BUFFALO, NY - A Lackawanna dental office has agreed to pay restitution to New York State in a Medicaid fraud case.
Baker Victory Health Services Dental Center has paid $325,000 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," said Attorney General Schneiderman. "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 the Attorney General's office revealed that during the period of January 1, 2005 though December 31, 2009, Baker Victory submitted and received payments for dental clinic services for which Medicaid reimbursements were not authorized.
The investigation also discovered that the clinic performed procedures over the course of multiple visits that should have been completed in one visit, resulting in additional fraudulent reimbursements.
Officials say Medicaid regulations only allow reimbursements for teeth cleanings performed every six months, barring medical necessity. In some cases, Baker Victory patients were receiving cleanings every three to four months without such medical necessity in violation of the rules.