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ECMC to repay New York State $268,000 in Medicaid dental overbilling

Erie County Medical Center will repay the state more than $268,000 in excess Medicaid payments on claims for services at its dental clinic over a six-year period, the state Attorney General’s Office announced Monday.

Medicaid regulations authorize reimbursement for teeth cleanings only once during a six-month period unless more frequent cleanings are medically necessary and a notation is made in the patient chart to that effect. In some cases, ECMC’s dental clinic billed Medicaid for patients who received cleanings more than once in six months, the attorney general said in a news release announcing that his office had reached agreement with ECMC on the repayment.

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 reimbursement, the statement said. The repayments cover a period from Jan. 1, 2006, to Sept. 30, 2012.

A spokesman for the medical center was reported to be out of the office and unavailable to comment Monday. Erie County officials, citing the medical center’s status as public benefit corporation spun off from county government in 2004, declined to comment, even though the county is still responsible for some payments to the hospital.

The excess Medicaid payments were revealed during an audit of the dental clinic by the office of Attorney General Eric T. Schneiderman, following the hospital’s own internal audit last fall. After reviewing ECMC’s disclosure report, Schneiderman’s office requested the hospital 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 and discovered further overpayments of $57,849.09.

The case was handled by Buffalo officials of the attorney general’s Medicaid Fraud Unit and other investigators.