Lowell Orthodontist to Pay $800,000 Over Claims of Improperly Billing MassHealth for Dental Ex-Rays
BOSTON – A Lowell orthodontist has agreed to pay $800,000 over allegations of improperly billing the state’s Medicaid program for certain dental x-rays, resulting in thousands of dollars in overpayments, Attorney General Martha Coakley announced today.
Under the terms of the settlement, John Burke, D.M.D. has also agreed to permanently resign as a MassHealth provider and not treat any new patients.
“We allege this dentist engaged in a pattern of problematic billing to MassHealth for dentistry services that were contrary to regulations,” AG Coakley said. “This settlement will provide restitution to MassHealth and taxpayers, and will permanently remove this dentist as a MassHealth provider.”
Burke – who was among the highest billing MassHealth orthodontists, receiving close to $5.5 million from September 2006 through August 2011 – was initially referred to the AG’s Office by MassHealth following a review of his billing. In 2010, the State Auditor’s Office issued a report contending that Burke was not in compliance with certain laws, regulations, and/or rules governing the MassHealth dental program, resulting in overpayments. The report, along with an investigation by the AG’s Office, focused on MassHealth dental regulations that place service limitations on a certain type of dental x-ray known as a “periapical x-ray” and requires that the provider must be the dentist who actually performed the service.
These regulations prohibit separate claims for x-rays, oral/facial images, and pre-orthodontic visits when a comprehensive orthodontic treatment code is billed and paid. The auditor’s report found that Burke routinely took periapical x-rays on his patients and billed and received payments from MassHealth for purposes not permitted by these regulations.
The matter was investigated by Assistant Attorney General Steven Hoffman and Investigator Donna Mitchell of Attorney General Martha Coakley’s Medicaid Fraud Division, with assistance from MassHealth and the State Auditor’s Office.