Easton Dentist to Pay $400,000 to MassHealth Over Improper Billing for Nursing Home Visits
Defendant to Comply with MassHealth Billing Regulations
BOSTON – An Easton dentist has agreed to pay $400,000 to the state’s Medicaid program (MassHealth) to resolve allegations of improperly billing for visits to MassHealth members living in nursing homes, Attorney General Martha Coakley announced today.
Following an extensive investigation, the AG’s Office determined that Dr. Donald P. Prohovich, a dental provider in the MassHealth program, violated a regulation established in 2010 that limits payments for providers to one “house call” to a facility per day. Investigators discovered that from July 2010 to September 2013, Prohovich allegedly improperly billed for house calls to elderly MassHealth patients in nursing homes in eastern Massachusetts on a per-patient-per-day basis.
“This dental program is intended to provide coverage to MassHealth members living in nursing homes and long-term care facilities to ensure necessary dental care,” AG Coakley said. “We allege this dentist submitted claims for reimbursement of house calls in reckless disregard of the limitation under MassHealth regulations.”
Under the terms of the civil settlement, Prohovich will pay MassHealth $400,000 as restitution for overpayments he received based on his alleged improper billing for house calls. Prohovich also agreed to certify that he and his dental staff review and comply with all existing and any new MassHealth billing regulations. MassHealth provides healthcare products and services to eligible low-income individuals, including people with disabilities, children and senior citizens.
The case was handled for the Commonwealth by Assistant Attorney General Kriss Basil, Investigator Arianna Sassone, and Assistant Investigator Eric Panicucci, all of AG Coakley’s Medicaid Fraud Division.