Schneiderman
BUFFALO, N.Y. (Legal Newsline) - New York Attorney General Eric Schneiderman announced a settlement on Monday with an Erie County dental clinic resolving allegations of Medicaid fraud involving excess payments received on dental service claims.
Schneiderman's Medicaid Fraud Control Unit alleged that between Jan. 1, 2005 and Dec. 31, 2009, Baker Victory Health Services Dental Center of Lackawanna submitted and received Medicaid payments for dental clinic services that were unauthorized. Baker Victory agreed to pay the state $325,000 in restitution.
"The regulations for dental clinics are clear and so are the obligations on healthcare providers - if services are billed in violation of the rules for Medicaid reimbursements, the state is owed that money," Schneiderman said. "My office is dedicated to recovering taxpayer dollars misspent through violations of the Medicaid program. Wasteful practices are a misuse of taxpayer dollars and abuses like this one will not be tolerated."
The unit alleged that the clinic also performed procedures that should have been done in one visit over the course of multiple visits, which resulted in additional fraudulent reimbursements.
Regulations for Medicaid authorize reimbursements only for teeth cleanings performed every six months, aside from additional treatments deemed medically necessary. In some cases, patients at Baker Victory were allegedly receiving cleanings every three to four months at the taxpayers' expense without medical necessity. In some alleged cases, Baker Victory performed such procedures as cleanings, X-rays and dental exams over separate visits, which enabled the clinic to collect more money from Medicaid.