Over the past couple of years, the Office of the Inspector General (OIG), which is part of the Department of Health and Human Services, has been looking into a colossal scandal across the country. Thousands of dentists have been implicated in a series of reports by the OIG. The charge? Highly questionable Medicaid reimbursement bills for excessive and even needless services given to low-income children, often to their great harm.
The latest report from OIG looks at California. It identified 335 providers with questionable billing practices who collected $117.5 million from Medicaid for pediatric dental services in 2012 alone. Half of these dentists worked for dental chains, suggesting an organized scam. They are, in fact, gaming Medicaid.
The OIS analysis found that some general dentists were providing an absurd—and frankly impossible—number of services per day compared to the average in California. Twenty-four services per day is average in the state; two dentists averaged more than 500 services per day; one dentist provided 1,658 services in a single day!
It gets worse. OIS uncovered evidence suggesting that over 100 general dentists were either billing for procedures they didn’t do or were performing unnecessary dental procedures:
- One hundred and eight general dentists provided stainless steel crowns to a suspiciously high proportion of Medicaid covered children (18% of children on Medicaid compared to a 5% average).
- Ninety-eight dentists provided pulpotomies to a high percentage of Medicaid children (18% compared to an average of 5%). A pulpotomy, often referred to as a “baby root canal,” involves the removal of a part of the tooth.
- Eleven general dentists extracted teeth from a very high percentage of their young Medicaid patients (44% of children on Medicaid against an average of 12%).
In one case, a dentist performed nineteen root canals—in addition to twenty-one other services!—on a single five-year-old child. Most children around this age have only twenty teeth.
The report “raises concerns about the quality of care and whether children treated by these dentists were harmed by these procedures.” Indeed! It is unconscionable to think that dentists around the country are performing excessive, needless procedures on children. To make matters even worse, there’s good evidence to suggest that root canals—despite the assurance of safety from conventional dentists—spread harmful bacteria throughout the body and can contribute to other diseases. Imagine the impact these procedures could have on a young immune system!
These are only the dentists who got caught. How many others are doing this? What about pediatricians treating children on Medicaid? One can only imagine the depths of this type of malfeasance.
Besides these Medicaid cases, there are also problems with Medicare, the program for seniors. Over the years, Medicare fraud has also cost taxpayers hundreds of millions of dollars: in 2012, for example, federal authorities arrested 107 healthcare providers in several cities and charged them with overbilling Medicare to the tune of $452 million. Just as dental chains were especially implicated in OIS investigation, Medicare fraud seems to be less a problem of individual practitioners and more of organized theft schemes involving dozens of doctors, nurses, and healthcare and medical supply companies.
As demand for care outstrips the supply of doctors willing to treat Medicare and Medicaid patients, patients are losing access to providers—and of course it’s the neediest patients who are affected. This well-documented problem will only worsen if such fraud continues unchallenged.