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March 25, 2009

State Wasting Millions on Dental Services
For Patients With No Teeth

Medicaid System Lacks Controls to Stop Overpayments
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The New York State Department of Health’s (DOH) Medicaid program may have overpaid as much as $2.9 million to 1,788 dentists for services performed on patients with dentures that are typically performed on patients with natural teeth, according to an audit released today by State Comptroller Thomas P. DiNapoli. Auditors also found the Medicaid claims processing system, eMedNY, lacks the controls needed to prevent such payments.

“Medicaid is the single most costly program administered by New York State,” DiNapoli said. “The last thing New York taxpayers should be paying for are x-rays or fillings for false teeth. Dentures don’t need fillings, and New York doesn’t need to pay for bogus Medicaid claims. DOH should get this money back.”

For the five-year period ended June 30, 2008, auditors identified 21,752 questionable services for 6,512 patients with dentures. Some dentists billed Medicaid $1,200 for full dentures when only partial dentures costing $720 were provided.

DiNapoli’s auditors found some dentists billed Medicaid for dental procedures typically performed on patients with natural teeth. For example, 1,483 dentists billed Medicaid $863,000 for cleanings, fillings, extractions and x-rays for 5,046 patients with full dentures. None of the patients had natural teeth at the time these services were performed.

Auditors visited five dentists to review their Medicaid billings for services. All were found to be inappropriately billing Medicaid for unneeded dental services on patients with dentures. DiNapoli has informed the Office of the Medicaid Inspector General of the audit’s findings and provided detailed Medicaid claims information to investigate the providers identified.

The audit recommends DOH:

  • Review the $2.9 million in potential overpayments and recover any inappropriate charges;
  • Investigate the five dentists auditors visited; and
  • Put in place controls to prevent these overpayments from occurring.

DOH officials generally agreed with our recommendations and indicated what actions they planned to take. A complete copy of DOH’s response is included in the audit.

About the State Comptroller’s Medicaid Audits:
The Office of the State Comptroller conducts regular audits of the state’s $45 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.

Last week, DiNapoli’s office released an audit finding New York’s Medicaid program allows recipients to obtain considerably more diabetic testing supplies than the federal Medicare program and 10 other states’ Medicaid programs. Auditors also found problems with DOH’s claims processing system that led to more than $90 million in questionable claims.

Click here for a copy of the full audit on dental service payments.



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