Attorney General Tong Announces $350,000 Settlement With Cornell Scott Hill Health Corporation Over Dental Service Overbilling
(Hartford, CT) – Attorney General William Tong today announced a $350,000 joint state and federal settlement with Cornell Scott Hill Health Corporation (CSHHC) resolving allegations that the New Haven-based health center carried out a policy that resulted in overbilling the state’s Medicaid program for certain dental services.
CSHHC is a community-based Federally Qualified Health Center (FQHC). The Connecticut Medicaid program uses an “encounter-based” reimbursement model to compensate FQHCs for all services provided to Medicaid recipients on the same day. Under this model, a FQHC is paid a pre-determined “encounter rate” that covers all services received by a patient during a visit to that FQHC. Every time a patient returns to a FQHC to receive a service or services, the FQHC gets paid another encounter rate. CSHHC’s current encounter rate is approximately $162.00.
A joint state and federal investigation found that from 2017 through 2019, CSHHC implemented a policy that required Medicaid patients to receive routine dental cleanings and exams on separate days. This policy resulted in CSHHC getting paid two encounter rates for services that could have been completed during the same visit. CSHHC cooperated with the investigation.
“Cornell Scott Hill applied a policy that caused the state Medicaid program to overpay for routine dental services. This policy burdened patients by needlessly requiring repeat visits for their dental exams and cleanings. This policy had real consequences for their Medicaid patients, including requiring adults and children to take more time off work and/or school, as well as the burden of additional transportation. In addition to the $350,000 restitution payment, Cornell Scott Hill will allow all Medicaid patients the ability to schedule both their dental cleaning and exam in one visit,” said Attorney General Tong.
Attorney General Tong thanked the U.S. Health and Human Services Office of the Inspector General/Office of Investigations, the Office of the United States Attorney, and the DSS Office of Quality Assurance for their assistance and coordination in this matter.
Anyone with knowledge of suspected fraud or abuse in the public healthcare system is asked to contact the Attorney General’s Antitrust and Government Program Fraud Department at 860-808-5040 or by email at firstname.lastname@example.org; the Medicaid Fraud Control Unit at 860-258-5986 or by email at email@example.com; or the Department of Social Services fraud reporting hotline at 1-800-842-2155, online at www.ct.gov/dss/reportingfraud, or by email to firstname.lastname@example.org.
Assistant Attorneys General Joshua L. Jackson and Michael E. Cole, Legal Investigator Kevin Jeffko, and Jeremy Pearlman, Chief of the Antitrust and Government Program Fraud Department, assisted the Attorney General with this matter.