Health center pays $350K to settle allegations of improper Medicaid dental billing

New Haven, Conn.-based Cornell Scott-Hill Health Center has entered a civil settlement agreement with the federal and state governments, paying $350,000 to resolve allegations that it improperly billed Connecticut's Medicaid program for dental services, according to an Aug. 11 news release from the state's justice department.

The facility, a federally qualified health center, provides a range of healthcare services, including dental care, to Connecticut Medicaid beneficiaries and others. The state of Connecticut compensates such centers on an "encounter-based" structure. For 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 government alleged that CSH implemented a policy requiring Medicaid patients to have prophylactic cleanings and dental exams on separate days, so CSH was paid two encounter rates instead of one.

CSH paid a $350,000 settlement to the federal and state governments for conduct occurring between Jan. 1, 2017, and Dec. 31, 2019. Additionally, CSH agreed to offer all Medicaid beneficiaries the option of scheduling a prophylactic cleaning and dental exam the same day.

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