Out of the Mouths of Babes: Millions of Medicaid Dollars

Last Monday the Office of Inspector General of Health & Human Services posted a hair-raising report.  “Questionable Billing for Medicaid Pediatric Services in California” raises alarming questions about the billing practices and service quality of some of that state’s dentists—especially those working for dental chains.

The report spotlights 329 dentists and six orthodontists who billed California Medicaid improbably large amounts—amounts so large as to suggest that the practitioners were either billing for services not performed or performing unnecessary services on vast numbers of children.

Overall, California dentists average 24 Medicaid pediatric services a day, but the OIG found that 229 of them claimed nearly three times that number.  Two of them claimed 500 services a day—one of them 862.  One claimed over 1,000 services on each of 97 days.  On one day he claimed 1,658—or 70 times the average for all dentists.  The report observes that even if each of those services took only five minutes, the dentist put in a 138-hour day–a pretty long day by anyone’s standard.

Perhaps most troubling finding is the number of services claimed for individual children.  One dentist, for example, claimed to have performed 11 baby root canals on a single 4-year-old.  Six dentists reported baby root canals on over half the children they saw—one on 68%.

A reader comes away from the report hoping that the dentists didn’t actually perform the reported services, because fraudulent billing is a lesser sin than subjecting innocent children to unnecessary dental work.

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