Performance Improvement 2008. Were Medicaid Payments for Pediatric Dental Services Appropriate?


This study assessed the appropriateness of Medicaid payments for pediatric dental services during the calendar year 2003 in five States. Improper Medicaid payments for dental services have been identified periodically by State Medicaid Fraud Control Units (MFCUs). In 2004, a MFCU investigation determined that dentists were reimbursed $4.5 million for unnecessary dental services. In 1967, Congress established the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program under Medicaid to ensure that children and youth received routine and preventive health care services. To meet the EPSDT requirements, States must provide routine services to children and youth, even if these services are not available to other needy populations in the State's Medicaid program. In this study, researchers examined a stratified random sample of Medicaid pediatric dental services to determine whether the services met requirements for proper documentation, billing, and medical necessity.

Thirty-one percent of Medicaid pediatric dental services in the five States resulted in improper payments. Documentation errors accounted for the largest amount of improper payments in all five States.

Report Title: Improper Payments for Medicaid Pediatric Dental Services,
Agency Sponsor:
OS-OIG, Office of Inspector General
Federal Contact:
Claire Barnard, 202-205-9523
Office of Inspector General

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"PerformanceImprovement2008.pdf" (pdf, 1.29Mb)

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