I support bill 1536.
The bill doesn’t go far enough however and that there needs to be due process provisions to protect providers at the beginning of an investigation and at the payment hold stage.
In 2010, an associate of mine, an independent contractor – not an employee, performed procedure on a Medicaid patient that I still am not sure what was treated. The patient’s parent was not happy and contacted Medicaid. I was unaware of this. Nor was I given the opportunity to remedy whatever the situation was.
In November 2011 I was contacted by a Medicaid investigator that I was under investigation for the incident. He requested over 150 charts to audit. I promptly copied and handed over all he asked for.
I do good dentistry and have nothing to hide.
Then the phone calls from patients started coming in because Medicaid had sent out a form to my patients inquiring about their treatment which was confusing and alarming. I saw many forms the parents brought to me to ask what they meant.
Then patients began calling because the investigator was showing up at their homes flashing his badge and scaring the patient’s parents. The investigator insisted on seeing the children and looking in their mouths. I wasn’t aware the investigator could diagnose or practice dentistry. I have the names of the patient’s parents that called me. Who knows how many others there were that were too scared or confused to contact me.
I received a letter from Medicaid stating they were charging me back for all the procedures ever performed – $1.3 million.
Now I have to prove everything I did on all these patients. This is onerous and terribly burdensome. My patient charts state the facts. There are no lies.
Medicaid has become a monster looking to demonize dental practitioners. We already have a dental board for complaints and resolutions.
I don’t know all the goings-on behind the scenes at Medicaid, but from my perspective, I see a broken system.
Specifically:
1) the system of predetermination and eligibility fails.
2) the lack of licensed dentists overseeing predetermination and
Claims process.
3) the new HMO aspect of patients on a roster fails the patient and the dentist.
4) the arcane and inane rules for Medicaid which are not even disseminated for dentists to understand.
5) predeterminations are now required for treatment that is required asap. Do you honestly believe this is the way to treat infection and pain? Do you believe the parents will be compliant to return for treatment?
6) the outsourcing of Medicaid reimbursements to 3 companies, now 2, has added more rules to compliance with Medicaid requirements. There are 3 new rules, now 2, that have to be complied with.
7) slow payments on claims for an already reduced fee.
In my humble opinion, if you continue down this path you will see dental Medicaid mills running children through them as fast as they can (for profit’s sake) with marginal dental quality. Is this what you would want for your children?
I am mad as hell at the way I’m being treated by Medicaid, for some super-secret treatment i’ve never been informed was performed, never giving me a chance to remedy it, and the way investigator tried to perform dental exams on my patients while scaring their parents with their badge and “authority” to do so.
Medicaid is out of control.
