Department of Health
Inappropriate Medicaid Billings for Dental Restorations (Follow-Up Report) In audit 2007-S-71, identified five dentists who often submitted questionable Medicaid claims. The claims were questionable because the dentists 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, on 151 different occasions, the dentists claimed to have provided a Medicaid recipient with 25 or more fillings during a single office visit. We visited the dentists’ offices and reviewed the medical records relating to their claims. We found that all the claims in our sample were inappropriate and potentially fraudulent because they either were not supported by the dentists’ medical records or did not comply with the rules set forth in the Department of Health’s Medicaid Dental Manual. We disallowed all $148,341 in payments on these claims, and because of the billing patterns identified by our audit, recommended that the Department of Health review an additional $9.9 million in Medicaid payments to the five dentists. We also recommended the Department implement controls that would prevent these kinds of overpayments in the future. When we followed up on these matters with Department officials, we found that they had made considerable progress in their implementation of our recommendations.
For a complete copy of Report 2008-F-56 click here.
For a copy of the 90-day response click here.