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North Carolina Claimed Federal Medicaid Reimbursement for Dental Services That Did Not Always Comply With Federal and State Requirements

The North Carolina Department of Health and Human Services (State agency) claimed Federal Medicaid reimbursement for dental services that did not always comply with Federal and State requirements. Our review of all claim lines for dental services provided to beneficiaries covered under the Medicaid for Pregnant Women (MPW) program during our audit period showed that the State agency improperly claimed $1.4 million ($1 million Federal share) for dental services provided after the day of delivery. Also, of the 100 non-MPW dental services (sample items), 96 complied with Federal and State requirements, but 4 did not.

The State agency's procedures for postpayment reviews were inefficient because the State agency did not identify all of the deficiencies that we found in our review of MPW claims or in our sample review.

We recommended that the State agency (1) refund $1 million to the Federal Government for unallowable dental services provided to MPW beneficiaries after the day of delivery and (2) increase postpayment reviews of dental claims, including claims for MPW beneficiaries, to help ensure the proper and efficient payment of claims and ensure compliance with Federal and State laws, regulations, and program guidance. The State agency partially agreed with our first recommendation and described corrective actions that it has taken or plans to take to address our second recommendation.

Filed under: Center for Medicare and Medicaid Services