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Some Massachusetts dentists appear to have abused state and federal insurance programs by billing for nearly $6 million in unnecessary X-ray and other service claims, state Auditor Joseph DeNucci said Wednesday.
The veteran auditor, who is leaving office in January, said the abuse was uncovered after examining over 360,000 claims submitted over four years to MassHealth, the state agency that administers federal Medicaid payments.
"My report raises serious concerns that MassHealth could be paying a significant amount in unnecessary and unallowable dental claims," DeNucci said in a statement. "Even worse, there appears to be a culture of using the system to maximize benefits to providers, which leads to reduced services for people in need and the waste of taxpayer funds."
Yet MassHealth said the bulk of the alleged wrongdoing can be attributed to an overly narrow reading of regulations by the auditor and his staff. The agency said a key regulation has since been clarified to assure proper billing in the future.
"MassHealth regularly refers all appropriate cases to the attorney general's Medicaid Fraud Division, and we have a long-standing practice of conducting regular reviews to identify over-utilization of services," the agency said in a statement.
MassHealth contracts for dentistry with Dental Service of Massachusetts Inc. through a subcontractor known as DentaQuest. Both share office space in Boston with Delta Dental of Massachusetts, a major dental insurer in the state. The companies did not immediately respond to a request for comment.
In particular, the audit found that numerous X-rays were taken routinely and not for specific purposes, as required by regulation.
"My report found well over $5 million in overcharges from a sample of dental providers over a four-year period, mostly for unnecessary X-rays," DeNucci said.
Also, one orthodontist was paid $322,000 over allowable limits for pre-orthodontic treatment visits and oral/facial photographic images.
A review of 258 patient files in a sampling of 10 dental providers also identified 11 instances of double billings totaling $2,694 for the same dental procedure.
The report is the latest in DeNucci's ongoing review of the Medicaid program, which now accounts for one-third of the entire state budget.
DeNucci was elected auditor in 1986. Upon his retirement in January, he will be replaced by a fellow Democrat, Suzanne Bump.
This program aired on November 17, 2010. The audio for this program is not available.
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