NEW ORLEANS (AP) — About 5 percent of the Louisiana dentists treating children under Medicaid may be padding their numbers, overcharging, providing unnecessary treatments or even harming children, according to a federal study released Wednesday.
Auditors for the Department of Health and Human Services checked 512 dentists and 41 oral surgeons. Twenty-six dentists and one oral surgeon — paid a total of $12.4 million for pediatric dental work in 2012 — billed for extremely high numbers of children or amounts of money or showed other possible excesses, according to the report from department inspector general's office.
Some of the bills may be legitimate but they warrant scrutiny, said a copy of the report provided to The Associated Press before its general release.
"Some of these cases are pretty alarming," said Calder Lynch, chief of staff for Louisiana's Department of Health and Hospitals. He cited doctors with high numbers of fillings and "baby root canals," or pulpotomies. According to the report, one dentist billed for 31 procedures, including 13 pulpotomies, four fillings and 10 stainless steel crowns on one 3-year-old — all during the same visit.
Lynch said he believes many of the dentists described in the audit are among more than 20 his department is already investigating. It recently hired a second dental technician to go over records and will check all 27 people as soon as the federal department sends their names, he said.
That list was "still going through internal processes" Tuesday "but will most certainly be provided," Janna Raudenbush, spokeswoman for the Office of Inspector General, said in an email.
State Medicaid Director Ruth Kennedy wrote in a July 24 response included with the report that, as a result of the study, DHH hired Managed Care of North America on July 1. The company will manage dental benefits under Medicaid and the state's Bayou Health program — an insurance-based model that covers 900,000 of Louisiana's 1.4 million Medicaid recipients, mostly pregnant women and children.
The report said the 512 dentists averaged $264 per child, but six billed for more than $663 per child.
"These dentists received more than $2,000 per child for a total of 237 children," and one was paid $8,000 for work done on one child over three visits, the report said.
"Extremely high payments raise concerns about whether these dentists are billing for unnecessary services or services that they did not provide," the auditors wrote.
Overall, the dentists averaged 27 procedures such as cleaning, extraction or X-rays per day, but three billed
Medicaid for 146 or more per day. One billed for 376 services in one day, the report said.
"If this dentist spent only 5 minutes performing each service, it would have taken over 31 hours to complete all these services," the auditors noted.
The auditors also checked on specific procedures, such as extractions, fillings, stainless steel crowns and pulpotomies. On the average, the dentists pulled out teeth from 11 percent of the children they saw, but six dentists extracted teeth from at least 40 percent of the children and one did so on 70 percent of the children he treated. Dentists who filled teeth did so for one-third of the children, but one did so for 92 percent.
The audit looked at Louisiana dentists and oral surgeons who billed Medicaid for at least 50 children in 2012.
One-third of the dentists worked for two dental chains, it said. The report did not identify the chains.
The DHHS report is the second in a series of state reports; the first found similar patterns in 23 of 719 dentists in New York State. That's about 3.1 percent.
The state reports are not being done in any particular order, Raudenbush wrote.
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Posted on Fri, August 22, 2014
by Janet Mcconnaughey, Associated Press