Department of Health

Inappropriate Medicaid Payments for Dental Services Provided to Patients With Dentures


The Department of Health administers the Medicaid program. In audit 2008-S-125, we reviewed claims for a five-year period and found that dentists may have been overpaid as much as $2.9 million for services provided to patients with dentures. For example, some dentists billed Medicaid for dental procedures that are typically performed on patients with natural teeth. We determined that the Medicaid claims processing system, eMedNY, lacked the controls necessary to detect and prevent such overpayments. We recommended that appropriate controls be developed and implemented. When we followed up on these matters, we determined that Department of Health officials made some progress in correcting the problems we identified. However, improvements were still needed.

For a complete copy of Report 2010-F-33 click here.