Upper Allegheny Health System, Medicaid Fraud, Pennsylvania 2023

PITTSBURGH – Upper Allegheny Health System, on behalf of Bradford (Pennsylvania) Regional Medical Centers and other New York dental clinics, has agreed to pay $2.7 million to settle False Claims Act allegations, according to a press release from the U.S. Attorney's Office for the Western District of Pennsylvania.

The settlement resolves allegations that Upper Allegheny Health System, the parent company of Bradford Dental Center, improperly billed the Pennsylvania Medicaid program between January 1, 2012, and May 31, 2015. Investigators discovered that dental personnel at the clinics treated patients with handpieces that had not been appropriately sterilized between uses, violating federal and state laws.

Acting U.S. Attorney Stephen R. Kaufman stated that the matter was jointly investigated by the U.S. Attorney's Office in the Western District of New York and his office. The investigation revealed that senior UAHS management directed clinic personnel to wipe the handpieces with CaviWipes, a germicidal disinfectant wipe, between patient usages due to the insufficient number of dental handpieces.

The United States alleged that billing Medicaid for services provided using unsterilized dental handpieces violates the Federal and New York False Claims Acts as well as Pennsylvania statutes. Assistant U.S. Attorneys MaryEllen Kresse and Paul E. Skirtich handled the case for the U.S. Attorney's Offices in Buffalo and Pittsburgh, respectively.

Under the settlement, Upper Allegheny Health System will pay $2.7 million, with the United States receiving approximately $1.3 million. The case against UAHS was brought in federal court by a whistleblower who alleged the health system violated the federal False Claims Act and the New York False Claims Act by improperly billing health-care programs.

The settlement was reached by the U.S. Attorney's Office for the Western District of New York, in conjunction with the U.S. Attorney's Office for the Western District of Pennsylvania; the New York State Attorney General's Office, Medicaid Fraud Control Unit (MFCU); and the Pennsylvania Department of Human Services attached to the Governor's Office.

The claims resolved by this settlement are allegations only, and there have been no determinations of liability. This settlement corrects improper practices exercised on a vulnerable population of patients, who relied on the clinics for dental services without knowing the health risks posed by the defective practices.

Source: https://www.justice.gov/usao-wdpa/pr/upper-allegheny-health-system-behalf-bradford-pennsylvania-regional-medical-centers-and