Purpose

To determine the extent of implementation of the three recommendations made in our audit report, Improper Payments to a Dentist (Report 2012-S-52).

Background

Our initial audit report, which was issued on July 15, 2013, determined that, for the period June 1, 2009 through September 30, 2012, Medicaid made $66,402 in improper payments to a dentist, Dr. Prosper Bonsi, DMD. The payments included claims for behavior management services for patients who were not eligible for behavior management and after-hours office visits – most of which were provided during normal office hours. We also determined the Medicaid program did not have controls to prevent improper payments for behavior management services and after-hours office visits. We recommended that the Department recover the improper payments and monitor claims submitted by Dr. Bonsi. We also recommended that the Department implement controls to prevent payment of the improper claims we identified.

Key Finding

Department officials made progress in addressing the problems we identified in the initial audit report. This included monitoring Dr. Bonsi’s claims for behavior management and after-hours office visits, as well as implementing eMedNY system edits to prevent improper payments on claims for these services. However, further actions are still needed. Of the initial report’s three audit recommendations, two were implemented and one was partially implemented.

Key Recommendation

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

Other Related Audit/Report of Interest

Department of Health: Improper Payments to a Dentist (2012-S-52)