NEW YORK – New York Attorney General Letitia James announced that her office’s Medicaid Fraud Control Unit (MFCU), together with the United States Attorney’s Office in the Western District of New York and Pennsylvania, has reached an agreement with a health care system operating several clinics in the Southern Tier of New York and Pennsylvania for allegedly treating patients with unsterilized and potentially dangerous tools. An agreement unsealed yesterday with the Upper Allegheny Health System (UAHS) — a domestic not-for-profit corporation that operates several dental clinics in the Southern Tier — resolved claims made by a former employee alleging that UAHS billed Medicaid for dental services where it failed to sterilize dental handpieces between patients. As part of the agreement, UAHS has agreed to pay $2.7 million to the United States, New York, and Pennsylvania — $2.4 million of which will, specifically, resolve claims pertaining to New York’s Medicaid program ($1.4 million will go to New York and $1 million will go to the federal government).
“Patients visit medical offices to seek treatment, not further endanger their health by coming in contact with unsterilized tools,” said Attorney General James. “It is shocking that the Upper Allegheny Health System skirted protocols and risked the safety of its patients, but what’s worse is that we may have never known about these disturbing practices had a whistleblower not come forward. Yesterday’s agreement sends a message that real safety protocols must be followed to protect patients going forward. My office will always fight to hold accountable those who cut corners and risk patient safety.”
Between April 1, 2010 and May 31, 2015, UAHS allegedly conducted dental services with dental handpieces that had not been heat sterilized between patient use and subsequently billed Medicaid for these services. Not only did the use of these unsterilized tools pose a health hazard to patients, but the billing of these services to Medicaid was a violation of both New York state and federal laws. The U.S. Centers for Disease Control and Prevention, the American Dental Association, and the manufacturer of the dental tools require that dental handpieces be heat sterilized between patient use.
The Office of the Attorney General’s (OAG) and USAO’s investigation commenced after a whistleblower complaint was filed by a former UAHS employee under the qui tam provisions of the New York False Claims Act as well as the federal False Claims Act in the U.S. District Court for the Western District of New York. The New York False Claims Act allows individuals represented by counsel to file actions on behalf of the government and share in any recovery.
Yesterday’s agreement forces UAHS to pay a total of $2.7 million in damages to the United States, New York, and Pennsylvania.
MFCU receives 75 percent of its funding from the U.S. Department of Health and Human Services under a grant award totaling $53,413,761 for federal fiscal year (FY) 2021, of which $40,060,324 is federally funded. The remaining 25 percent of the approved grant — totaling $13,353,437 for FY 2021 — is funded by New York state. Through MFCU’s recoveries in law enforcement actions, it regularly returns more to the state than it receives in state funding.
The OAG wishes to thank the USAO from the Western District of New York and Pennsylvania for their joint effort to resolve this matter.
The investigation by OAG’s MFCU department was conducted by Detective Janice Boyd — under the supervision of Supervising Detective James Zablonski; and Senior Auditor-Investigator Mary Henry — both under the supervision of Chief Auditor Stacey Millis of MFCU’s Civil Enforcement Division. The case is being handled by Special Assistant Attorney General Laurie A. Frank — under the supervision of Regional Director Maura O’Donnell; and by Senior Counsel Diana Elkind of MFCU’s Civil Enforcement Division, which is led by Chief Alee N. Scott. MFCU is led by Director Amy Held and Assistant Deputy Attorney General Paul J. Mahoney, and is a part of the Division for Criminal Justice. The Division for Criminal Justice is led by Chief Deputy Attorney General José Maldonado, and is under the oversight of First Deputy Attorney General Jennifer Levy.
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May 25, 2021 at 09:59PM
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Attorney General James Teams With Federal Prosecutors to Make Dental Clinics Agree to Pay $2.7 Million for Alleged Use of Unsterilized Tools - New York State Attorney General
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