BOSTON (Legal Newsline) - Massachusetts Attorney General Martha Coakley announced a settlement on Tuesday with an Easton dentist who allegedly engaged in improper billing to the state's Medicaid program, MassHealth.
Between July 2010 and September, Donald Prohovich allegedly improperly billed for visits to MassHealth members living in nursing homes. For a three-year period, Prohovich allegedly engaged in improper billing for house calls to elderly MassHealth patients in nursing homes in eastern Massachusetts on a per-patient-per-day basis.
In 2010, the MassHealth program established a regulation that limits payments for providers to one house call to a facility per day.
"This dental program is intended to provide coverage to MassHealth members living in nursing homes and long-term care facilities to ensure necessary dental care," Coakley said. "We allege this dentist submitted claims for reimbursement of house calls in reckless disregard of the limitation under MassHealth regulations."
Under the terms of the settlement, Prohovich agreed to pay MassHealth $400,000 as restitution for the overpayments he received for the alleged improper billing for house calls. Prohovich also agreed to certify that he and his dental staff review and comply with all existing and new MassHealth billing regulations.
MassHealth provides healthcare services and products to eligible low-income Massachusetts residents, including children, people with disabilities and senior citizens.