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August 17, 2010

DiNapoli: Medicaid Overpaid for Dental Care by $40 Million

New York’s Medicaid program paid more than $40 million for excessive dental cleanings and oral examinations over a five-year period, according to an audit released today by New York State Comptroller Thomas P. DiNapoli. The amount constituted nearly 10 percent of the total amount Medicaid paid for these services, and could have been avoided if the Department of Health changed its eMedNY software program to stop or suspend these payments. DiNapoli’s audit also found the State could have saved $60 million by aligning reimbursements with other states’ levels.

“New York needs to root out the rot in the Medicaid dental system,” DiNapoli said. “Taxpayers are paying for procedures that are either unnecessary or aren’t performed at all. One dentist billed for 79 oral exams in four years for one patient. Oral health is important, but no one needs to go to the dentist 20 times a year for a checkup.

“On top of that, New York pays more for the same procedures than most of our peer states. These are taxpayer dollars. DOH has to start protecting those dollars. New Yorkers can’t afford this kind of waste.”

DiNapoli’s audit examined $418 million in Medicaid payments for routine dental services (including cleanings and oral exams) during a five-year period that ended on August 31, 2009, and found several dubious reimbursement claims. One dentist billed for 18 cleanings for one patient over five years, while another recipient supposedly received 32 cleanings from 19 separate providers in a three-year period.

The audit also found that New York’s Medicaid fees were higher than the average in 15 peer states. By adjusting these fees to match those found in peer states, New York could have saved more than $60 million over the audit period. For example, setting the fee for an adult cleaning midway between New York’s current $58 fee and the average in peer states ($38) would save the State $16.5 million.

DiNapoli’s audit recommended that DOH:
  • Develop early warning systems that help to determine whether a recipient has exceeded their Medicaid limits before providing services;
  • Recover the excessive payments identified in the audit; and
  • Determine if New York’s fees should be adjusted to match dental fees paid in other states.

DiNapoli recently audited GHI, New York’s public employee dental insurer, and found $1.6 million in overpayments to dentists for scalings, root planings and other routine procedures.

Click here to read a copy of the audit, or visit



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