A new federal report raises questions about the billing practices of nearly 100 Indiana Medicaid dentists, as well as the quality of care provided by several dental chains that serve poor children in the state.
While the report, produced by the U.S. Department of Health and Human Services’ Office of Inspector General, does not explicitly name specific dentists or clinics, the authors note that two-thirds of the dentists whose billing practices raised concerns worked for four dental chains. Three of the chains have been the focus of state and federal scrutiny, they observed.
“One chain has been under scrutiny in several States for providing unnecessary services,” the authors wrote. “Thirty-one dentists whom we identified with questionable billing worked for this chain,” they added. The remark was footnoted with a reference to a June 2012 report, “The Business Behind Dental Treatment for America’s Poorest Children,” by David Health and Jill Rosenbaum for the Center for Public Integrity and Frontline that focused on the Georgia-based Kool Smiles dental chain. (See ‘Dollars and dentists:’ Investigating the dental care crisis in the U.S. and Complaints to attorneys general yield sources for dental investigation.)
A description of the second unnamed chain was footnoted with a federal announcement of a 2010 agreement requiring the company managing the Small Smiles chain of dental clinics to pay $24 million to resolve fraud allegations.
“The third chain, which operates mobile school-based clinics, has been the subject of investigations arising from complaints that dentists affiliated with it had treated children without their parents’ permission and had provided medically unnecessary services,” the authors wrote. That comment was followed by a link to a reference to 2012 story by Sydney Freedberg of Bloomberg News looking at problems at clinics run by dental management-services companies owned or backed by private-equity firms.
The Indiana report is part of an ongoing federal oversight effort examining pediatric dental services under Medicaid. The investigators examined claims paid by Medicaid in 2012 for dental services across the state and focused upon providers who served more than 50 children.
The “extreme billing patterns” of 94 dentists and one oral surgeon – about 11 percent of the providers reviewed – raised concerns. Together, those providers received about $30.5 million in government funds for pediatric dental services in 2012, the investigators wrote.
“Although our findings do not prove that providers either billed fraudulently or provided medically unnecessary services, providers who bill for extremely large numbers of services warrant further scrutiny,” they said in the report. The findings raised concerns that dentists might be billing for services that were unnecessary or never provided as well as concerns about the quality of care the children were receiving.
“One dentist billed Medicaid for 343 services in one day,” Marisa Kwiatkowski recounted in a Nov. 5 story for the Indianapolis Star. At that rate, even if the dentist had spent only five minutes performing each service, it would have taken her more than 28 hours to complete the work. Other providers attracted attention for the high rate at which they billed for the “behavior management” of children getting care, Kwiatkowski wrote.
“Federal officials recommended Indiana improve how it monitors billing by providers in dental chains, enhance the state’s ability to identify patterns, stop paying more than once for behavior management and take action on providers with questionable billing,” Kwiatkowski wrote. State Medicaid Director Joseph Moser, Kwiatkowski wrote, is taking the steps necessary to address the problems and has recovered about $324,000 in overpayments.
