Buffalo, N.Y.-based Kaleida Health has agreed to pay $1.6 million after a state attorney general investigation revealed the system overbilled Medicaid for dental clinic services for which reimbursement was not authorized.
The overbilling, which resulted in excess payments of $1.6 million, took place from January 2005 through June 2012 and pertained to dental services at Buffalo Women's & Children's Hospital Dental Clinic. Attorney General Eric Schneiderman's Medicaid Fraud Control Unit conducted an investigation after Kaleida reported the dental clinic had received payments earlier in 2012 for services that did not authorize Medicaid reimbursement.
For instance, Medicaid authorizes reimbursement for teeth cleanings only once during a six-month time span unless there is documentation of medical necessity. Kaleida had billed Medicaid for patients who received cleanings more often than once in six months.
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The overbilling, which resulted in excess payments of $1.6 million, took place from January 2005 through June 2012 and pertained to dental services at Buffalo Women's & Children's Hospital Dental Clinic. Attorney General Eric Schneiderman's Medicaid Fraud Control Unit conducted an investigation after Kaleida reported the dental clinic had received payments earlier in 2012 for services that did not authorize Medicaid reimbursement.
For instance, Medicaid authorizes reimbursement for teeth cleanings only once during a six-month time span unless there is documentation of medical necessity. Kaleida had billed Medicaid for patients who received cleanings more often than once in six months.
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