MEDICAID FRAUD: Public, Private Interests Clean Up Denti-Cal
The latest fraud perpetrated against California's Medicaid system involves dentists, who have bilked Denti-Cal out of hundreds of thousands of dollars through fraudulent billing. According to the Delta Dental Plan of California, which has worked with state officials to curtail fraud, crooked dentists have charged Denti- Cal for fillings in already crowned teeth and unnecessary procedures performed on baby teeth, which eventually fall out. In addition, dentists have billed routine services at emergency rates and have falsely charted complex and expensive services when only simple procedures were performed. Some have even charged the program for services never they provided.
Cleaning Up Fraud
State officials, in partnership with private interests, however, have moved to shut down the fraudulent operations. At least 57 investigations into Denti-Cal fraud currently are underway and the state Attorney General's office is pursuing cases against dentists who have bilked the program out of small and large amounts of money. "There's some real momentum gathering in our efforts to purge the Denti-Cal system of dentists who are defrauding taxpayers. We now have at our disposal some of the most advanced security systems and state-of-the-art software, which allows auditors to flag suspicious dental claims and know where to look for the tell-tale signs of fraud," Delta Senior Vice President Michael Kaufmann said (Delta Dental release, 1/12).