Report Finds HHS OIG Dental Study Methodology “May Undermine The Effectiveness Of Identifying Waste, Fraud and Abuse”
ATLANTA – The Benevis Foundation released a report today outlining the complex issues surrounding the provision of pediatric dental care to children on Medicaid. The white paper by Sellers Dorsey, a national consulting firm with expertise in the operations, policy, and finance of Medicaid, examined recent reports from the Office of Inspector General (OIG) examining fraudulent and abusive dental practices. The report concluded that while identifying potential fraud and abuse in publicly funded health care programs is critical, the methodologies used by the OIG may not accurately capture the practices of dentists who serve largely low-income, minority populations who rely on Medicaid to access dental care.
The white paper, sponsored by the Benevis Foundation, entitled “A Closer Look at Dental Care Practices That Specialize in Serving Medicaid Populations,” provides perspective on the role of Medicaid dental providers and the needs of children on Medicaid. The report examines several aspects of the methodologies used in recent reports by the OIG offices in Indiana, New York, California, and Louisiana to identify instances of potential overutilization by Medicaid dental providers in those states. Reports in other states are expected.
The intent of the white paper, which followed a series of reports by the OIG evaluating dental practices in the areas of medical necessity, quality and patient safety, is to promote education and awareness about the unique and important role Medicaid dental providers play in filling a void in the U.S. healthcare delivery system, and the niche population they serve, which should be taken into consideration when analyzing trends among the entire dental profession and Medicaid patient population.
The white paper notes that the services per day metric utilized by state OIG offices needs to be thoughtfully examined due to the scarcity of providers willing to treat children covered by Medicaid, which may impact the number of services provided per day for some providers who do accept Medicaid patients. The report states, “Given the need for dental care among Medicaid children and the scarce pool of participating dental providers, the average number of services provided per day may be higher for some of the providers who treat Medicaid children.” For example, the outlier threshold of procedures per day in Indiana is 51. A dentist there who sees seven patients per day, averaging seven procedures per patient (75 percent more procedures per patient than the average) would not be flagged as an outlier, whereas a dentist that sees 13 patients per day, averaging only four procedures per patient would be listed.
Scion Dental, a leading dental administrator referenced in the white paper, states that only 15 percent of all U.S. dentists accept Medicaid patients. The Benevis Foundation points out that most dentists will not accept Medicaid patients because of the typically lower reimbursement levels and the sheer volume of paperwork and associated compliance. Practices simply don’t have the resources to take on the administrative paperwork burdens nor do they want to be underpaid for their services.
“We commend the OIG’s intentions in their reporting to ensure that the dental profession is providing medically necessary dental care based on patient needs that adhere to quality standards and clinical best practices,” said Geoffrey Freeman, spokesperson for the Benevis Foundation. “Benevis is aligned with OIG’s mission to stamp out fraud and abuse.”
The Sellers Dorsey paper states that, without giving further consideration to the challenges of providing dental care to Medicaid patients, a potential impact of the OIG reports is a “chilling effect” on the already limited pool of Medicaid dental providers by dissuading some new providers from accepting Medicaid dental patients.
“We look forward to working with government officials and other stakeholders in a collaborative and transparent way to ensure this patient population’s needs continue to be met while also ensuring the integrity of the Medicaid dental program,” added Freeman. “Every child deserves a dental home. It is important that we work together to ensure that dentists continue to accept and take care of this underserved population.”
To read the white paper in its entirety, please click here.