8% of Calif. Dentists May Overcharge Medicaid for Pediatric Services
About 8% of California dentists who treat children covered by Medi-Cal might be overcharging for their services, according to an HHS Office of Inspector General report, the AP/Sacramento Bee reports.
Medi-Cal is California's Medicaid program.
Details of Report
For the report, HHS' OIG reviewed claims data for dentists and orthodontists who treated at least 50 children and billed Medi-Cal in 2012 for services, including:
- Baby-tooth root canals;
- Extractions; and
The report did not determine whether the providers had taken part in fraudulent billing or provided medically unnecessary services, according to the AP/Bee.
The report identified 329 dentists and six orthodontists with questionable billing practices.
In total, such providers were paid $118 million for pediatric dental services in 2012.
According to the report:
- Two-thirds of dentists and orthodontists in the report claimed a very high number of procedures per day;
- Half of providers in the report worked for dental chains;
- 19 dentists in the report received "unusually high" reimbursements per child; and
- 12 dentists in the report had been investigated by California's dental board.
Deputy Regional Inspector General Meridith Seife said the findings were "very concerning," noting that some dentists' "unusual behavior ... points to some real vulnerabilities in the care being provided to children."
While the dentists and orthodontists remained anonymous in the report, HHS' OIG said it would send their names to the state for follow-up.
In a response included with the report, the California Department of Health Care Services said it will increase its monitoring efforts to identify providers with such questionable billing practices and take action if necessary (Chang, AP/Sacramento Bee, 5/17).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.