Bassiri claims that he has already paid back $400,000. The Board’s records do show that he has indeed begun paying back the sums. The dentist is even looking into selling his home to get more money to make restitution. “I just want to pay this money back,” he asserted.

According to the Board’s findings, Dr. Bassiri and his office manager had made calls to EDS beginning in Oct. 2008 which the Board alleges proved he knew he was misusing Code D0160. His office manager was specifically told on Oct. 23, 2008 that Code D0160 couldn’t be used for routine office visits. She reported this advice to Dr. Bassiri.

There were four other calls to EDS about Code D0160 in May and Dec. 2009. Once, Dr. Bassiri himself spoke to an EDS representative about the code.

Dr. Bassiri told The Stokes News that he had transcriptions of his conversations with EDS. He asks why would he have called them and kept records of it if he was trying to cheat them?

There was also a charge that Dr. Bassiri had “knowingly and fraudulently” billed DMA for four quadrants of scaling and root planing (SRP) when these procedures had not occurred. A former hygienist for Dr. Bassiri testified that approximately 50 percent of Dr. Bassiri’s patients scheduled for SRP didn’t need the procedure and instead just got regular prophylactic appointments.

Another charge was for several instances of Dr. Bassiri charging for placing two fillings in a tooth that actually only received one. The doctor insisted that he had thought he could bill a single filling with multiple surfaces as two separate filings, according to a DMA code sheet.

However, his billing records show that for patients who had no insurance or private insurance plans, Dr. Bassiri charged these fillings correctly.

In the records of the Board’s hearing, there are other instances of fraudulent charges by Dr. Bassiri’s office, involving full mouth debridement, alveoloplasties, surgical extractions and routine extractions.

There were also cases involving minors whose primary teeth were pulled even though they were about to fall out or children who had sealants put on teeth that were decayed or about to fall out. DMA was billed erroneously for these.

The Board stated: “The Respondent engaged in a deliberate pattern or practice of submitting inflated bills that were materially false or misleading to DMA for payment of treatment of Medicaid patients with the intent to obtain money that he knew or should have known he was not entitled to receive.

Although the Board found Dr. Bassiri guilty of misconduct, there were some mitigating factors: he has volunteered at several free dental clinics plus he has never before been disciplined by the Board.

The aggravating factors were that Dr. Bassiri has defrauded Medicaid by his misconduct, his pattern of conduct happened over such a long period of time that it couldn’t have been the result of a one-time only lapse of judgment, he didn’t show “genuine remorse or accept full responsibility for his misconduct” and he fraudulently deprived DMA of large amounts of money that could’ve been used for other indigent people, including children.

A final aggravating factor was that Dr. Bassiri’s conduct “was driven by greed.” The Board found that much of his monetary gain was used to allow him to live an opulent lifestyle, with a house worth nearly $1 million, expensive cars, a new office building, tracts of land in NC and condos in Myrtle Beach.

Because the aggravating factors outweighed the mitigating factors, the Board felt that the only way to protect the public was to revoke Dr. Bassiri’s license. They judged that his dishonesty is a “significant character flaw in a professional entrusted with the health and safety of the citizens of North Carolina.”

Dr. Bassiri says he was shocked with the verdict. “Everyone is so surprised,” he said. “I worked so hard to get my dental license, coming from another country. I was the only dentist in the area to accept Medicaid. I offered my services regularly for charity.”

Dr. Bassiri feels that revocation of his license was a harsh sentence, considering the circumstances and mitigating factors. He believes a more correct thing might have been to put him on probation and monitor him.

“This really hurts,” Dr. Bassiri admits. “I never tried to hide anything. I even asked for punishments.”

But the biggest thing that worries him right now is what will happen to those with whom he works and those he has treated over the years. “I am very concerned about my staff and my patients,” Dr. Bassiri says with obvious emotion in his voice.

He is considering an appeal, but a decision has not been reached at this time.

Read more: The Stokes News - Dr Bassiri’s dental license revoked Medicaid fraud charged

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