Konstantin Shtrambrand, DAB CR5782 (2020)

DECISION

I affirm the five-year exclusion that the Inspector General (IG) of the United States Department of Health and Human Services imposed on Petitioner, Konstantin Shtrambrand, from participation in all federal health care programs. 

I.  Background

In a July 31, 2020 notice, the IG informed Petitioner that he was being excluded from participation in all federal health care programs under section 1128(a)(3) of the Social Security Act (42 U.S.C. § 1320a-7(a)(3)), for a period of 5 years, due to his felony conviction in the New York State Supreme Court for Kings County (Supreme Court) of a criminal offense related to fraud, theft, embezzlement, breach of fiduciary responsibility, or other financial misconduct in connection with the delivery of a health care item or service, including the performance of management or administrative services relating to the delivery of items or services, or with respect to any act or omission in a health care program (other than Medicare and a State health care program) operated by, or financed in whole or in part, by any Federal, State or local Government agency.  The notice stated that the exclusion would be effective 20 days from the date of the notice.  IG Exhibit (Ex.) 1 at 1.

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Petitioner requested a hearing to dispute the exclusion.  On October 8, 2020, I held a telephonic prehearing conference, which is summarized in my October 8, 2020 Order Following Prehearing Conference and Setting Schedule for Prehearing Submissions.  Based on the prehearing submission schedule established at the conference, the IG filed a brief (IG Br.) and seven proposed exhibits (IG Exs. 1-7).  Petitioner filed a brief (P. Br.) but no proposed exhibits.1   The IG filed a reply brief (IG Reply).

II.  Issue

Whether the IG properly excluded Petitioner for five years under 42 U.S.C. § 1320a-7(a)(3). 

III.  Jurisdiction

I have jurisdiction to adjudicate this case.  42 U.S.C. § 1320a-7(f)(1); 42 C.F.R. §§ 1001.2007, 1005.2.

IV.  Decision on the Record

Petitioner did not object to the IG’s proposed exhibits.  Therefore, I admit IG Exs. 1‑7 into the record.  Standing Prehearing Order ¶ 12; see 42 C.F.R. § 1005.8(c). 

Neither party offered any witnesses, and both parties indicated that an evidentiary hearing was unnecessary in this case.  IG Br. at 8; P. Br. at 2.  Therefore, I decide this case based on the written record.  Standing Prehearing Order ¶¶ 11, 16.

V.  Findings of Fact, Conclusions of Law, and Analysis

My findings of fact and conclusions of law are in bold and italics. 

The Secretary of Health and Human Services must exclude an individual from participation in all federally funded health care programs when that individual:

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has been convicted for an offense which occurred after August 21, 1996, under Federal or State law, in connection with the delivery of a health care item or service . . . of a criminal offense consisting of a felony relating to fraud, theft, embezzlement, breach of fiduciary responsibility, or other financial misconduct.

42 U.S.C. § 1320a-7(a)(3). 

Therefore, for the purposes of this case, the three essential elements to support a mandatory exclusion are:  (1) the excluded individual must have been convicted of a felony offense for conduct that occurred after August 21, 1996; (2) the felony offense must be in connection with the delivery of a health care item or service; and (3) the felony conviction must have been related to fraud, theft, embezzlement, breach of fiduciary responsibility, or other financial misconduct.  42 C.F.R. § 1001.101(c)(1).

The record in the present case supports the existence of each of these elements. 

1. On September 24, 2019, after a trial by jury before the Supreme Court, the jury found Petitioner guilty of engaging in the unauthorized practice of dentistry from December 9, 2013 to December 16, 2013, in violation of New York State Education Law § 6512(1).  On December 10, 2019, a Supreme Court justice sentenced Petitioner to three years of conditional discharge and 25 hours of community service.  A violation of § 6512(1) is a class E felony.  Therefore, for purposes of 42 U.S.C. § 1320a-7(a)(3), Petitioner was convicted of a felony offense that occurred in 2013.

On September 1, 2015, Petitioner was indicted with three other individuals for the unauthorized practice of dentistry in violation of New York State Education Law § 6512(1).  IG Ex. 2 at 1.  Count One of the Indictment pertained to Petitioner and alleged that “from on or about and between December 9, 2013 and December 16, 2013, in the County of Kings, City and State of New York, while not being licensed or otherwise authorized to practice the profession of dentistry, for which a license is a prerequisite under Education Law Section 6602, [Petitioner] did practice, offer to practice, and hold himself out as being able to practice the profession of dentistry.”  IG Ex. 2 at 2.  Subsequent to this Indictment, on April 17, 2017, Petitioner was indicted again along with five other defendants, including the dentist and dental practice that employed him.2   IG Ex. 3; see also IG Exs. 4-5, 7.  The April 2017 Indictment included

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12 counts.  IG Ex. 3 at 1.  Of those, Petitioner was indicted of the following:  Count One for Healthcare Fraud; Count Two for Grand Larceny; and Count Nine for Offering a False Instrument for Filing.  IG Ex. 3 at 1-2, 6. 

The Supreme Court justice assigned to the criminal case commenced a jury trial on September 11, 2019, for Petitioner and the other defendants.  IG Ex. 4.  On September 24, 2019, the justice charged the jury, and the jury delivered a guilty verdict against Petitioner related to the unauthorized practice of dentistry.  IG Ex. 5 at 1, 14-45, 76-77. 

According to the justice, the “verdict sheet” used in the proceeding indicated that Petitioner was charged in Count Three with “on or about and between December 9th of 2013 and December 16th of 2013, in the County of Kings, [Petitioner], Konstantin, not being authorized to practice dentistry for which a license is a prerequisite, practiced, or offered to practice, or held himself as being able to practice dentistry.”3   IG Ex. 5 at 34-35.  The justice explained that: 

The next crime is Unauthorized Practice of a Profession, Dentistry.  Under our law, a person is guilty of Unauthorized Practice of a Profession, when he, not being authorized to practice dentistry for which a license is a prerequisite, practices, or offers to practice, or holds himself out as being able to practice dentistry.

To practice the profession of dentistry means:  Diagnosing, treating, operating, or prescribing for any disease, pain,

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injury, deformity, or physical condition of the oral and maxillofacial, which means upper jaw, area related to restoring and maintaining dental health. 

The practice of dentistry includes the prescribing and fabrication of dental prostheses and appliances.

The practice of dentistry may include performing physical evaluations in conjunction with the provision of dental treatment.

The practice of dentistry does not include:  Cleaning, performing solely mechanical work upon inert matter in a dental office or on a dental laboratory prescription of a dentist holding a license or limited permit, or an uncertified dental assistant who, under the supervision of a licensed dentist, operates an X-ray machine.

* * * * *

For you to find Konstantin guilty of this crime, the People are required to prove, from all the evidence in the case, beyond a reasonable doubt, that on or about and between December 9th of 2013 and December 16th of 2013, in the County of Kings, the defendant, Konstantin, not being authorized to practice dentistry for which a license is a prerequisite, practiced, or offered to practice, or held himself as being able to practice dentistry.

If you find that the People have proven this, beyond a reasonable doubt, then you must find the defendant guilty of this crime.

IG Ex. 5 at 33-35.

The jury found Petitioner guilty only as to Count Three on the “verdict sheet” (Unauthorized Practice of a Profession, Dentistry).  IG Ex. 5 at 76-77, 81.  The jury found him not guilty of Healthcare Fraud, Grand Larceny, and Offering a False Instrument for Filing.  IG Ex. 5 at 76-77.

On December 10, 2019, the Supreme Court sentenced Petitioner to conditional discharge with 25 hours of community service.  IG Ex. 7 at 6-7.  A January 6, 2020 Certificate of Disposition of Indictment from the Clerk of the Supreme Court indicated that, on

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December 10, 2019, Petitioner was convicted of violating New York State Education Law § 6512(1) and the Court sentenced Petitioner to conditional discharge for three years and 25 hours of community service.  IG Ex. 6 at 1.

For exclusion purposes, the word “convicted” means that a judgment of conviction has been entered against an individual by a federal, state or local court, or a federal, state or local court has made a finding of guilt against the individual.  42 U.S.C. § 1320a-7(i)(1), (2).  As indicated above, a jury found Petitioner guilty, and the Clerk of the Supreme Court certified Petitioner’s conviction.  Finally, New York State Education Law § 6512(1) states that unauthorized practice of a profession requiring a license is a class E Felony.  Petitioner does not dispute that he was convicted of a felony, which was committed after August 21, 1996.  P. Br. at 1.  Therefore, I conclude that Petitioner was convicted of a felony offense committed after August 21, 1996.

2. Petitioner’s felony conviction was based on providing dental services that he could not legally provide.  Therefore, for purposes of 42 U.S.C. § 1320a-7(a)(3), Petitioner’s felony offense was in connection with the delivery of a health care item or service.

For the IG to exclude Petitioner under 42 U.S.C. § 1320a-7(a)(3), Petitioner’s felony offense must have been for conduct in connection with the delivery of a health care item or service.  To be “in connection with” the delivery of a health care item or service, there only needs to be a nexus or common-sense connection to the delivery of a health care item or service.  Charice D. Curtis, DAB No. 2430 at 5 (2011).

In the present case, Petitioner was convicted of the practice of dentistry without a state license.  The September 1, 2015 Indictment specified that Petitioner “did practice, offer to practice, and hold himself out as being able to practice the profession of dentistry.”  IG Ex. 2 at 2.  As the Supreme Court justice who presided at the criminal trial advised the jury:  “To practice the profession of dentistry means:  Diagnosing, treating, operating, or prescribing for any disease, pain, injury, deformity, or physical condition of the oral and maxillofacial, which means upper jaw, area related to restoring and maintaining dental health.”  IG Ex. 5 at 33.  During the trial, the prosecutor described the evidentiary basis for the state’s charge: 

You will learn that on December 16 of 2013, the undercover [individual] along with another investigator from [the prosecutor’s] office, Investigator [name redacted], both equipped with the audio and video recording devices, went to [redacted] for her appointment with Konstantin Shtrambrand.

She will tell you that upon checking in, she was escorted to the examination room by defendant Shtrambrand himself[,]

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and she will tell you how he examined her teeth and gave advice as to what needed to be done.

IG Ex. 4 at 19.  In his brief, Petitioner did not dispute that this incident was the basis for the charge of unauthorized practice as a dentist. 

Because the jury concluded that Petitioner had engaged in the unauthorized practice of dentistry and because the specifics of that practice included examining a patient and advising what action needed to be taken based on that examination, I conclude that Petitioner’s conviction was in connection with the delivery of dental services and, therefore, healthcare services.

3. Petitioner’s felony conviction involved providing dental services (i.e., an examination and advice as to treatment) to a patient.  Petitioner could not legally provide those services.  There is nothing in the record indicating that Petitioner informed the patient that he was not legally qualified to conduct an examination and recommend treatment.  Further, another person working at the same dental practice that employed Petitioner was convicted of the unauthorized practice of dentistry.  In addition, the dentist who owned the dental practice and the dental practice itself were convicted of aiding and abetting the unauthorized practice of dentistry, offering a false instrument for filing with intent to defraud related to the unauthorized practice of dentistry, and falsifying a business record with intent to defraud related to the unauthorized practice of dentistry.  Therefore, for purposes of 42 U.S.C. § 1320a-7(a)(3), Petitioner’s felony offense of the unauthorized practice of dentistry was both directly and indirectly related to fraud.   

For a conviction to qualify as one mandating exclusion under 42 U.S.C. § 1320a-7(a)(3), it must be a felony relating to fraud, theft, embezzlement, breach of fiduciary responsibility, or other financial misconduct. 

In the present case, Petitioner was convicted of unauthorized practice of dentistry, but was found not guilty of healthcare fraud, grand larceny, and offering a false instrument for filing.  IG Ex. 5 at 76-77.  Petitioner argues, based on the outcome of these charges, that he was not convicted of a felony relating to fraud, but only as to the unauthorized practice of dentistry.  Petitioner also points to a Certificate of Relief from Disabilities (i.e., employment bars) issued by the Supreme Court, as well as the Supreme Court’s decision not to exclude Petitioner from the New York Medicaid program, in support of reversing his exclusion from all federal health care programs under 42 U.S.C. § 1320a-7(a)(3).  P. Br. at 2, 4; Hearing Req.; Hearing Req. Supporting Document (DAB E-File document number 1c).

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The IG argues that Petitioner was part of a fraudulent scheme with his co-defendants to seek reimbursement from the State of New York through Petitioner’s unauthorized practice of dentistry, and asserts that his unauthorized practice is, in and of itself, related to fraud.  IG Br. at 6-7.  The IG also posits that the Supreme Court’s actions related to his ability to continue to work as a dental assistant or participate in the New York Medicaid program do not affect the IG’s obligation to impose a mandatory exclusion from participation in federal healthcare programs.  IG Reply at 2.

Although the IG presented a relatively minimalistic argument, I agree with it in principle.

The question as to whether Petitioner’s felony offense requires exclusion turns on whether that offense is one that is “relating to” fraud.  The terms “related to” and “relating to” under 42 U.S.C. § 1320a-7 simply mean that there must be a nexus or common-sense connection.  See James Randall Benham, DAB No. 2042 at 5-6 (2006) (internal citations omitted); see also Friedman v. Sebelius, 686 F.3d 813, 820 (D.C. Cir. 2012) (describing the phrase “related to” in another part of section 1320a-7 as “deliberately expansive words,” “the ordinary meaning of [which] is a broad one,” and one that is not subject to “crabbed and formalistic interpretation”) (internal quotation marks omitted).  Further,

in determining whether the requisite nexus exists, the “labeling of the offense under the state statute” is not determinative.  Berton Siegel, D.O., DAB No. 1467, at 7 (1994) (emphasis omitted).  We consider, as appropriate, “evidence as to the nature of an offense,” such as the “facts upon which a conviction was predicated.”  DAB No. 1467, at 6-7.  Thus, how an offense is labeled or classified under state law may very well be a relevant consideration, but it does not, alone, inform the [DAB]’s determination of whether or not the requisite nexus exists.  The [DAB] also looks to the factual allegations underpinning the offense with which a petitioner was charged and which form the basis for the requisite conviction.  It would follow, then, that the fact that Petitioner pled guilty only to PHL § 12-b(2), an unclassified misdemeanor, does not mean that we may not or do not examine the record of the criminal proceeding below, of which the Misdemeanor Information is a part, to determine whether there is indeed a nexus between the offense and patient neglect or abuse.

Robert C. Hartnett, DAB No. 2740 at 7 (2016) (footnote omitted).

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Reviewing “the factual allegations underpinning” Petitioner’s offense, as quoted in the previous section of this decision, I must conclude that Petitioner’s felonious conduct related to fraud.  In its most general legal sense, the term “fraud” means:  “A knowing misrepresentation or knowing concealment of a material fact made to induce another to act to his or her detriment.”  FRAUD, Black’s Law Dictionary (11th ed. 2019).  The factual allegations charged in the September 1, 2015 Indictment along with those made by the prosecutor at trial provide a scenario where Petitioner apparently did not disclose to the patient the limitations on his ability to conduct a dental examination and to advise as to treatment.  Members of the public would expect that health care providers would act only within the scope of their certifications or licenses and cannot be expected to know when a healthcare provider exceeds that scope.  While the record does not disclose what Petitioner advised the patient to do or not to do following the examination, any illegally provided advice from an unqualified individual could cause the patient to act (or refrain from acting) to his or her detriment.  Therefore, the record supports a direct relationship between Petitioner’s offense and fraud. 

The record also shows that Petitioner’s offense is indirectly related to a scheme involving fraud.  As explained below in detail, the dentist and dental office that Petitioner worked for were convicted at the same time as Petitioner for aiding and abetting the unauthorized practice of dentistry and two other crimes in which the jury found the dentist and practice had the intent to defraud New York State.  Further, the jury found another defendant guilty of unauthorized practice of dentistry.  Therefore, while Petitioner was found not guilty of charges that expressly alleged fraud, it is impossible to overlook that the dentist and dental practice that employed Petitioner were engaged in fraudulent conduct that was based on their employees’ unauthorized practice of dentistry. 

As mentioned above, on September 1, 2015, Petitioner was indicted with three other individuals for the unauthorized practice of dentistry in violation of New York State Education Law § 6512(1).  IG Ex. 2 at 1.  Further, on April 17, 2017, Petitioner was indicted again along with five other defendants, including the dentist and dental practice who employed him.  IG Ex. 3.  The April 2017 Indictment included 12 counts.  IG Ex. 3 at 1.  The dentist and the dentist’s practice were each charged with, among other things, aiding and abetting the unauthorized practice of dentistry, offering a false instrument for filing, and falsifying business records.  Ultimately, they were both found guilty of those crimes following a joint criminal trial with Petitioner and others charged with the unauthorized practice of dentistry.  IG Ex. 3; IG Ex. 5 at 74, 79-80.  In Count Eight of the April 17, 2017 Indictment, the dentist and the dental practice for whom Petitioner worked were charged with offering a false instrument in violation of New York State Penal Law § 175.35(1).  Significantly, this charge was expressly premised on an effort to defraud New York State.  The charge alleged: 

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The defendants, acting in concert, on or about March 22, 2013, in the County of Kings and elsewhere in the State of New York, knowing that a written instrument contained a false statement and false information and with the intent to defraud the State of New York, knowingly offered, submitted and caused to be submitted a claim for payment to the New York State Medical Assistance Program (Medicaid)  . . . that falsely stated care was furnished to a Medicaid recipient in compliance with all the rules and regulations when in fact services were rendered by an unlicensed provider.   

IG Ex. 3 at 5 (emphasis added).  In his charge to the jury about this charge, the Supreme Court justice made it clear to the jury that, for a guilty verdict, it needed to find that the dentist and the dental practice had filed the claim in question with the intent to defraud the state.  This charge appears to be labeled as Count Seven in the verdict sheet.  The jury charge was as follows: 

The next crime alleged is Offering a False Instrument for Filing in the First Degree.

Under our law, a person is guilty of Offering a False Instrument for Filing in the First Degree when, knowing that a written instrument contains a false statement or false information, and with intent to defraud the state, or any political subdivision, political authority, or public benefit corporation of the state, he offers or presents to a public office, public servant, public authority or public benefit corporation, with the knowledge or belief that it will be filed with, registered or recorded in, or otherwise become a part of the record of such public office, public servant, public authority or public benefit corporation.

A “written instrument” means any instrument or article, including computer data or a computer program, containing written or printed matter or the equivalent thereof, used for the purpose of reciting, embodying, conveying, or recording information, or constituting a symbol or evidence of value, right, privilege or identification, which is capable of being used to the advantage or disadvantage of some person.

“Intent” means conscious objective or purpose.

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Thus, a person acts with intent to defraud the state, or any political subdivision, public authority or public benefit corporation of the state, when that person’s conscious objective or purpose is to defraud the state, or any political subdivision, public authority, or public benefit corporation of the state.

“Public servant” means any public officer or employee of the state, or any political subdivision thereof, or of any governmental instrumentality within the state, or any person exercising the functions of any such public officer or employee.

The term “public servant” includes a person who has been elected or designated to become a public servant.

[The dentist and dental practice] are charged with this crime in count seven . . . of their respective verdict sheets. . . . 

For you to find the defendants guilty of this crime, the People are required to prove, from all of the evidence in the case, beyond a reasonable doubt, each of the following five elements:  

Now, the first element is a bit different, depending on the person, and 2005 are the same, so I broke them down for you.  

For count seven, the first element is:

That on or about March 22, 2013, in the County of Kings, the defendant, [the dentist], individually and as a high managerial agent, acting within the scope of his employment, and on behalf of corporate defendant, [the dental practice], offered, or presented, a written instrument to a public office, or public servant or public authority, or public benefit corporation under claim number [omitted].

* * * * *

Number two.  That the defendant did so with the knowledge or belief that it would be filed with, registered or recorded in, or otherwise become part of, the records of such public office,

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or public servant, or public authority, or public benefit corporation.

And, three.  That the written instrument contained a false statement or false information.

And, four.  That the defendant knew that the written instrument contained a false statement or false information.

And, five.  That the defendant offered, or presented, the written instrument with intent to defraud the state or any political subdivision, or public authority, or public benefit corporation of the state.

If you find that the People have proven, beyond a reasonable doubt, each of those five elements for a defendant, then you must find that defendant guilty of this crime.

IG Ex. 5 at 38-41 (emphasis added). 

The jury found the dentist and the dental practice guilty as to this charge (Count Seven of the verdict sheet).  IG Ex. 5 at 74-75.  Therefore, the jury’s guilty verdict means they found fraud in relation to the claim and the fraud related to the unauthorized practice of dentistry. 

The same is true of Count Ten in the Indictment related to falsifying a business record.  The Indictment stated: 

The defendants [the dentist and the dental practice], acting in concert, on or about January 8, 2014, in the County of Kings and elsewhere in the State of New York, with an intent to defraud which included an intent to commit another crime and to aid and conceal the commission thereof, made and caused to be made a false entry in the business records of [redacted name] (to wit:  claim number [redacted]) that falsely stated dental care was furnished by [redacted], a licensed provider, to a Medicaid recipient in compliance with all Medicaid rules and regulations when in fact services were rendered in violation of said rules and regulations by [redacted] an unlicensed individual.

IG Ex. 3 at 6 (emphasis added). 

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Regarding the charge of falsifying a business record, the Supreme Court justice charged the jury as follows:

Now, [the dentist and the dental practice] are charged with this crime in count nine of their respective verdict sheet. . . .

For you to find the defendant guilty of this crime, the People are required to prove, from all the evidence in the case, beyond a reasonable doubt, each of the following two elements:

Number one.  That on or about January 8, 2014, in the County of Kings, the defendant, [the dentist] individually and as a high managerial agent acting within the scope of his employment and on behalf of his corporate defendant, [the dental practice], while acting in concert, made or caused a false entry in the business records of an enterprise . . . .

And, two.  That the defendants did so with the intent to defraud that included an intent to commit another crime or to aid or conceal the commission thereof.

If you find that the People have proven, beyond a reasonable doubt, each of those elements then, for that defendant, you must find that defendant guilty of this crime.

IG Ex. 5 at 42-43.

The jury found the dentist and the dental practice guilty as to this charge (Count Nine of the verdict sheet).  IG Ex. 5 at 74, 76.  Therefore, the jury’s guilty verdict means they found fraud in relation to documentation that involved the unauthorized practice of dentistry. 

The jury also found the dentist and the dental practice guilty as to Count Five of the verdict sheet, which was aiding and abetting in the unauthorized practice of dentistry.  IG Ex. 5 at 74-75.  In addition to Petitioner, the jury found a fourth defendant, whose name has been redacted, guilty (Count Four of the verdict sheet) as to the unauthorized practice of dentistry.  IG Ex. 5 at 77-78, 80-81.

While Petitioner was found not guilty of charges that expressly alleged fraud, Petitioner’s co-defendants and employers were, and that fraud was directly related to the unauthorized practice of dentistry that was being aided and abetted.  This provides a relation between Petitioner’s conviction and fraud.   

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4. Petitioner must be excluded for five years under 42 U.S.C. § 1320a-7(a)(3).

I conclude that Petitioner’s conviction meets the three elements for a mandatory exclusion under 42 U.S.C. § 1320a-7(a)(3).  Therefore, Petitioner must be excluded for at least five years.  42 U.S.C. § 1320a-7(c)(3)(B); 42 C.F.R. § 1001.102(a). 

VI.  Conclusion

I affirm the IG’s determination to exclude Petitioner from participating in all federal health care programs for the statutory five-year minimum period pursuant to 42 U.S.C. § 1320a-7(a)(3).

1. Petitioner uploaded each page of his three-page brief separately to the Departmental Appeals Board (DAB) E-File system.  The DAB E-File system assigned each page a document number (i.e., 6, 6a, 6b).  Petitioner also uploaded a document that explains Part II of Petitioner’s brief (DAB E-File document number 6c).  However, Petitioner’s file name for this document is Petitioner Ex. 1.  Because Petitioner did not sign this document under oath or penalty of perjury, I do not consider it to be written testimony.  Standing Prehearing Order ¶ 10; 42 C.F.R. § 1005.16(b); see P. Br. at 2 (indicating Petitioner has no witnesses to testify in this case).  Consequently, I treat it as a fourth page of Petitioner’s brief.  Therefore, I cite to Petitioner’s brief as one document with pages one through four correlating to document numbers 6-6c (e.g., P. Br. at 3 is document 6b).
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2. The IG redacted the names of all defendants, save for Petitioner’s, in each of her exhibits.  Other than a single defendant, who was exonerated by the jury, it is not clear why the other defendants, who were publicly convicted of crimes, needed this level of privacy.  The significant amount of redaction made review of the record challenging but not impossible because the IG occasionally failed to redact the defendants’ names.  Based on this information and a close review of the exhibits, I could differentiate the defendants in most circumstances.  One of the defendants, with the initials J.S., is the dentist who ran or owned the corporate defendant J&S A. (i.e., the dental practice) in this case.  IG Ex. 4 pt. I at 31; IG Ex. 4 pt. II at 67; IG Ex. 5 at 37, 73.  As to the other two defendants, who appear to be non-dentists primarily charged with the unauthorized practice of dentistry, the last name of one starts with a V and the other a Z.  IG Ex. 4 pt. I at 40, 46.  Although the April 17, 2017 Indictment indicated six defendants, the criminal trial involved only five defendants, as discussed in this footnote.  See IG Ex. 5 at 73-79.
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3. It appears possible that, because this case involved two separate indictments, the Supreme Court consolidated those charges and renumbered the counts on a “verdict sheet,” referenced by the Supreme Court justice while charging the jury.  The facts alleged in Count One of the September 1, 2015 Indictment appear to correspond to Count Three from the “verdict sheet.”  The IG neither addressed this apparent discrepancy in her brief nor did she submit the “verdict sheet,” thus complicating review of the record in this case.
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