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Monday, August 21, 2017

AG HEALEY RETURNS $500,000 TO MASSHEALTH IN SETTLEMENT WITH SPRINGFIELD DENTIST OVER ALLEGED IMPROPER BILLING

AG HEALEY RETURNS $500,000 TO MASSHEALTH IN SETTLEMENT WITH SPRINGFIELD DENTIST OVER ALLEGED IMPROPER BILLING

BOSTON – Attorney General Maura Healey announced today that her office has reached a settlement with a pediatric dentist in Springfield, returning $500,000 to the state’s Medicaid program (MassHealth) and resolving claims that the dentist improperly billed the program for services.

The settlement agreement resolves allegations that Dr. Annie Watson, DDS and her dental practice, Gentle Smiles, LLC, improperly billed MassHealth for palliative care (emergency pain treatment) between March 2010 and June 2013, and failed to comply with MassHealth rules associated with the use of that emergency treatment billing code. 

The AG’s Office began an investigation into Dr. Watson and Gentle Smiles upon a referral from MassHealth, which identified Dr. Watson as the top biller of the palliative care code among all MassHealth dental providers.

Palliative care is the emergency treatment of dental pain that relieves the pain but is not curative and can include draining of an abscess or prescribing pain medication or antibiotics. In order to bill this code, the patient’s dental record must contain a description of the treatment provided and must document that the treatment was given on an emergency basis.

The AG’s investigation revealed that Dr. 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, Dr. Watson and her business will pay MassHealth $500,000 as restitution for improper billing. The settlement also requires that Dr. Watson and her employees review and comply with all applicable state and federal statutes, and all regulations governing participation in MassHealth.
MassHealth provides healthcare products and services to eligible low-income individuals, including people with disabilities, children and senior citizens.

            This matter was handled by Managing Attorney Lee Hettinger and Investigator Deborah El Majdoubi, both of the AG’s Medicaid Fraud Division. 
MassHealth assisted in this investigation.