BUFFALO, N.Y. (Legal Newsline) - New York Attorney General Eric Schneiderman announced a $1.6 million settlement with Kaleida Health on Friday to resolve allegations of excess Medicaid payments on dental service claims.
Kaleida Health allegedly submitted and received payments for dental clinic services at Buffalo Women's & Children's Hospital Dental Clinic for which Medicaid reimbursement was not authorized. Kaleida Health allegedly engaged in the excess claims between Jan. 1, 2005 and June 29, 2012.
"The regulations for dental clinics are clear and so are the obligations on health care 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."
Schneiderman's Medicaid Fraud Control Unit looked into the matter after Kaleida Health revealed that the Buffalo Women's & Children's Hospital Dental Clinic received the excess payments earlier in 2012 for unauthorized services. Kaleida Health voluntarily disclosed the result of an internal audit to Schneiderman's office.
Medicaid regulations authorize reimbursement for teeth cleanings just once during a six-month period, unless medical necessity is established for more frequent cleanings and a notation has been made in the patient chart to that effect. In some instances, Kaleida billed Medicaid in violation of the rule for patients who received more than one cleaning in a six-month period. In other instances, the dental clinic performed and billed for cleanings, x-rays and exams separately over multiple visits. Medicaid regulations require dental clinics to perform and bill during one office visit, Schneiderman says.
Schneiderman commended Kaleida Health for cooperating with the Medicaid Fraud Control Unit and agreeing to pay restitution.