State auditor raises alarm over dental spending under Medicaid
Millions wasted, DeNucci asserts
State Auditor A. Joseph DeNucci is sounding the alarm about spending for dental services under the state’s Medicaid program, saying an audit has found that millions of dollars are being wasted annually on claims that are unnecessary, inflated, and even possibly fraudulent.
The audit of a sample of dental providers found nearly $5.7 million in overcharges and other unnecessary costs, mostly from excessive X-rays, over a period of four years, the auditor’s office said.
“My report raises serious concerns that MassHealth [which administers the program] could be paying a significant amount in unnecessary and unallowable dental claims,’’ DeNucci said in a statement.
“Even worse, there appears to be a culture of using the system to maximize benefits to providers, which leads to reduced services for people in need and the waste of taxpayer funds.’’
The Executive Office of Health and Human Services issued a statement saying it shared DeNucci’s commitment to controlling costs and had “initiated many successful efforts to realize cost savings for the Commonwealth.’’
“Over the last two years, while still maintaining access to vital services for our members, we have reduced the MassHealth budget by $1.275 billion,’’ agency spokeswoman Jennifer Kritz said in a statement.
At the same time, Kritz said, “we agree with the auditor on a number of his findings and have already begun to implement efforts to ensure appropriate billing of MassHealth dental X-ray services.’’
Over the past four fiscal years, payments to the program’s dental providers have more than doubled, from $116 million to more than $300 million, the auditor’s office said.
Medicaid is the state-federal program that pays for medical and dental care for low-income people.
Some of the audit’s findings included:
■Numerous X-rays were taken routinely and not for specific purposes, resulting in $5.2 million in unallowable payments.
■One orthodontist was overpaid by $321,553 because of a lack of control of spending on orthodontic services.
■A review of 258 patient files found 11 instances of double billing for the same procedure. MassHealth’s claims processing system failed to identify them as duplicates.
The audit looked at 360,000 claims made over four years for services at 10 providers. Auditors also reviewed 258 patient files at those providers.
The Massachusetts Dental Society issued a statement saying it “shares the concern of the state auditor regarding possible improprieties in the spending for dental services under the state’s Medicaid program and does not condone anyone who would abuse the system.’’
Martin Finucane can be reached at firstname.lastname@example.org.