Department of Health

Inappropriate Medicaid Billings for Dental Services

We audited a sample of $307,537 in Medicaid claims submitted by a dentist who maintained eight dental facilities in Brooklyn. We initiated our audit because our ongoing analysis of Medicaid records indicated that the dentist had submitted questionable claims. For example, in several instances, the dentist claimed to have provided Medicaid recipients with fillings in all 32 of their teeth and shortly thereafter claimed to have extracted the teeth.

To determine whether the claims in our sample were valid and appropriate, we visited the dentistís office to review the medical records relating to the claims. However, no records were available for us to review. We disallowed all $307,537 in claims from our sample. In addition, we recommended that the Department of Health review an additional $1.4 million in Medicaid payments to the dentist 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 2008-S-67 click here.
For a copy of the 90-day response click here.