MA Audit Finds $1.3 Million in Questionable Medicaid Dental Claims
Monday, March 18, 2013
The audit was part of an ongoing investigation into claims for MassHealth, the state's public health insurance program for low- and medium-income residents, from dental providers. Bump's office unearthed questionable, unallowable and even medically unnecessary claims in its audit.
Since 2010, the Auditor's office has identified $7,585,443 in questionable Medicaid dental claims.
“I acknowledge the challenge of advancing quality dental care to underserviced populations, but audit after audit has shown that MassHealth needs to improve its screening of claims for payments from dental providers,” said Bump.
“So far they have been very responsive to our reports, but in the past two and a half years, five audits reviewing just 23 providers have identified $7.4 million in improper payments. There clearly needs to be more comprehensive action taken by MassHealth to address any systemic problems that exist within its dental claims processing system.”
An array of unallowed procedures
According to the Auditor's office, test results from an audit sample of 10 dental providers revealed more than $1.2 million in questionable specialized oral exams, or detailed oral screenings. Despite the procedure only being allowed under MassHealth regulations for members undergoing radiation treatment, chemotherapy or organ transplant, the 10 providers billed and were paid for over 19,000 claims of detailed oral screenings even though the patients in question did not meet MassHealth's specified criteria.
Bump's audit also found claims for 972 unallowable photographic images procedures to the tune of $37,687 paid out to two providers. Two providers racked up $14,280 for unallowable fluoride treatments, which exceeded recommended levels set by the American Academy of Pediatric Dentistry.
Other findings included claims for service performed by the spouse of a provider, who is a dentist but does not participate in MassHealth as a dental provider, as well as $15,803 in unallowable and medically excessive oral evaluations.
MassHealth’s claims processing system is administered through the subcontractor DentaQuest and has been the subject of continued state audits since 2010. Bump's office said that DentaQuest did not identify the system deficiencies because it has not adequately monitored the dental program.
In response to the various audit findings, MassHealth said DentaQuest has amended its systems to identify and refuse payment for such unallowable billings in the future.
Bump has called on MassHealth to recover all unallowable payments identified in the report and to further investigate all detailed oral screenings for the past four fiscal years.
- Central MA Seniors Fear Medicare Uncertainty
- Industry Group to Call for Tough Regulations on Medical Marijuana at Worcester Hearing
- Medicare Fraud: How to Protect Yourself and Others
- NEW: Company Sues State over Medicaid Cuts
- NEW: Mass Medical Society Urges Parents to Learn About Child Sex Abuse
- NEW: MA Medical Society Cites Concerns on Medical Marijuana Law
Enjoy this post? Share it with others.
Commenting is not available in this channel entry.