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Claims vs. Facts: A Closer Look Into the Dental Fraud Case known as the ‘Tooth Fairy Heist’

During the past several weeks, Florida Daily has corresponded with the attorneys representing the five doctors fired by ACPDO Management. In our role, we have covered and will continue to cover the claims made by both sides of this investigation.

Here is the response attorneys sent to Florida Daily on our recent story about this case. 

“The so-called “Tooth Fairy HeistMedicaid dental fraud case has become the centerpiece of mudslinging about “pay-to-play” investigators. However, official court records show the investigation began when an insurance company, Liberty Dental, triggered a potential fraud filing with the state Agency for HealthCare Administration (AHCA), which runs Florida Medicaid.”

More facts below show that even the Miami Dade Assistant State Attorney believed that Medicaid fraud was committed by those who were arrested.

Claim: “‘This move is nothing more than a scheme, and …. ultimately seemed to have no merit – no case,’ one source told Florida Daily.

Fact: According to Florida law, no person other than a dentist licensed pursuant to Florida law, nor any entity other than a professional corporation or limited liability company composed of dentists, may own a dental practice.

Official records show that on February 2, 2023, Dr. Howard Fetner stated, “I am doing them [ACPDO] a favor as the doctor of record, and I have never even been down there.” Dr. Fetner, the supposed owner of this practice, admitted he had never stepped foot in the ACPDO office.

Fact: In an ongoing civil trial, Dr. Fetner pleaded the 5th over 400 times.

Other Notable Facts Regarding the Investigation:

On March 21, 2024 a special investigator for Liberty Dental gave the following testimony about state requirements for suspected Medicaid fraud.

 Attorney: “If Dr. Cabrerizo retires and sells the practice… on the day that happens, is the practice still the entity – still have a contract with Liberty?

Rebecca Nichols Gould, Liberty Dental Plan Associate Vice President over Florida Compliance and National Special Investigations Unit: No.

● Attorney: “So then, if the new owner, after acquiring the practice, continues to bill under the entity’s NPI number, is that permitted or not by liberty?

Gould: No. It’s considered a false claim. The entity is no longer owned by her.

● Attorney: Where is the requirement that indicates upon the change of ownership that the entity needs to – the new owner needs to reapply in order to have a contract with Liberty?

○ Gould: The Florida Medicaid program, in its application process, has the same requirement. In this scenario, they went in and they – because you cannot just take someone’s Medicaid number, even an entity’s Medicaid number.

You would have to go in and reapply and say, look, it’s me now. And you’ll be issued a new number… and so a new number is given.

Claim: “Operation Tooth Fairy, the insurance fraud case cooked up by Florida CFO Jimmy Patronis that Miami-Dade prosecutors refused to prosecute, has been quietly reanimated and retargeted by Gov. Ron DeSantis.” – Florida Bulldog: “DeSantis joins Patronis in boosting fortunes of big contributor in ‘Tooth Fairy’ case.”

Fact: The special investigator for Liberty Dental continued with the following testimony about how she initiated the “suspected fraud” investigation with an official submission to the State of Florida’s Medicaid Program at the Agency for HealthCare Administration. Her investigation began in October 2022, according to her official testimony.

● Gould: “I made the determination — I received a request for information. So based on the request for information, I did my research of what was being requested. And I had concerns that there was possibly, you know, fraud that may have occurred, or abuse, at a minimum abuse that had occurred. I made an immediate referral, within my contractual requirements, to the State of Florida’s Medicaid Program Integrity department, a reference to suspected fraud.”

Claim: “Sources tell Florida Daily they found it curious that three months later [Dec. 2022], Patronis’ in-house law enforcement powers were unleashed in a targeted, cynical investigation into Mellado’s enemies. The effort was entitled “Operation Tooth Fairy Heist” to maximize appeal to media and was personally monitored by Patronis, according to a report from the Florida Bulldog.” (Florida Daily, Honest Review of StateGovernment’s Suspect ‘Operation Tooth Fairy Heist’.)

Fact: Liberty Dental’s fraud investigator was directly asked if Mellado or Cabrerizo contacted her and she said they did not, according to official testimony.

● Attorney: “Did my clients, Dr. Cabrerizo or Dr. Mellado, involve with or direct your investigation at all?”

○ Gould: “No. I’ve not– I did not speak to them during the time of this investigation.”

● Attorney: “So, then, any assertion or assumption that my clients had pressured you or lobbied you to reach an outcome would be incorrect?”

○ Gould: “Correct. They did not.”

Claim: ACPDO attorney Dan Gelber told Action News Jax: “These allegations have at least twice now been presented to different state-level prosecutorial offices in Florida, all of which ultimately found the allegations without merit.” [Jacksonville dentist under investigation in connection with South Florida ‘Tooth Fairy Heist’ – Action News Jax]

Fact: Miami Dade Assistant State Attorney Michael Spivack wrote in an email obtained by public record request that, “It is simply factually incorrect that the continued use of Ania’s personal NPI and name was occurring without Ryon’s knowledge. After being confronted with this fact, Ryon admitted it to me and Detective Fajardo in Susy’s presence. At this point, the most productive process to follow is to move forward with the two charges listed in the information I have provided to all counsel…For my part, I truly believe Ryon is guilty and that the state has sufficient evidence to prove it.”

● SOURCE: State Attorney Spivack’s email about guilt of Medicaid fraud.

● Liberty Dental also confirmed they were contacted to start an investigation by AHCA.

○ Attorney: Then, am I correct in assuming that the law enforcement person who contacted you would’ve received that form from the Medicaid fraud unit or AHCA?

■ Gould: Liberty Dental Plan Associate Vice President over Florida Compliance and National SpecialInvestigations Unit: Yes.

○ Attorney: And you were in a stand-down period for how long?

■ Gould: “Once it was accepted — the second law enforcement agency is the Department of Financial Services in the State of Florida. So they’re sworn law enforcement. Once he picked up the investigation, he basically said, We’re taking this, please have no — you know, please — you can continue, you know, verifying your contract side of it. But they had — you know, they were interviewing and they were doing a criminal investigation. So we usually, just at that point, work with them directly so that we don’t impede on their investigation.”

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2 Comments

2 Comments

  1. Christi

    June 14, 2024 at 11:34 am

    Interesting story, but it is a story. ACPDO filed for change of ownership and was issued a new Medicaid number under new ownership effective 5/6/2022. The facts are that AHCA took several months to process the change of ownership, and their was significant confusion between Dr. Ania Caberizo the individual and Dr. Ania Caberizo PA the entity. This was something Liberty could not wrap their head around. The difference between the individual and the entitiy seem to still evade the leadership at Liberty Insurance Company.

  2. Brad

    June 14, 2024 at 11:47 am

    What about the large donations to politicians made by those who would benefit financially from these investigations? Is there a correlation between when those donations were made and the kick off of these investigations?

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