Department of Health
Inappropriate Medicaid Billings for Dental Services We audited a sample of about $125,000 in Medicaid claims submitted by a sole proprietor (Dr. Mayell) who maintains two dental facilities in Brooklyn. We initiated our audit because our ongoing analyses of Medicaid records indicated that Dr. Mayell often submitted questionable claims. The claims were questionable because Dr. Mayell claimed to have provided Medicaid recipients with an unusually large number of dental services, either over a period of months or in a single office visit. For example, in 97 different instances, Dr. Mayell claimed to have provided Medicaid recipients with 25 or more fillings during a single office visit, including one instance in which he claimed to have provided the recipient with 52 fillings.
To determine whether the claims in our sample were valid and appropriate, we visited Dr. Mayell’s office and reviewed the medical records relating to the claims. We were assisted in our review by dental staff from the Department of Health. We found that the claims in our sample were not supported by Dr. Mayell’s medical records and did not comply with the rules set forth in the Department of Health’s Medicaid Dental Manual. In fact, we considered Dr. Mayell’s Medicaid billing practices to be potentially fraudulent. We disallowed all $125,000 in claims from our sample. In addition, we recommended that the Department of Health review an additional $771,000 in Medicaid payments to Dr. Mayell and recover any additional unsupported or otherwise inappropriate payments. We also recommended the Department implement controls that would prevent these kinds of overpayments in the future.
For a complete copy of Report 2007-S-3 click here.
For a copy of the 90-day response click here.
For a copy of the associated follow-up report click here.