Department of Health

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

In audit 2007-S-3, we examined a sample of about $125,000 in Medicaid claims submitted by a sole proprietor who maintained two dental facilities in Brooklyn. We initiated our audit because our analysis of Medicaid records indicated that the dentist often submitted questionable claims. We reviewed the medical records relating to the claims, and found that the claims were not supported by the medical records and did not comply with the rules set forth in the Department of Health’s Medicaid Dental Manual. We disallowed all $125,000 in claims and recommended that the Department review an additional $771,000 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 this matter with Department officials, we found that our recommendations had been implemented, and as a result of our audit, the dentist had been convicted for Medicaid fraud and surrendered his license to practice dentistry.

For a complete copy of Report 2008-F-46 click here.
For a copy of the 90-day response click here.