The Massachusetts Attorney General’s office has reached a settlement with a pediatric dentist in Springfield, returning $500,000 to the state’s MassHealth Medicaid program and resolving claims that the dentist improperly billed the program for services.
The settlement agreement resolves allegations that Annie Watson, DDS, and her Gentle Smiles dental practice improperly billed MassHealth for palliative care between March 2010 and June 2013 and failed to comply with MassHealth rules associated with the use of that emergency treatment billing code.
The Attorney General’s office began its investigation upon a referral from MassHealth that identified Watson as the top biller of the palliative care code among all MassHealth dental providers. To bill this code, the patient’s dental record must describe the treatment provided and document that it was given on an emergency basis. According to the Attorney General’s office, Watson routinely billed for palliative care without any supporting documentation, including when patients only received cleanings and x-rays.
Under the terms of the civil settlement, Watson and her business will pay MassHealth $500,000 as restitution for improper billing. It also requires Watson and her employees to review and comply with all applicable state and federal statutes as well as all regulations governing participation in MassHealth.
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