Audit  Audit of the Office of Medicaid (MassHealth)—Review of Claims Submitted by Dental Arts Lawrence: Dr. Snehal Pingle, Dr. Yuan Fu Shek, and Dr. Ke Wang

The Office of the State Auditor (OSA) receives an annual appropriation for the operation of a Medicaid Audit Unit to help prevent and identify fraud, waste, and abuse in the Commonwealth’s Medicaid program. This program, known as MassHealth, is administered under Chapter 118E of the Massachusetts General Laws by the Executive Office of Health and Human Services, through the Division of Medical Assistance. Medicaid is a joint federal-state program created by Congress in 1965 as Title XIX of the Social Security Act. At the federal level, the Centers for Medicare and Medicaid Services, within the US Department of Health and Human Services, administer the Medicare program and work with state governments to administer state Medicaid programs.

OSA has conducted an audit of MassHealth claims for dental services paid to Dr. Snehal Pingle, Dr. Yuan Fu Shek, and Dr. Ke Wang of the Dental Arts Lawrence practice for the period July 1, 2019 through June 30, 2023. During this period, MassHealth paid these Dental Arts Lawrence providers $13,998,338 for 164,633 claims for dental services provided to 6,476 MassHealth members. The purpose of this audit was to determine whether Dr. Snehal Pingle, Dr. Yuan Fu Shek, and Dr. Ke Wang properly billed MassHealth for dental services and maintained documentation in members’ dental records to support these services.

This audit was initiated as the result of a referral from OSA’s Bureau of Special Investigations. The Bureau of Special Investigations is charged with investigating potentially fraudulent claims or wrongful receipt of payment and/or services from public assistance programs.

This audit was conducted as part of OSA’s ongoing independent statutory oversight of the state’s Medicaid program. Several of our previously issued audit reports disclosed weaknesses in MassHealth’s claim processing system and improper billing practices by MassHealth providers, which identified millions of dollars in potentially improper payments. As with any government program, public confidence is essential to the success and continued support for public expenditures, such as the state’s Medicaid program. Our audit is designed to identify issues that will help improve the Medicaid program, so taxpayers know that their dollars are spent prudently and that there is a system of continuous improvement of efficiency and service over time.

Below is a summary of our findings, the effects of those findings, and our recommendations, with links to each page listed.