Improper Medicaid Pediatric Dental Payments

According to a sample of 1,824 claims in five states, between 27 and 35 percent of Medicaid pediatric dental service payments were “improper” in calendar year 2003. Most of the errors were documentation errors. This means that the information required to determine whether the services that taxpayers paid for were either medically necessary or properly billed was not provided with the claim.

The 2007 study was conducted by the Office of Inspector General, U.S. Department of Health and Human Services. The amount estimated to be improperly paid ranged from $137 million to $172 million for these 1,824 claims. The Inspector General’s report claimed that the total cost of Medicaid pediatric dental services in those states was $555 million, about 18 percent of total US Medicaid pediatric dental expenditures in 2003.

These amounts must be considered approximate given a 2007 GAO report concluding that it was not possible to determine exactly how much Medicaid spends on pediatric dental services. However, the Medicaid/SCHIP Dental Association estimated that total national spending on Medicaid pediatric dental services was about $3.4 billion in 2005.

If those findings are extended to the United States as a whole, Medicaid pediatric dentistry generated over $1 billion a year in questionable claims in 2003, a year in which total Medicaid spending was $263 billion according to the CMS Office of the Actuary. The Department of Health and Human Services considers improper payments a “management challenge.”

Comments (5)

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  1. Ken says:

    Nice to know our taxpayer dollars are being so well managed.

  2. Bruce says:

    Why am I not surprised at this result?

  3. Joe S. says:

    This is the insurance program that is working so well, we are going to enroll an additional 16 million people into it.

  4. Devon Herrick says:

    There’s a lot of fraud that goes on among pediatric Medicaid dentists, such as cavities filled where there was no cavity and crowns installed on baby teeth.

  5. Lutfi says:

    Do you rlaley reckon it?s a fail? For it to be a failure you would have mediate that the Democrats rlaley WANTED to improve health care. The truth is this is just so what they wanted. Why do you reckon Obama soothe supports the new law? Obamacare is effective just so as smooth, a total accomplishment rlaley.