The New York State Department of Health improperly paid an Oneonta dentist $66,402 for 2,361 inflated or questionable Medicaid claims he submitted for unwarranted services, including "behavior management," and dentures that were not delivered to the recipients, according to an audit released by New York State Comptroller Thomas P. DiNapoli.

“This dentist took advantage of a system that routinely fails to catch errors and over-payments to line his own pockets,” DiNapoli said. “Numerous audits by my office have shown the state’s Medicaid program to be subject to this kind of waste and abuse. DOH needs to figure out how to stop letting taxpayer dollars go to waste.”

The Department of Health is responsible for administering Medicaid in New York State. All Medicaid claims are processed and paid by an automated system called eMedNY. Through this process, all claims are subject to automated controls to prevent waste. DiNapoli's auditors found that these controls are often failing to catch errors and fraud.

From June 1, 2009 to Sept. 30, 2012, auditors discovered that Medicaid paid Dr. Prosper Bonsi about $593,000 for 10,700 claims for dental services he provided to 915 Medicaid recipients.

Medicaid permits dentists to submit a claim for additional reimbursement services for patients who are developmentally disabled of mentally ill. In these cases, dental staff must provide additional time, skill and/or assistance to such patients to render treatment properly. Medicaid also allows dentists to bill an additional fee for emergency treatment provided between the hours of 10 p.m. and 8 a.m.

Bonsi submitted 2,361claims under these circumstances. DiNapoli's auditors found that $52,866 worth of claims Bonsi submitted should not have been paid because the patients were not eligible for such services.

Bonsi was also paid a total of $11,776 for 533 claims of after hours services that were in fact given during normal business hours.

Medicaid rules also mandate that claims for dentures should not be submitted until the recipient receives the dentures, but Bonsi often billed for dentures when he took the impression of the recipient's mouth, rather than when he provided the dentures to his patients. While this practice is improper under Medicaid rules, there is no overpayment if the patient eventually receives the dentures. However, in two instances, enrollees did not receive their dentures. Thus medicaid overpaid Bonsi $1,760 for these claims.

This discovery comes as DiNapoli has expanded an ongoing medical audit initiative that has found more than $1.63 billion in waste, fraud and abuse, including $77.6 million in 2013 alone. Earlier in July DiNapoli released two other audits that revealed $11.4 million in provider over-payments.

 

 

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