For Immediate Release - March 10, 2014

AG Coakley Sues Wellesley Dental Provider for Allegedly Overbilling MassHealth More Than $1 Million

BOSTON – A Wellesley-based dental provider has been sued for allegedly overbilling the state’s Medicaid program (MassHealth) for more than $1.1 million of house calls to patients in multiple nursing homes, Attorney General Martha Coakley announced today.

The complaint against HealthDrive Corporation, filed in Suffolk Superior Court, 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. 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 also has dental offices in Newton, allegedly continued the improper billing practice even though officials at MassHealth directly 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,” AG Coakley said. “Providers who take advantage of this MassHealth program weaken the Commonwealth’s ability to maintain it.”

The complaint seeks civil penalties, restitution and other compensation due to the allegations. The AG’s Office 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.

In a similar case last month, the AG’s Office reached a $400,000 settlement with Dr. Donald P. Prohovich of Easton regarding overpayments he received from MassHealth for dental house calls.

This case is being handled by Assistant Attorney General Kriss Basil and Investigators Arianna Sassone and Eric Panicucci, all of AG Coakley’s Medicaid Fraud Division, with assistance from Assistant Attorney General Diane Barry of AG Coakley’s Executive Bureau.

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