Markeshia Ricks file photo
Taylor: Hill Health needed to put matter “behind us.”
In the wake of a $350,000 settlement with the state and federal governments, Cornell Scott Hill Health Center CEO Michael Taylor said his organization was seeking to give underserved clients better care, not breaking rules, when it scheduled multiple dental care visits for Medicaid patients.
Taylor offered that response during a Thursday morning interview with the Independent.
His comments came one day after the state Attorney General’s office and the U.S. Attorney’s office announced in separate email press releases that the local health center (CSHHC) has agreed to pay $350,000 and change its scheduling policies to settle an investigation into three years of alleged dental service double-billing.
“We did not violate any law, regulation or rule,” Taylor said. “What we have in this instance is a difference in the interpretation of the rules, and no guidelines that precluded us from scheduling as we did.”
The settlement agreement (detailed below) and Wednesday’s government press releases allege that CSHHC implemented a policy between 2017 and 2019 that had Medicaid patients set up separate appointments for routine dental cleanings and dental exams.
Because Connecticut Medicaid uses an “encounter-based” reimbursement model to compensate federally qualified health centers for all services provided to Medicaid recipients on the same day, the two-appointment setup meant that CSHHC got paid two encounter rates “for services that could have been completed during the same visit.” CSHHC’s current encounter rate is approximately $162.
“Cornell Scott Hill applied a policy that caused the state Medicaid program to overpay for routine dental services,” state Attorney General William Tong is quoted as saying in one of Wednesday’s press releases. “This policy burdened patients by needlessly requiring repeat visits for their dental exams and cleanings. This policy had real consequences for their Medicaid patients, including requiring adults and children to take more time off work and/or school, as well as the burden of additional transportation. In addition to the $350,000 restitution payment, Cornell Scott Hill will allow all Medicaid patients the ability to schedule both their dental cleaning and exam in one visit.”
During Thursday’s interview, Taylor disagreed with Tong’s take on the matter. He repeated that his organization broke no rules and acted solely in the interests of its patients.
“Our practices were about maximizing access for patients who came to us, sometimes in very dire straits. The money never crossed our mind. This is about patient welfare,” he said.
He offered an explanation for the prior policy that had Medicaid patients set up two dental service appointments rather than one.
“Many uninsured and underinsured people don’t have historical, ongoing dental access,” Taylor said. “When they come to us, their acuity levels are so severe. We wanted to afford an appropriate amount of time to stabilize them. And we can’t do that in one visit. It’s just too much.”
He said that many of the health center’s dental patients haven’t seen a dentist in five, 10, 15 years: “They come to us when they are in excruciating pain.”
“That is the reason that we did that practice” of scheduling two dental appointments rather than one,” he said. “So that our providers would have enough time to care for people appropriately and carefully.”
Now, as required by the settlement with the state and federal governments, the health center will offer patients the opportunity to schedule routine cleanings and dental exams on the same visit. “The choice will be the patient’s.”
Hill Heath didn’t offer that one-visit option before “because of the typical clinical profile of the patients who were coming to us,” Taylor said. “We are now. We are offering the patients that option.”
Taylor stressed that Hill Health wasn’t aware that the billing practice violated federal regulations,“because that is still not codified in law or regulation.”
Taylor was asked about a section of the state Department of Social Services regulations that is referenced in the settlement agreement. It states that federally qualified health center Medicaid claims “are limited to one all-inclusive encounter per day to include all services received by a client on the same day unless the client suffers an illness or injury subsequent to the first encounter that requires additional diagnosis or treatment or if the client has different types of visits on the same day such as medical and dental or medical and behavioral health.”
That language “doesn’t speak specifically to this,” Taylor said. And he repeated that the health center is “first guided by what is in the best interested and clinical appropriateness of the patient.”
Taylor said that the health center ultimately agreed to the $350,000 settlement and policy change because “we needed to put this issue behind us. It’s really stressful to undergo one of these negotiations.” And the legal fees add up very quickly.
“This settlement in no way compromises our commitment to our patients,” he concluded. “We have always and we will always stand here to provide access to all people who come to us, and to provide the highest quality services to anyone.”
Settlement Details
The only publicly available document in the case is the 12-page settlement agreement signed on Aug. 3 by Taylor and health center-hired attorney Joan Feldman, and on Aug. 4 by state Assistant Attorney General Joshua Jackson and Assistant U.S. Attorneys John Hughes and Richard Molot.
Click here to read that settlement agreement document in full.
The document provides the same high-level allegations first disclosed in the joint state and federal email press releases put on Wednesday without diving into any further details on the investigation.
“The United States and the State of Connecticut contend that they have certain civil claims against CSH arising from the following conduct during the time period from January 1, 2017 through December 31, 2019: CSH implemented a policy that required Medicaid patients to receive prophylactic cleanings and dental exams on separate days, resulting in CSH getting paid two encounter rates instead of just one rate,” the document reads.
“CSH denies the United States’ and the State of Connecticut’s allegations… This Settlement Agreement is neither an admission of liability by CSH nor a concession by the United States or the State of Connecticut that their claims are not well founded.”
The health center and the state and federal governments subsequently struck a settlement agreement to “avoid delay, uncertainty, inconvenience, and expense of protracted litigation of the above claims”.
The two key terms of the agreement are:
• The health center agreed to pay the state and federal governments a total of $350,000, “all of which is restitution, no later than the Effective Date of this Agreement, by electronic funds transfer pursuant to written instructions to be provided by The Office of the United States Attorney for the District of Connecticut.”
• Starting on the effective date of the agreement, which was Aug. 4, the health center “shall offer all Medicaid beneficiaries the option of scheduling a prophylactic cleaning and dental examination on the same day. Should a Medicaid beneficiary choose to have a cleaning and exam performed on the same day, CSH shall schedule such same day appointment on the first available appointment day.”
Per the agreement, the state and federal governments have released the health center from any civil monetary claim the federal government has for the alleged overbilling. The governments have not released the health center, however, from any criminal or tax code liability that could arise from this alleged scheduling practices.
The health center is also prohibited from covering the costs of the $350,000 settlement payment through other charges to state and federal government programs. “Unallowable Costs shall be separately determined and accounted for by CSH,” the document reads, “and CSH shall not charge such Unallowable Costs directly or indirectly to any contracts with the Untied States or the State of Connecticut, or seek payment for such Unallowable Costs through any cost report, cost statement, information statement, or payment request submitted by CSH or any of CSH’s subsidiaries or affiliates to the Medicare, Medicaid, ConnPACE, TRICARE, or FEHBP Programs.”
And the agreement further prohibits the health center from seeking payment “for any of the health care billings covered by this Agreement from any health care beneficiaries or their parents, sponsors, legally responsible individuals, or third party payors based upon” the alleged double-billing.
