November 6, 2013

MaineCare dentists say minor clerical errors draw massive fines

Some clinics face more than $200,000 in penalties under a new audit system that threatens to wipe out services for kids.

By Joe Lawlor jlawlor@pressherald.com
Staff Writer

(Continued from page 1)

click image to enlarge

Kristina Lake Harriman poses for a portrait at her 93 Main St. dental office in Waterville on Tuesday. Dentists are being fined exorbitant amounts by the state DHHS over computer glitches in MaineCare system. Some dentists say it's going to put them out of business. It has to do with a new contractor fining the dentists over billing problems.

Michael G. Seamans/Staff Photographer

Dowling said DHHS officials made conflicting statements, at a legislative hearing and then in a private meeting with dentists, about whether the samples were random.

HMS did not respond to requests for comment Tuesday.

Even the problems that have been discovered are coding errors that have nothing to do with Medicaid abuse, said Dowling and Harriman.

For example, if a patient sees one dentist but the bill goes out under the name of another dentist in the same practice, that is considered an error and the dentists are fined 20 percent of the cost of service, Dowling and Harriman said.

Harriman said most of her errors fell into that category, which is not fraud or overbilling but a computer glitch.

“Nobody got hurt by these errors,” said John Bastey, director of government affairs for the Maine Dental Association.

Bastey and a group of dentists, including Harriman and Dowling, met with state officials Tuesday. The dentists said they did not come away confident that the fines will be reduced.

The Legislature could pass laws outlawing contracts that give auditors financial incentives to find errors or forbidding the kind of extrapolation that leads to the giant fines, Farnsworth said, but that won’t help dentists who have already been fined and are in danger of losing their practices.

Dowling said the system is unfair to dentists who are forgoing higher pay to serve underprivileged children.

“Those who help the most are getting hurt the most,” he said.

Joe Lawlor can be contacted at 791-6376 or at:

jlawlor@pressherald.com

Twitter: @joelawlorph@joelawlorph

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