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Connecticut health center pays $350,000 to settle improper billing allegations related to Medicaid dental services

September 13, 2021 A federally qualified health center in Connecticut has paid $350,000 to resolve allegations it improperly billed the Connecticut Medicaid program for certain dental services, the U.S. Attorney's Office for the District of Connecticut announced in an Aug. 11 news release.

The payment was part of a civil settlement agreement with the state of Connecticut and U.S. governments, which allege Cornell Scott Hill Health Corp. implemented a policy that required Medicaid patients to receive prophylactic cleanings and dental examinations on separate days, resulting in the center getting paid two encounter rates instead of just one, according to the release.

Pursuant to federal requirements, the state of Connecticut compensates federally qualified health centers on an "encounter-based" reimbursement structure. For the provision of dental services, claims are limited to one all-inclusive encounter per day to include all dental services received by a patient on the same day, the release stated.

Cornell Scott Hill Health Corp. provides a variety of health care services, including dental services, to Connecticut Medicaid beneficiaries and other individuals.

In addition to the $350,000 the center paid to the state and federal governments to resolve its liability for conduct allegedly occurring between Jan. 1, 2017, and Dec. 31, 2019, it has agreed to change its policy and offer all Medicaid beneficiaries the option of scheduling a prophylactic cleaning and dental examination on the same day, according to the release.