For the five years ended August 31, 2009, New York’s Medicaid program paid about $418 million for routine dental services such as cleanings and oral evaluations. Generally, these services are not eligible for reimbursement if they exceed certain frequency limits (i.e., if they are provided to the same recipient more times than is allowed during a certain time period). However, we found that the Department often reimburses routine dental services that exceed these frequency limits. During our five-year audit period, we identified a total of about $40 million in such reimbursements (nearly 10 percent of the total reimbursements for such services). For example, one dental clinic billed 79 separate oral evaluations for one recipient in a four-year period, which is 71 more than is allowed by the frequency limit of once every six months;
In addition, we determined that dental providers would be better able to comply with the frequency limits if certain enhancements were made to the Medicaid information system used by providers. Our report contains six recommendations for improving controls over Medicaid payments for routine dental services and for reducing the costs of these services.For a complete copy of Report 2009-S-46 click here.