Latest OIG Quarterly Report

Is it us or does Medicaid dentistry seem to get more attention in these reports than other specialties?

Are we being sensitive?

We couldn’t help but be struck by the fact that again complaints against Medicaid dentists make up only 6% of the complaints received by OIG, yet Medicaid Provider Integrity investigations into dentists make up 16% of all investigations.

Our impression is further bolstered because three of the 11 “Agency Highlights” have to do with Medicaid dentistry.  The very first one reports the exclusion of a dentist from Medicaid.  Another one on improved data analytics notes that it has “produced significantly faster analytics processes that support data mining of Medicaid claims data for potential fraud, waste or abuse. For example, a data query of 21 million dental services previously took 11.5 hours to return; now the task requires slightly more than 10 minutes.”  “Dental team improves efficiency” is yet another Agency Highlight.

Although physicians are investigated at the same rate as dentists, there are NO mentions in the highlights.  The word “doctor” occurs 0 times in the whole document and the word “physician” only four times.

Readers’ comments would be appreciated.

Lots of collections

Be that as it may, we applaud the report and its detail.

OIG recovered some $212 million this past quarter, $169 million of which came from third party recoveries.  There are no details on where this came from, however.  As the  Third Party Recoveries unit works to ensure that Medicaid is the payor of last resort, it may have come from collections from other insurers.

The report is below to read.

oig-quarterly-report-q3-fy20

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