Medicaid Dental Fraud: Cases of Truth Decay

I want to call attention to a new article in Journal of Insurance Fraud in America. That dental sealants are placed by dentist but billed as fillings. This upcoding might impact the reports from Medi-Cal Dental that reports the number of sealants placed. Thus, those policy advocates and policy makers that utilize these data might be reviewing under reporting of sealants, by how much we don’t know. 

Children with modest to moderate tooth decay are grossly over-treated with painful stainless-steel crowns and root canals. Routine preventive dental sealants are upcoded to expensive fillings. Excessive and abusive “patient encounters” (a/k/a “patient churning”) at federally qualified health facilities. This scam is widespread, and growing.

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