Buffalo, NY - June 16, 2014 - Attorney General Eric T. Schneiderman today announced that his Medicaid Fraud Control Unit (MFCU) has reached a Memorandum of Understanding with the State University of New York (SUNY) to recover $115,094 in excess Medicaid payments for dental services performed from January 1, 2005, through August 31, 2009, at the Daniel Squire Oral Diagnostic & Treatment Center on the University’s Main Street campus in Buffalo.
“If services are billed in violation of the rules for Medicaid reimbursements, New Yorkers are owed and deserve that money,” Attorney General Schneiderman said. “This settlement demonstrates our commitment to recovering taxpayer dollars misspent through violations of the Medicaid program.”
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 these services must be performed over multiple visits.
During its audit-investigation, MFCU determined that in some cases, the dental clinic performed such services over two separate visits without noting the reason in the patient record 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.
Gary A. Baldauf, Regional Director of the MFCU Buffalo Regional Office, handled the settlement negotiations. The case was investigated by Supervising Special Auditor/Investigator Raymond August and Investigator Katie O’Neill. The Medicaid Fraud Control Unit is led by Acting Director Amy Held. The Criminal Justice Division is led by Executive Deputy Attorney General Kelly Donovan.