A settlement has been reached with the State University of New York to recover $115,094 in excess Medicaid payments for dental services performed from Jan. 1, 2005, through Aug. 31, 2009, at the Daniel Squire Oral Diagnostic & Treatment Center on the university’s Main Street campus in Buffalo.
According to the office of the attorney general, Medicaid billing rules require that dental clinics perform a cleaning, dental exam and X-rays (if required) during a single reimbursable visit with a patient, unless there is a specific reason — recorded in the patients’ record — why the services must be performed over multiple visits.
During its audit-investigation, the Medicaid Fraud Control Unit found, in some cases, the dental clinic performed such services over two separate visits without noting the reason and billed Medicaid for each visit. As a result, the clinic received double reimbursement from Medicaid for such services.
In other cases, MFCU found that the clinic’s records did not contain sufficient documentation to substantiate the services it claimed to have rendered to patients, which was also in violation of Medicaid billing rules.