Audit of Dentist Uncovers Potential Medicaid Fraud Activity
Medicaid investigation uncovers $154,019 in unallowable billing
BOSTON, MA — State Auditor Suzanne Bump today referred an audit report of a Quincy dentist to the Massachusetts Attorney General for further investigation into possible Medicaid fraud. The audit uncovered signs of pervasive fraud by the MassHealth dental provider, Dr. Shahrzad Haghayegh-Askarian, including $154,019 in unallowable and sometimes medically excessive procedures.
“It is clear to me that Dr. Haghayegh systematically bilked the MassHealth dental program,” said Auditor Bump. “Her operation was an affront to the taxpayers and her clients. I hope the Attorney General can use this audit as a tool to uncover the extent of her wrongdoing and obtain justice for the Commonwealth.”
A review of MassHealth payment information and the files of just 40 of the 357 MassHealth members seen by Dr. Haghayegh between 2008 and 2011 found repeat patterns of the dentist obtaining payment for dental procedures contrary to MassHealth regulations.
- 1,429 unallowable detailed oral screenings, intended for patients receiving radiation therapy, chemotherapy or organ transplants. The dental patients for which Dr. Haghayegh submitted claims were not undergoing any of these procedures;
- 865 claims for dental services including X-rays, fillings, and denture repairs that were not documented in member files;
- 259 oral evaluations in excess of MassHealth limits;
- 176 claims for “dental enhancement fees,” payments meant for more general health centers to improve their dental services;
- 13 cases of Dr. Haghayegh circumventing MassHealth limits on denture replacements by instead replacing every tooth in the denture individually;
- 98 tooth restorations in excess of state limits.
In addition, the audit identified 95 claims for medically excessive fluoride treatments. In one specific example, Dr. Haghayegh billed 53 fluoride treatments in a 12-month period for a single child-aged member. According to guidelines set by the American Academy of Pediatric Dentistry, a dentist should provide no more than four fluoride treatments in a year.
During the four year audit period MassHealth paid Dr. Haghayegh $912,167 for more than 10,000 claims of service.
In addition to the report, Auditor Bump’s Bureau of Special Investigations has conducted an investigation into other potential fraudulent activity and has forwarded its findings to the Attorney General as well.
Unrelated to the audit, and acting on patient complaints about her dental treatments, the Massachusetts Board of Registration in Dentistry suspended Dr. Haghayegh’s license to practice for one year, effective May 31, 2013. MassHealth has terminated her participation as a MassHealth provider based on its own review of Dr. Haghayegh’s billing.
“Given the egregious findings of our audit and investigative work I believe the Board of Registration should review its current suspension and consider a further disciplinary action,” said Auditor Bump.
Today’s report comes after Dr. Haghayegh denied state auditors access to her records for nearly a year. Dr. Haghayegh was the first MassHealth provider to challenge the State Auditor’s authority to obtain such records. Auditors were only able to begin the review after a May 2012 decision by Suffolk Superior Court required Dr. Haghayegh to allow access.
“We appreciate the Auditor’s partnership with MassHealth in working to hold this individual accountable,” said MassHealth Director Kristin Thorn. “MassHealth initiated an internal audit that identified program violations with this provider, we ordered her to repay inappropriately billed funds to the Commonwealth, and terminated her participation in MassHealth.”
As highlighted in earlier audits released by the Office of the State Auditor over the past four years, MassHealth’s dental claims processing system, which is administered through the subcontractor DentaQuest, has not contained adequate controls to identify and reject unallowable claims for certain dental services. Since 2010, the Office of the State Auditor has identified $7,678,115 in total questionable Medicaid dental claims. In response to audit work, MassHealth has implemented many changes to its claims system to better prevent similar unallowable billings in the future.
The Office of the State Auditor conducts technical and performance assessments of state government’s programs, departments, agencies, authorities, contracts, and vendors. With its reports, the OSA issues recommendations to improve accountability, efficiency, and transparency.