NY dental clinic to pay $1.6M for Medicaid overbilling

Kaleida Health, the largest healthcare provider in western New York, has agreed to pay the state $1.6 million after an investigation revealed that one of its dental clinics had repeatedly overbilled Medicaid over a seven-year period.

The attorney general's investigation revealed that during the period of January 1, 2005, through June 29, 2012, Kaleida submitted and received payments for dental clinic services for which Medicaid reimbursement was not authorized.

The attorney general's Medicaid Fraud Control Unit conducted the investigation after Kaleida revealed that its Buffalo Women & Children's Hospital Dental Clinic had received the excess payments earlier this year.

Medicaid regulations authorize reimbursement for teeth cleanings only once during a six-month period, unless there is a medical necessity for more frequent cleanings and a notation in the patient chart to that effect. In some cases, Kaleida had billed Medicaid in violation of this rule for patients who received cleanings more often than once in six months. In other cases, the dental clinic performed and billed for exams, x-rays, and cleanings -- which Medicaid regulations require dental clinics to perform and bill during one office visit -- separately over multiple visits, resulting in additional cost to the Medicaid program.

Kaleida Health voluntarily disclosed the results of an internal audit to the attorney general's office and cooperated with the Medicaid Fraud Control Unit investigation.

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