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Attorney General Schneiderman announces $268k settlement with Erie County Medical Center

by jmaloni

Press release

Mon, Jul 22nd 2013 03:40 pm

Dental center disclosed having received Medicaid payments for services in violation of regulations

Attorney General Eric T. Schneiderman today announced an agreement with Erie County Medical Center to recover $268,493.50 in excess Medicaid payments on claims for services at its dental clinic during the period from Jan. 1, 2006 through Sept. 30, 2012.

"For millions of New Yorkers, Medicaid provides access to critical and cost-effective health care services," Schneidermansaid. "Those who abuse this integral program endanger the welfare of New York's most vulnerable citizens. My office is committed to ensuring that Medicaid is preserved for those who need it most."

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, ECMC's dental clinic 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 billed for services it provided that were not properly documented in patient files, other services provided more frequently than permitted, and services for which Medicaid does not allow for reimbursement - all in violation of Medicaid regulations.

The excess payments were revealed during an audit of the ECMC's dental clinic performed by the attorney general's office, following the hospital's own internal audit last fall. After reviewing ECMC's disclosure report, the attorney general's office requested ECMC to generate a series of billing reports, which showed overpayments of $210,646.41 during the audit period. The attorney general's office then performed its own review concerning patient chart documentation and discovered further overpayments to the hospital of $57,849.09.

Schneiderman thanked the Erie County Medical Center for self-disclosing the results of its internal audit and cooperating with his office's investigation.

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 and Executive Deputy Attorney General of Criminal Justice Kelly Donovan. The investigation was conducted by Supervising Special Auditor-Investigator Raymond August and Special Investigator James Zablonski, under the supervision of Chief Investigator Dominick Zarrella.

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