Dentists appeal fines assessed in Medicaid audit
Dentists claiming that a state contractor improperly assessed around $800,000 in fines through a new Medicaid program audit have appealed the fines with the Maine Department of Health and Human Services.
The Portland Press Herald reported the DHHS has authority to alter the amount of the fines through the appeal process, which involves an informal review and then, if both parties are not satisfied, an administrative hearing.
Dentists claim the fines handed down by the New York-based HMS Holdings Inc. are for minor clerical errors. They also allege the auditor selected records that were likely to contain those errors rather than a random sample. That, they claim, led to an unfair and inaccurate extrapolation of errors across the MaineCare population they serve.
A state official said it’s too early to tell what will come of the administrative process for the new audits, introduced through the Affordable Care Act. In Maine, dentists were the first to undergo the new audits. Hospitals will be next.
Some lawmakers are now calling for a review of the auditing contract, which ends in December. Rep. Richard Farnsworth, House chairman of the Legislature’s Health and Human Services Committee, told the paper the large fines assessed for dentists should lead to an examination of the contract and why the fines were so large.
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