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

The New York State Department of Health claimed Federal Medicaid reimbursement for dental services billed by a New York City dentist that did not comply with certain Federal and State requirements. Of the 100 randomly selected claims that we reviewed, 88 claims complied with Federal and State requirements. However, for the remaining 12 claims, 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. On the basis of our sample results, we estimated that the State agency claimed at least $64,400 in Federal reimbursement for unallowable dental services billed by the New York City dentist.