BUFFALO, NY (WKBW/Release) - Attorney General Eric T. Schneiderman today announced an agreement with Kaleida Health to recover $1.6 million in excess Medicaid payments on claims for dental services at Buffalo Women’s & Children’s Hospital Dental Clinic.
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 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,” said Attorney General Schneiderman.
“My office is dedicated to recovering taxpayer dollars misspent through violations of the Medicaid program.”
The Attorney General’s Medicaid Fraud Control Unit conducted an investigation after Kaleida Health revealed that its Buffalo Women’s & Children’s Hospital Dental Clinic had received the excess payments earlier this year for dental clinic services for which Medicaid reimbursement was not authorized.
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.
Attorney General Eric T. Schneiderman commended Kaleida Health for voluntarily disclosing the results of their internal audit, cooperating with the Medicaid Fraud Control Unit investigation, and agreeing to make restitution.
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.