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Local News

July 16, 2013

Local dentist accused of false Medicaid billing

The New York State Office of the State Comptroller has accused a local dentist of improperly billing Medicaid tens of thousands of dollars.
 
The comptroller’s office released a report Monday claiming that Dr. Prosper Bonsi, who owns and operates Advanced Family Dentistry in Oneonta, improperly billed Medicaid for 2,361 procedures, to a cost of $66,402.
 
These procedures included billing Medicaid for after hours visits that were made during normal business hours, charging for dentures that were never delivered, and billing for behavior management for patients that didn’t qualify. Dentists can bill Medicaid extra for behavior management when treating patients who are developmentally disabled or mentally ill.
 
“This dentist took advantage of a system that routinely fails to catch errors and overpayments to line his own pockets,” Comptroller Thomas DiNapoli said in a statement to the media.
Dr. Bonsi said, however, that these billings were due to clerical errors, and not intentional.
 
“It (the report) made it look like we were deliberately trying to defraud the system, but that’s not what the situation was,” said Dr. Bonsi.
 
Dr. Bonsi said that his office created its own medical routing system, which he says was put into place to increase efficiency. He claims that the information on the patient’s routing slips was used as the basis to file claims under Medicaid by his staff, and because this information was not sufficient, errors occurred.
 
Dr. Bonsi says he was made aware of these problems at the end of last year by the comptroller’s office, while the audit that forms the basis of the report took place, and that his office changed its practices as a result.
 
“We stopped,” he said, “we corrected.”
 
The comptroller’s report recommends that the New York Department of Health, which administers Medicaid in New York, seek the return of the $66,402. When asked about this, Dr. Bonsi said that they would pay back any improperly billed money the department of health asks for.
 
“That’s money that came to us that wasn’t supposed to,” he said.
 
The audit also finds fault with eMedNY, the automated system that processes and pays Medicaid claims in New York. At the time the claims in question were filed, the system had no way of screening claims for after hours visits or behavior management from dental providers. 
Presently, such claims are subject to manual review.

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