Health Center Pays $350K to Settle Improper Billing Allegations Related to Medicaid Dental Services
(STL.News) Acting United States Attorney Leonard C Boyle and Connecticut Attorney General William Tong today announced that CORNELL SCOTT HILL HEALTH CORPORATION (“CSH”) has entered into a civil settlement agreement with the federal and state governments and has paid $350,000 to resolve allegations that CSH improperly billed the Connecticut Medicaid program for certain dental services.
CSH is a Federally Qualified Health Center (“FQHC”) that provides a variety of health care services, including dental services, to Connecticut Medicaid beneficiaries and other individuals. Pursuant to federal requirements, the State of Connecticut compensates FQHCs on an “encounter-based” reimbursement structure. For the provision of dental services, claims are limited to one all-inclusive encounter per day to include all dental services received by a patient on the same day.
The allegations against CSH arise out of improper billing for certain dental services, specifically prophylactic cleanings and dental exams. The government alleges that CSH implemented a policy that required Medicaid patients to receive prophylactic cleanings and dental exams on separate days, resulting in CSH getting paid two encounter rates instead of just one rate.
To resolve their liability, CSH paid $350,000 to the federal and state governments for conduct occurring between January 1, 2017 through December 31, 2019. In addition, CSH has agreed to change its policy and offer all Medicaid beneficiaries the option of scheduling a prophylactic cleaning and dental examination on the same day.
This matter was investigated by the Office of Inspector General for the Department of Health and Human Services. The case was prosecuted by Assistant U.S. Attorney Richard M. Molot and by Assistant Attorneys General Michael Cole and Joshua Jackson of the Connecticut Office of the Attorney General.