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

The New York State Department of Health claimed Federal Medicaid reimbursement for dental services billed by a Queens dentist that did not always comply with certain Federal and State requirements. Of the 100 randomly selected beneficiaries that we reviewed, claims associated with 67 beneficiaries complied with Federal and State requirements. However, claims for the remaining 33 beneficiaries were unallowable because the dentist who performed the services was not enrolled in the Medicaid program. On the basis of our sample results, we estimated that the State agency claimed at least $82,000 in Federal reimbursement for unallowable dental services billed by the Queens dentist.