NY clinic pays $325K Medicaid fraud settlement

Baker Victory Health Services Dental Center of Lackawanna, NY, has paid the state $325,000 in restitution to resolve a Medicaid fraud case involving excess payments received on claims for dental services.

An audit investigation conducted by New York Attorney General (AG) Eric Schneiderman's Medicaid Fraud Control Unit revealed that during the period of January 1, 2005, though December 31, 2009, the dental center submitted and received payments for dental clinic services for which Medicaid reimbursements were unauthorized. The 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, according to the AG's office.

"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 in a press release.

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, the center performed such procedures over separate visits, thereby enabling it to collect more money from the Medicaid program, according to the AG's office.

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