Department of Health

Inappropriate Medicaid Billings for Dental Services (Follow-Up Report)

In audit 2008-S-67, we examined a sample of more than $300,000 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, we visited the dentistís office to review the related medical records. However, no records were available for us to review. We disallowed all the claims in our sample and recommended that the Department of Health review an additional $1.4 million in Medicaid payments to the dentist. 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 fully implemented all our recommendations.

For a complete copy of Report 2009-F-34 click here.