For Immediate Release - May 10, 2011

Auditor Bump Cites Two Dentists for Overcharging Health Program

Medicaid investigation uncovers $311,572 in unallowable billing

BOSTON, MA (May 10, 2011) – In an ongoing investigation into MassHealth dental provider claims, State Auditor Suzanne M. Bump today reported that two dentists have received more than $311,000 in unallowable reimbursements from the state’s insurance agency.

Dr. Melvin Frankel DMD of Taunton and Dr. Doreen Chong DDS of Boston billed MassHealth for approximately $4.9 million in orthodontic services for 2,514 patients over a five year period. Audits of their separate practices cited excessive x-ray charges, and in the case of Dr. Frankel, duplicate payments and reimbursements for services that were never performed on patients.

“These are two glaring examples of how health providers can reap undue monetary benefits from the MassHealth system at the cost of the taxpayer,” said Auditor Bump. “A more troubling question is why MassHealth didn’t catch these abuses.”

The audits are the latest in the State Auditor’s ongoing review of the Medicaid program, which now accounts for one third of the state budget. An audit released last November found similar abuses which were tied to inadequate controls in identifying unallowable claims by DentaQuest, the subcontractor which administers the dental program for MassHealth.

Auditor Bump found that DentaQuest approved claims from both dentists for $305,182 in x-rays, orthodontic consultations, periodic treatments and orthodontic retention that were against regulation. The audit also found that Dr. Frankel was paid twice for the same dental procedures 29 times and DentaQuest failed to identify the duplicate claims resulting in a $4,982 overpayment as well as $1,408 in payments for orthodontic treatments he never performed on patients.

Auditor Bump is calling on MassHealth to recover the improper claims and establish additional controls over its payment system to prevent a significant pattern of waste, fraud, and abuse in vendor billings.

Over the past four fiscal years, payments to dental providers in the program have increased by more than 250 percent from $116 million to over $300 million which Auditor Bump cited as a primary reason to increase oversight of the program.