The Massachusetts attorney general (AG) is suing HealthDrive for allegedly overbilling the state's Medicaid program, MassHealth, for more than $1.1 million for house calls to patients in nursing homes.
The complaint against HealthDrive alleges that since July 2010, the dental provider overbilled for nursing home visits by charging a separate "house call" fee for multiple patients treated at the same facility on the same day, according to statement by Attorney General Martha Coakley.
While providers can charge for treating multiple patients on the same day, MassHealth limits the separate house call charge to one per facility per day, regardless of the number of patients who receive dental care.
HealthDrive, which is based in Wellesley and has dental offices in Newton, allegedly continued the improper billing practice even though officials at MassHealth told the corporation's chief executive officer that it was illegal.
"We allege this dental provider collected more than $1 million in overpayments from MassHealth despite having knowledge that its billing practices violated state regulations," Coakley said. "Providers who take advantage of this MassHealth program weaken the Commonwealth's ability to maintain it."
The complaint alleges that HealthDrive was paid for more than 34,400 claims on a per-patient per-day basis, contrary to MassHealth's regulations on dental house calls established in 2010.
The complaint seeks civil penalties, restitution, and other compensation.
In a similar case last month, the attorney general's office reached a $400,000 settlement with Easton dentist Donald Prohovich, DDS, regarding overpayments he received from MassHealth for dental house calls.
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