Schneiderman Announces $325,000 Medicaid Fraud Settlement With Erie County Dental Clinic

January 9, 2012 Updated Jan 9, 2012 at 5:53 PM EDT

By WKBW News

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Schneiderman Announces $325,000 Medicaid Fraud Settlement With Erie County Dental Clinic

January 9, 2012 Updated Jan 9, 2012 at 5:53 PM EDT

Buffalo, N.Y. (WKBW release) -- New York Attorney General Eric T. Schneiderman on Monday 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,” Schneiderman said in a news release. “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 allegedly 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 allegedly 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 allegedly 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 allegedly performed such procedures over separate visits, thereby enabling it to collect more money from the Medicaid program.

Baker Victory Services, meanwhile, issued its own news release Monday.  It reads:

On Monday, January 9, 2012, the New York Attorney General released news of a settlement between the State and the Baker Victory Services Dental Center.  Baker Victory Services has paid $325,000 as a result of a Medicaid Audit which reviewed a random sampling of patient documentation between January 1, 2005 and December 31, 2009.  However, Baker Victory Services denies being involved with any intentional misrepresentations or fraudulent activities.
 
The Baker Victory Services Dental Center is an area expert in providing dental care to individuals with physical, developmental and behavioral disabilities.  A number of the agency's patients have profound mental retardation, cerebral palsy, genetic abnormalities, autism, seizure disorders and other disabling conditions.  Individuals with profound disabilities are unable to care for their own dental hygiene, and it is extremely difficult for caregivers to attend to routine brushing and flossing.  As a result, this population is at high risk for dental infection and severe health conditions caused by neglected or insufficient dental care.
 
James Casion, CEO of Baker Victory Services, explains the need for more frequent dental visits for a disabled individual.  "Day-to-day dental hygiene is impossible for a profoundly disabled individual to attend to and challenging for caregivers, therefore, in many cases, the individual benefits greatly from having four routine dental cleanings annually as compared to two.  It is far more comfortable and cost effective for a disabled individual to receive more frequent preventative care than to be possibly subjected to the trauma and expense of emergency hospital visits.  This practice is allowed by the State Department of Health, which encourages this treatment plan as long as it is properly documented."
 
The Medicaid audit claimed that Baker Victory Services did not appropriately document the medical necessity for a number of cases.  "Because an individual's developmental disability does not change from visit to visit, we acknowledge that we did not thoroughly document the medical necessity of quarterly appointments at every visit," Casion explained further.  "Since the time of the audit, BVS has enhanced its documentation procedure to demonstrate the medical need each time a patient is seen."
 
The audit also claimed BVS provided services over two visits that could have been provided in one.  "Once again, this practice is for the comfort of a patient with profound developmental disabilities," Casion stated.  "A dental visit that involves sitting in a dental treatment chair, or wheelchair, with one's mouth open for an extended period, typically causes anxiety for a disabled individual.  The objective is to lessen this discomfort by spreading out the treatment over two visits."