Utah Tries (and Fails) to Slash Medicaid Payments to Dentists

Cutting costs: Utah dentists get less from MedicaidLucky for Utah dentists, a federal agency has vetoed Utah’s plan to slash Medicaid payments to dentists.

While the state’s dentists received a one-time 24% pay raise in 2008, Utah lawmakers recently reversed that. (And the dentists didn’t get their 4.5% cost-of-living raise either.)

Understandably, Utah’s dentists objected… and so did the Centers for Medicare and Medicaid Services (CMS), which rejected the plan on the grounds that it would make accessing services even more difficult for dental Medicaid patients – particularly kids seeking a pediatric dentist – not to mention seniors in need of false teeth.

Utah’s Medicaid program will now have to scramble to cut other programs, as the 2010 budget relied on cutting dentist payments by $1.4 million.

Read more: Feds reject Utah’s low Medicaid pay for dentists

Louisiana Wants To Ban Mobile Dental Clinics

The Louisiana legislature is considering a bill – backed by state’s Dental Association – that would ban mobile dental clinics that travel to schools to provide dental care to children.

Critics say these travelling clinics (often set up in school gymnasiums or libraries) are unsanitary and inadequate.

Some changes to the bill have loosened the regulations, allowing mobile clinics to treat children in areas the state has deemed underserved by dentists.

Mobile clinics have become more common in Louisiana in the past year because higher Medicaid payouts have made treating poor children more profitable. No problems have been reported.

Read more about it

Dentists in New York Skim $3M from Medicaid?

New York state auditors have discovered some questionable billing practices among dentists. Officials say that the state may have paid $3 million in Medicaid claims for fraudulent dental procedures.

It’s not always easy to spot Medicaid fraud, but some dentists get too greedy to overlook.

Remember the dentist who billed for 30 fillings for a single one-hour pediatric dentistry appointment? In this case, dentists filed claims for typical dental treatments.

The problem? None of the patients actually had teeth. Nonetheless, Medicaid was billed for natural tooth procedures for these denture patients.

It’s not clear how widespread this problem, but the state comptroller has released information on the audits of 5 dentists. Over five years, these 5 dentists filed over $46,000 in improper Medicaid claims.

Read more about it

Most Dentists Do Not Accept Medicaid

Dentists Accepting Medicaid In this survey, two-thirds of dentist respondents revealed that they do not accept Medicaid payments.

Though one in three dentists does take Medicaid, many were unimpressed. “Too much red tape, broken appointments and unappreciative patients,” complained one doctor. “Not worth my time or my staff’s time.”

General dentists are three times as likely to accept Medicaid as are specialists. In addition, the majority of rural dentists do accept Medicaid, whereas most of their urban and suburban colleagues do not.

What else do dentists have to say about Medicaid? Here’s a sampling:

  • “Medicaid is a loss leader. If they ever reimburse for what the procedures/time/materials are worth, I might change my mind.” (Arkansas dentist)
  • “With all the dentists being prosecuted and some thrown in jail lately for what appear to be honest coding mistakes, I’d quit dentistry before I’d take Medicaid patients. It’s just too risky.” (Texas dentist)
  • “I can’t in good conscience refuse to treat a patient because of who pays the bill, especially if an existing patient falls on hard times.” (New York dentist)
  • “I accepted Medicaid for 18 years, but no longer serve this population. They are the most unreliable and ungrateful group of patients.” (Kansas dentist)
  • “I lose money on each Medicaid patient I see, but it’s a matter of charitable community service.” (California dentist)
  • “States promise but do not deliver adequate funding for socially-needed projects. Waste and mismanagement undercut the truly necessary oral health initiatives.” (Connecticut dentist)
  • “With the economy sliding downward, rapidly, I’m glad I’ve got the extra source in a small town.” (Arkansas dentist)

Read more: Dentists Say Medicaid Isn’t Worth It

Dentist, Busted for Medicaid Fraud, Owes $1.3M

 

A Michigan dentist convicted of Medicaid fraud has been ordered to repay the state $1.3 million. During the years of 2004 and 2005, Dr. Billy Shee Lim fraudulently billed Medicaid for over $2.1 million. In fact, one of the cases against the doctor involved billing for the removal of 37 primary teeth from a single pediatric patient – hardly a sophisticated scheme, considering children only have 20 baby teeth! Considering the scope of Dr. Lee’s fraud, he’s lucky to have avoided jail time with a three-year probation sentence.

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