Pediatric Dentist Medicaid Audit

Pediatric Dentist Medicaid Audit
In a very interesting but sad set of facts, our client, a Pediatric Dental clinic was audited by Medicaid for calling in their patients before the specified and allowable cleaning dates.
Here are the facts: Our client called their patients (children) sooner than the allowable six month period for cleanings. The purpose behind the more frequent cleanings was the the children were not keeping up with their oral hygiene, thus, causing increased dental issues inclusive but not limited to gum disease and cavities. By calling in their patients in less than the prescribed timelines, our client attempted to mitigate the damages to their patients, who would in turn endure more pain, increased health concerns, and increased costs.
As a result, the State built their case on the premise that our client was over billing by calling in their patients more frequently. This is a case where as Medical providers your oath may not withstand the rules surrounding medicaid payouts. Although one can raise the argument that in fact money was saved by mitigating the damage to one’s oral health, the State was steadfast in their thinking that dental appointments for cleanings must occur in a given time frame.
Given the strong and clear documentation of previous visits, we were able to prove that the cleanings were detrimental and necessary in such cases where children suffer from oral health conditions. We were very lucky that our client kept excellent records that we were able to prove in most cases that without the shortened time lapse between appointments, the results would have been far most costly to the government.
Pediatric Dentist Medicaid Audit