BOSTON (WWLP) – A state audit claims that two local dental practices- both owned by the same dentist- were improperly billing MassHealth for a specific kind of X-ray.
The report released Tuesday by the office of Auditor Suzanne Bump found that Hampshire Family Dental of Northampton, and Orchard Family Dental of Indian Orchard, both of which are owned by Dr. Samer Tahoun, improperly billed MassHealth for periapical radiographs- a type of x-ray that shows an entire tooth from the top of the jaw. The total amount of improper billing totaled to approximately $290,417.
Bump called on Tahoun to collaborate with MassHealth to repay the agency, and take steps to prevent future improper billings.
“MassHealth providers must adhere to the regulations of the program and must document their claims,” Bump said. “MassHealth must now recover the improper payments made to these offices and decide whether further action should be taken against Dr. Tahoun. Additionally, MassHealth should take steps to identify these wrongful patterns of practice more quickly.”
Under state regulations, MassHealth will only pay for this procedure once every three years as part of a full-mouth series, or for specific areas when extraction is anticipated, documentation of pain, infections, or other issues. The audit found that Tahoun’s dental practices performed and billed MassHealth for these radiographs as part of routine dental exams without the proper claims.
According to Bump, Tahoun’s practices were selected for audit because claims for periapical radiographs represented 46% of total x-rays billed, significantly higher than the average of 28%.