Department of Health
Inappropriate Medicaid Payments for Dental Services Provided to Patients with Dentures We audited the Medicaid claims submitted by dentists over a five-year period for services provided to patients with dentures and found that the dentists may have been overpaid as much as $2.9 million on these claims. For example, some dentists billed Medicaid for full dentures when only partial dentures were provided to the patients, and other dentists billed Medicaid for dental procedures that are typically performed on patients with natural teeth. We determined that the Medicaid claims processing system, eMedNY, lacked the controls necessary to detect and prevent such overpayments. We recommended that appropriate controls be developed and implemented. We also recommended that the overpayments be investigated and recovered.
For a complete copy of Report 2008-S-125 click here.
For a copy of the 90-day response click here.
For a copy of the associated follow-up report click here.