State’s Medicaid program paid cheating dentists for questionable billings: report

A new federal report will be released Wednesday showing that shady dentists and orthodontists billed the state’s Medicaid program for questionable procedures on children. One dentist claimed to have provided one child 42 tooth fillings in a single visit.

The state’s Medicaid program paid through the teeth for questionable billings by shady dentists and orthodontists, a new federal report charges.

One dentist claimed to have provided one child 42 tooth fillings in a single visit.

Another dentist averaged 16 procedures per child, compared with a statewide average of five, according to the report, which is being
released Wednesday.

They were among 23 pediatric dentists and six orthodontists in the state who pocketed $13.2 million in Medicaid payments in 2012 for services that appeared unnecessary or may not have been performed at all, according to the report by the Department of Health and Human Services inspector general.

“We found one orthodontist who treated almost 5,000 children in a single year,” said Lucia Fort, an analyst in the inspector general’s
office.

“That’s about 10 times higher than the state average for orthodontists.”

Fort and other federal officials declined to identify the dentists and orthodontists, saying they did not want to jeopardize ongoing
investigations and possible criminal charges. But the report is filled will examples of questionable practices.

The dentist who averaged 16 procedures per child received almost $900 in government Medicaid payments per child in 2012, far above the state average of $200 per child, the report found.

Two dentists frequently billed for three or more baby root canals during a single visit, including one instance where a 2-year-old
received six baby root canals during an office visit.

Investigators also found four dentists who were especially anxious to pull teeth; more than 38% of their young patients had one or more teeth extracted during the year. One of the four dentists extracted teeth from 76% of his patients.

On average, only 10% of the patients served by dentists in New York had teeth pulled.

Seven of the 23 dentists were associated with the Small Smiles dental chain, which shut down its New York operations in 2012 after accusations that it provided unnecessary treatments.

In 2010, the chain refunded $24 million to the government and agreed to increased monitoring of its operations to settle charges that it was providing unnecessary care.

The report stopped short of criticizing the state Health Department, which oversees the state Medicaid program, but it urged officials to develop “adequate safeguards” to prevent dentists from bilking taxpayers.

The Health Department did not dispute its findings but insisted it has been working to crack down on fraud.

The state’s Medicaid inspector general is “actively investigating and monitoring numerous orthodontists and general dentists,” and will seek to recover any overpayments, officials said. State investigators are also developing a review system to spot bogus billing.