Department of Health
Medicaid Payments for Dental Consultations
The Department of Health (Department) administers New York’s Medicaid program. For the period March 1, 2005 to March 31, 2010, Medicaid spent more than $10 million for dental consultation services. We audited to determine whether the Medicaid program is appropriately reimbursing dental specialists for consultation services. We found that the Department is not always appropriately reimbursing dental specialists for consultation services. Based on a statistical analysis of a sample of claims paid to the ten dental specialists with the highest reimbursements for consultations during the audit period, we estimated that the claims for these specialists alone accounted for approximately $1.2 million to $1.3 million in Medicaid overpayments. If these results hold true for the claims of all other providers of dental consultations during our audit period, then the Medicaid program overpaid an additional $2.6 million.
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