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NYS Comptroller

THOMAS P. DiNAPOLI

Taxpayers' Guide to State and Local Audits

Department of Civil Service
New York State Dental Program: Payments for Scaling and Root Planing Procedures (Follow-Up)


Issued: November 12, 2013
Link to full audit report 2013-F-20

Purpose
To determine the extent of implementation of the three recommendations included in our initial report Group Health Incorporated New York State Dental Program: Payments for Scaling and Root Planing Procedures (Report 2009-S-95).

Background
Our initial audit report, which was issued on July 28, 2010, we examined information to see if Group Health Incorporated (GHI) established adequate controls over the payment of scaling and root planing procedures and to determine if GHI overpaid for scaling and root planing services. Our audit covered the period January 1, 2005 through December 31, 2008. New York State provides dental insurance benefits to certain State employees and their dependents. The New York State Department of Civil Service contracts with Group Health Incorporated (GHI) to process dental claims on behalf of the State. Emblem Health is the parent company of GHI and HIP Health Plan of New York, formed when the two companies affiliated in 2006. At that time, existing GHI contracts such as the New York State dental contract were continued under the same terms and conditions. GHI processes and pays approximately $57 million a year for dental services provided to eligible members. Services covered by GHI include periodontal scaling and root planing for the treatment of periodontal disease. Scaling involves the removal of tartar, plaque and toxins from above and below the gum line. Root planing involves a smoothing of the rough spots on root surfaces. Scaling and root planing are covered by GHI for the treatment of periodontal disease, and according to GHI's policies, they are not intended to be prophylactic in nature. Instead, they are used when periodontal disease is indicated. The objective of the treatment is to help shrink periodontal pockets, heal gum tissue and thereby prevent tooth loss.

Key Finding

  • GHI officials have made progress in correcting the problems we identified in the initial report. However, improvements are still needed. Of the three prior audit recommendations, two recommendations have been implemented and one recommendation is no longer applicable.

Key Recommendations

  • None

Other Related Audits/Reports of Interest

Group Health Incorporated New York State Dental Program:  Payments for Scaling and Root Planing Procedures (2009-S-95)


State Government Accountability Contact Information:
Audit Director: John Buyce
Phone: (518) 474-3271; Email: StateGovernmentAccountability@osc.state.ny.us
Address: Office of the State Comptroller; Division of State Government Accountability; 110 State Street, 11th Floor; Albany, NY 12236