A.G. Schneiderman Announces $325,000 Medicaid Fraud Settlement With Erie County Dental Clinic
Audit Uncovered Dental Center Accepted Fraudulent Overpayments For Medically Unnecessary Procedures In Violation Of Medicaid Rules
Schneiderman: My Office Is Dedicated To Recovering Taxpayer Dollars Misspent Through Violations Of The Medicaid Program
BUFFALO – Attorney General Eric T. Schneiderman today announced that Baker Victory Health Services Dental Center, of Lackawanna, has paid the state $325,000 in restitution to resolve a Medicaid fraud case involving excess payments received on claims for dental services.
“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,” said Attorney General Schneiderman. “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.”
An audit-investigation conducted by Attorney General Schneiderman's Medicaid Fraud Control Unit revealed that during the period of January 1, 2005 though December 31, 2009, Baker Victory submitted and received payments for dental clinic services for which Medicaid reimbursements were not authorized. The audit-investigation determined that in addition to performing unnecessary procedures, the clinic performed procedures that should have been done in one visit over multiple visits, resulting in additional fraudulent reimbursements.
Medicaid regulations authorize reimbursements only for teeth cleanings performed every six months, barring medical necessity. In some cases, Baker Victory patients were receiving cleanings every three to four months without such medical necessity at the taxpayers’ expense. In other cases – in violation of Medicaid regulations that required Baker Victory to perform and bill for cleanings, X-rays, and dental exams in one office visit – the Center performed such procedures over separate visits, thereby enabling it to collect more money from the Medicaid program.
The case was handled by Gary Baldauf, Buffalo Regional Director of the Attorney General’s Medicaid Fraud Control Unit under the supervision of Deputy Attorney General for the Medicaid Fraud Control Unit, Monica J. Hickey-Martin. The investigation was conducted by Supervising Special Auditor-Investigator Raymond August.