23 Dental Providers Settled Litigation with OIG in 2022

Texas Health and Human Services Office of the Inspector General came out with its last quarterly report for fiscal year 2022 this month.

OIG provider settlements

One of the key takeaways from the report is that 16% of the 147 cases that the OIG litigation team settled in 2022 were with dental providers.  Only home health agencies had more cases, some 38% or 59 of the 147 total.  Physicians came third with 14% or 20 cases.

However, when it came to tallying up the total settlements from these cases, dental providers ranked 5th in dollar value at $696,713 out of a total of $16,278,408 collected by the litigation team – a mere 4.2% of the total.  Hospitals, home health agencies, physicians and pharmacies all paid out much more, totalling 88% of the monies collected.

Provider investigations

When it comes to provider investigations, 6% of preliminary investigations opened by OIG were on dental providers in 2022.  Attendants ranked highest in preliminary investigations with 41% of the total and physicians with 17%.  Full-scale investigations opened saw dental providers only account for 2% of the total with the bulk made up by physicians with 29% and home health agencies at 25%.

That’s a pretty impressive performance for dental providers.

OIG did highlight one dental settlement in its report:

Settlement reached with a North Texas dental provider – In June, the OIG settled a case involving a dentist in Dallas. The case involved allegations that the provider billed for services not rendered, upcoded services, maintained inadequate/incomplete medical records, failed to provide or maintain x-rays and provided medically unnecessary services. The provider agreed to pay $200,000 in overpayment to resolve this case.”

Recommendations on THSteps Dental Preventative Services policy

One other item of note is that OIG made recommendations to change the THSteps Dental Preventative Services policy.

“The OIG continues to review and provide feedback related to HHS policy changes. This quarter, the OIG reviewed the THSteps Dental Preventive Services policy and recommended clarified timelines for written consent and when, and to whom, oral hygiene instructions are provided. Recommendations were also made regarding payments for the removal of space maintainers in certain circumstances.”



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