DiNapoli: Brooklyn Dentist Billed
for Filling & Pulling Same Teeth
A Brooklyn dentist billed Medicaid for seven patients he claimed to have given 32 fillings each and then submitted bills a few months later for pulling the same 32 teeth for each of these patients, according to an audit released today by State Comptroller Thomas P. DiNapoli. In each case, the dentist claimed he filled or pulled all 32 teeth in a single office visit. Many of the questionable bills were for services supposedly provided to patients that lived in upstate New York, several hundred miles away from the dentist’s offices in Brooklyn.
“The human mouth typically holds 32 teeth,” DiNapoli said. “Billing Medicaid for filling and then pulling all 32 teeth from seven different patients within a few weeks should have raised a red flag. But this story gets even more unbelievable. This same dentist also billed Medicaid for pulling 256 teeth from eight patients - 32 teeth per mouth - all in the same day.
“In three separate recent audits, my auditors have identified millions in questionable and often outrageous services provided by dentists. Clearly the state Department of Health needs to strengthen its automated claims processing system to weed out the dishonest dentists who are stealing from the taxpayers. Medicaid is paying too much money for too many teeth.”
In 2007, the State Comptroller’s Office issued two audits that identified five dentists based in New York City that over-billed Medicaid by potentially millions of dollars for dental fillings, and another audit where a dentist billed Medicaid for 52 fillings for one patient in a single office visit. In June, this dentist pled guilty to a felony charge and surrendered his dental license.
The audit release today was initiated after the Office of the State Comptroller detected a high number of unusual bills from Dr. Alan Zukor, who has eight dental offices in Brooklyn. Auditors found he billed Medicaid approximately $418,000 in first two months of 2008 - more than double the total amount he billed in 2007.
In total, auditors examined $307,537 in bills for a six month period and found evidence that these bills were fraudulent. Findings include:
- In one instance, Dr. Zukor claimed he filled 30 teeth for one patient in two office visits. For each tooth, he claimed to have filled three or more tooth surfaces (a tooth has five surfaces). Five months later, he claimed he extracted all 32 teeth from the same patient, who supposedly lived in central New York, in one office visit;
- On January 8, 2008 he claimed he filled 243 teeth for 18 patients;
- On February 21, 2008, he claimed he extracted 256 teeth from eight patients - 32 teeth per patient; and
- When auditors attempted to examine his dental records, they found that there were no medical or dental records available.
Although the State Health Department’s Medical Review Unit considers claims for more than 24 fillings for a single patient visit to be excessive, it has not established specific policies or controls in its automated systems to detect excessive or improbable procedures.
Auditors recommended that the department stop all payments to Dr. Zukor, determine whether Dr. Zukor should be decertified as a participating provider, and examined all $1.4 million in previous claims paid to him. In addition, auditors recommended that the department implement controls to prevent payments for excessive dental services.
The Department of Health generally agreed with the audit findings and indicated that it was working to improve its automated claims processing system to identify when dentists bill for working on an unreasonable number of teeth.
The findings of the audit were provided to the Office of Medicaid Inspector General and the Medicaid Fraud Unit of the Attorney General’s Office.
About the State Comptroller’s Medicaid Audits
The Office of the State Comptroller conducts regular audits of the state’s $47 billion Medicaid program. Auditors review Medicaid claims that have been submitted by service providers and identify billing patterns and other circumstances that warrant an examination to determine whether claims are valid and appropriate.
Click here for a copy of the audit.