The U.S. Department of Health and Human Services Office of Inspector General (OIG) has found questionable billing practices by 94 dentists and one oral surgeon who treated children covered by Medicaid in Indiana in 2012, according to a new report.
The report focused on providers who served more than 50 children, which represented 11% of all dentists reviewed. The dentists received more than $30 million in federal funds for pediatric dental services.
A majority of the dentists cited in the report worked for four dental chains, three of which have been the target of previous state and federal investigations, the report noted.
Among the report's findings:
Dentists in Indiana provided an average of 18 dental services per day to children with Medicaid; 64 dentists averaged at least 51 services. One dentist provided 39 services to a child during a single visit, primarily restorations and extractions, according to the report.
One dentist billed Medicaid for 343 services in one day. If she spent only five minutes performing each service, it would have taken her more than 28 hours to complete them, the report noted.
"An extraordinarily large number of services per day raises concerns that a dentist may be billing for services that were not medically necessary or were never provided, as well as raising concerns about the quality of care being provided," federal officials stated in the report.
Thirteen of the dentists reviewed provided behavior management to an "extremely high proportion" of these children, according to the report. It also noted that 11 of these dentists billed "inappropriately" for behavior management payment (that is, receiving payment more than once for the same child during the same visit).
The billing patterns "warrant further scrutiny," the report noted, although it does not provide evidence that the providers submitted fraudulent billing or provided medically unnecessary services.
Indiana dentists received average payments of $254 for each child on Medicaid, but some received significantly more. Nine dentists received an average of more than $650 per child, according to the report, and one averaged $1,082 per child.
The report recommended that Indiana improve how it monitors billing by providers in dental chains, enhance the state's ability to identify patterns, stop paying more than once for behavior management, and take action on providers with questionable billing.
State Medicaid Director Joseph Moser said he agreed with the federal government's recommendations and is making necessary changes. Indiana has recovered about $324,000 in overpayments, according to an indystar.com story.
