Cornell Scott Hill Health Pays $350K To Settle Billing Case: Feds

NEW HAVEN, CT — The Acting U.S. Attorney and Connecticut Attorney General William Tong announced Wednesday that Cornell Scott Hill Health entered into a civil settlement agreement with the federal and state governments and has paid $350,000 to resolve allegations that the health center located in the Hill neighborhood of New Haven improperly billed the Connecticut Medicaid program for certain dental services.

The allegations against Cornell Scott Hill Health come from what federal and state prosecutors say was "improper billing for certain dental services, specifically prophylactic cleanings and dental exams."

The federal government alleges that Cornell Scott Hill implemented a policy that required Medicaid patients to receive prophylactic cleanings and dental exams on separate days, resulting in them getting paid two encounter rates instead of just one rate.

A Federally Qualified Health Center, Cornell Scott Hill provides a variety of health care services, including dental services, to Connecticut Medicaid beneficiaries and others, the statement from Tong and the U.S. Attorney reads. And, pursuant to federal requirements, the state compensates those federally-qualified health centers on an “encounter-based” reimbursement structure, the news release reads. 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, federal prosecutors explained.

"To resolve their liability," the statement reads, Cornell Scott Hill paid $350,000 to the federal and state governments for "conduct occurring between January 1, 2017 through December 31, 2019."

In addition, CSH 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.

This matter was investigated by the Office of Inspector General for the Department of Health and Human Services. The case was prosecuted by Assistant U.S. Attorney Richard M. Molot and by Assistant Attorneys General Michael Cole and Joshua Jackson of the Connecticut Office of the Attorney General.