On Monday, August 21,2017, Massachusetts Attorney General Maura Healey announced that her office had reached a settlement with a pediatric dentist in Springfield. In return, the Attorney General’s Office has been able to return $500,000 to MassHealth, which is the state’s Medicaid program. Allegations that the dentist improperly billed the program will be resolved.
The settlement resolves allegations against Dr. Annie Watson, DDS and Gentle Smiles LLC. The trio was originally accused of improperly billing MassHealth for emergency pain treatment from March 2010 to June 2013. They were also accused of failing to comply with rules related to the utilization of that emergency treatment billing code.
A referral from MassHealth triggered an investigation into Dr. Watson and Gentle Smiles by the Attorney General’s Office. Dr. Watson was recognized as the top biller for the palliative care code among all MassHealth eligible dental providers. For dentists to bill for palliative card, the patient’s record needs to contain a description of the treatment provided. The record must also contain details of the treatment given during the emergency.
The Attorney General’s investigation suggested that Dr. Watson frequently billed MassHealth for palliative care without the appropriate documentation and even when patients had only received x-rays and cleanings. As a part of the civil settlement, Dr. Watson and her business will be required to pay MassHealth $500,000 in restitution.
Dr. Watson and her employees will be required to review and comply with all related state and federal statutes, as well as regulations governing participation in the MassHealth program.