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September 28, 2007

 

State Audit Identifies Highly Irregular
Medicaid Billing by Brooklyn Dentist

Urges Department of Health to Develop Better Controls

A dentist improperly billed Medicaid on 97 separate occasions for filling 25 or more teeth for patients in a single day, including one instance where he claimed to have provided a patient with 52 fillings, according to an audit released today by State Comptroller Thomas P. DiNapoli.

The findings of the audit were referred to the Kings County District Attorney Charles J. Hynes, the State Department of Health and the State Education Department’s Office of Professional Discipline.

“When the state pays a dentist for 52 fillings in one mouth in one day, the patient isn’t the only one getting drilled. This should have raised red flags,” DiNapoli said. “The District Attorney’s Office will determine whether criminal charges are necessary, but this dentist should never have been paid for work it appears he clearly did not do. My office will continue to pursue those who are cheating the taxpayers, but more must be done to prevent these payments from being made in the first place.”

Auditors and investigators reviewed Medicaid claims submitted by Mohinder Mayell, who has two dental facilities in Brooklyn, for the period of April 2003 to March 2007. During this period, Dr. Mayell was reimbursed for nearly $900,000 in Medicaid claims about $125,000 of these claims were reviewed by auditors and investigators. The Comptroller’s Office was assisted in their review by dental staff from the Department of Health’s (DOH) Division of Medical Review and Provider Enrollment.

Among the audit’s primary findings:

  • Eight patients supposedly received between 123 and 170 dental procedures, primarily fillings, during a three-year period.
  • In 97 other instances, Dr. Mayell claimed to have provided Medicaid recipients with more than 24 fillings in a single office visit, including one instance where he billed Medicaid for 52 fillings for one patient that he claimed were done in one day. When Comptroller staff asked Dr. Mayell about these 52 fillings, he initially claimed that he was able to complete the work in about one hour, which he later stated took two hours. He also said that this patient’s fillings were for cosmetic rather than restorative purposes, which is not covered by Medicaid.
  • Dr. Mayell’s dental charts documented the use of only a topical anesthetic for most of these fillings. Local anesthesia, such as Novocain, was not used even though some of these patients supposedly had two dozen cavities.

Suspicious Circumstances & Unsanitary Conditions
During five visits to Dr. Mayell’s Office, Comptroller staff found suspicious circumstances that call into question the validity of Dr. Mayell’s dental practice. For instance, he did not employ a dental hygienist. Nor did he use an appointment book, because he claimed his patients are all walk-ins. He also billed for services from his residence, where he maintained records, including x-rays.

Comptroller staff also observed extremely unsanitary conditions, including a used fly strip hanging above a denture repair area and roach poisoning in an examination room (photos included in the audit). The Comptroller’s Office referred the matter to the State Education Department’s Office of Professional Discipline. The office did not cite Dr. Mayell for any sanitary violations.

Upon the recommendation of auditors, DOH suspended all payments to Dr. Mayell, including $47,000 in pending reimbursements. Auditors recommend that DOH recover an additional $78,000 already paid that was examined in the audit sample and review the remaining $771,000 paid during this four-year period. Auditors recommend that DOH determine whether Dr. Mayell should be decertified as a participating Medicaid provider. Auditors also urged DOH to establish and implement a maximum threshold for the number of fillings that a recipient can receive in a dental visit and develop controls to flag claims that are over this threshold.

In its response to the audit, DOH said it would limit the number of tooth surfaces that could be restored on a given date of service and said it has established a control in its eMedNY control system (Edit 712) to prevent a provider from billing for repeat work on the same tooth within a two-year period. However, auditors pointed out that this control in eMedNY did not work and failed to catch that Dr. Mayell billed for filling the same 21 teeth twice within eight months for four patients.

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, as was the case with Dr. Mayell. In 2007 alone, the State Comptroller’s Office identified more than $35.6 million in potential overpayments or inappropriate claims paid by the state’s Medicaid program.

Click here for a copy of the audit.

Click here to view photos of Dr. Mayell's Office.

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