Purpose

To determine the extent of implementation of the six recommendations included in our initial audit report, Medicaid Payments for Excessive Dental Services (Report 2009-S-46).

Background

Our initial audit report, issued on August 16, 2010, examined Medicaid payments for routine dental services, such as cleanings and oral evaluations, provided during the period September 1, 2004 through August 31, 2009.  Our audit identified $40 million of excessive dental services that exceeded certain frequency limits (i.e., cleanings and oral evaluations provided to the same recipient more times than is allowed during a certain time period).  While some of the dental services reimbursed by these payments may be legitimate services provided in good faith, other dental services appeared highly questionable and may not have been provided at all.  We also determined that if the Department adjusted its Medicaid fees for these services to the averages of  other comparable states, it could have saved more than $60 million during our audit period.  We recommended the Department seek recoveries as appropriate and determine whether certain providers abused the Medicaid program.  We also recommended the Department implement controls to prevent Medicaid reimbursement for excessive routine dental services and reassess the fees paid for them.

Key Finding

Department officials made progress in addressing several of the issues identified in our initial report.  In particular, changes to payment schedules for routine dental services saved Medicaid more than $11 million.  However, additional actions still need to be taken.  Of the six prior audit recommendations, two were implemented, two were partially implemented, and two were not implemented.

Key Recommendation

Officials are given 30 days after the issuance of the follow-up review to provide information on any actions that are planned to address the unresolved issues discussed in this review.

Other Related Audits/Reports of Interest

Department of Health: Medicaid Payments for Excessive Dental Services (2009-S-46)
Department of Health: Medicaid Payments for Dental Consultations (2010-S-12)