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Fines totaling as much as $200,000 are bringing shock and awe to dental practices around the state, with many dentists complaining that the preponderance of errors cited are of a clerical nature that did not affect treatment.

In what might be one of the first reported cases of a Medicaid contractor going after dentists for overpayments, the Portland Press Herald newspaper yesterday told readers that dentists who treat low-income patients were being hit with what the newspaper described as “major fines for minor clinical errors. 

Joe Lawlor, a staff writer for the newspaper, explained to readers that “a new auditing system adopted by the state” in compliance with the Affordable Care Act was used to snag dentists participating in the state’s MaineCare program. The Medicaid contractor is New York-based HMS, the contractor that has the lion’s share of state contracts in the Medicare RAC program.

Lawlor quoted one dental clinic director, Kristina Lake Harriman of Community Dental in Waterville, as saying she “actually started crying” when she received a fine of $58,000—a fine she is quoted as saying she is appealing.

Another dentist, Michael Dowling, quoted in the Lawlor article, accused the state of a “clawback,” saying that state officials “are trying to take back money that we billed them legitimately.” Dowling, according to the article, would not reveal how much his practice had been fined, but described the amount as “substantial.”

Lawlor wrote that some dentists indicated they would have to stop treating MaineCare patients, or sharply reduce their services, if the fines are upheld on appeal. He wrote that dentists had met with state Department of Health and Human Services officials to contest the fines.

J. Paul Spencer, the director of regulatory and coding compliance for Providence Health Services, who has been tracking the Medicaid RACs on behalf of RACmonitor, reports that from the very beginning of the Medicaid RAC program on January 1, 2012, some overlap of types of services reviewed was to be expected between Medicare and Medicaid RACs. According to Spencer, this was particularly evident with claims for dental, behavioral health, and Early Periodic Screening Diagnosis and Treatment (EPSDT).

“Dentists in the know have been reaching out to me unofficially for about a year,” Spencer told RACmonitor. “They have been concerned about how destructive and deleterious these audits could be over time. Unfortunately, the canary in Maine’s coal mine is showing that their fears are well-founded.”

Spencer said the best advice he can offer to affected practices is that if you think that you have grounds for an appeal, you must fight.

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Chuck Buck is the publisher of RACmonitor.

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Chuck Buck

Chuck Buck is the publisher of RACmonitor and is the program host and executive producer of Monitor Monday.

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