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New York Claimed Medicaid Reimbursement for Unallowable Dental Services Billed by a Dentist Based in Westchester County

The New York State Department of Health claimed Federal Medicaid reimbursement for dental services billed by a Westchester County dentist that did not always comply with certain Federal and State requirements. Of the 100 randomly selected beneficiaries that we reviewed, claims associated with 78 beneficiaries complied with Federal and State requirements. However, claims for the remaining 22 beneficiaries did not comply with Federal and State requirements. For 14 of these 22 beneficiaries, the dentist who performed the services was not enrolled in the Medicaid program because their Medicaid enrollment status was not verified prior to the services being provided. For services provided to eight other beneficiaries, the Westchester County dentist did not provide documentation to support services billed. On the basis of our sample results, we estimated that the State agency claimed at least $84,000 in Federal reimbursement for unallowable dental services billed by the Westchester County dentist.

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Office of Inspector General, U.S. Department of Health and Human Services | 330 Independence Avenue, SW, Washington, DC 20201