For Immediate Release:
Tuesday, February 1, 2022
Nazneen Ahmed (919) 716-0060
(RALEIGH) Attorney General Josh Stein today announced two civil health care settlements through his office’s Medicaid Investigations Division (MID) that will refund nearly $1.5 million to the North Carolina Medicaid Program.
“When health care providers defraud the Medicaid program, they take away taxpayer resources from people who need them,” said Attorney General Josh Stein. “My office will continue to look closely at health care providers’ billing practices and hold accountable those who submit false claims.”
Knowles, Smith, & Associates LLP
Attorney General Stein reached a $1,150,000 settlement with Knowles, Smith & Associates LLP in Fayetteville to resolve allegations that the company submitted false claims to the North Carolina Medicaid program. The company allegedly submitted claims for anesthesia for dental services its providers performed on Medicaid patients between Jan. 1, 2016, and Dec. 31, 2020. However, these services weren’t provided, were medically unnecessary, had insufficient supporting documentation, or were performed in violation of Medicaid policy. Attorney General Stein alleged that the company failed to adequately monitor how much anesthesia was being billed to Medicaid as compared to how much was actually being used.
Operation Root Canal is an ongoing MID review of billing practices for a wide variety of dental services, including dental cleanings, use of nitrous oxide, repetitive restorations on the same tooth, palliative care, and upcoding of patient examinations. Through this effort, MID has settled 16 cases of Medicaid fraud among dental providers and won more than $8 million in settlements.
This settlement was obtained with the assistance of the North Carolina Department of Health and Human Services, Division of Health Benefits – Office of Compliance and Program Integrity and Clinical Policy Section.
Stacy Benton Lewis/Center for Women’s Health, P.A
Attorney General Stein also reached a $340,000 settlement to resolve allegations that Stacy Benton Lewis, M.D., an obstetrician-gynecologist in Granville and Center for Women’s Health, P.A. submitted false claims to the North Carolina Medicaid program.
Between Jan. 1, 2017, and Feb. 2, 2021, the Center for Women’s Health allegedly submitted false claims for office visits by existing patients that involved high levels of interactions with the patients. However, medical records of these visits showed that no complex or comprehensive patient interactions, such as patient histories or exams, occurred during these visits. Because these claims had no supporting clinical documentation, were medically unnecessary, or violated policy, Dr. Lewis and his practice were reimbursed for funds they should not have received.
The investigation and prosecution of this case was part of MID’s continuing data mining efforts to identify and prosecute health care fraud.
The claims resolved by these settlements are allegations only, and there has been no determination of liability.
About the Medicaid Investigations Division (MID)
The Attorney General’s MID investigates and prosecutes health care providers that defraud the Medicaid program, patient abuse of Medicaid recipients, patient abuse of any patient in facilities that receive Medicaid funding, and misappropriation of any patients’ private funds in nursing homes that receive Medicaid funding. To date, the MID has recovered more than $900 million in restitution and penalties for North Carolina. To report Medicaid fraud or patient abuse in North Carolina, call the MID at 919-881-2320.
The MID receives 75 percent of its funding from the U.S. Department of Health and Human Services under a grant award totaling $6,106,236 for Federal fiscal year (FY) 2021. The remaining 25 percent, totaling $2,035,412 for FY 2021, is funded by the State of North Carolina.