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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 Overview of Audited Entity

This section describes the makeup and responsibilities 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.
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Overview

Under Chapter 118E of the Massachusetts General Laws, the Executive Office of Health and Human Services, through the Division of Medical Assistance, administers the state’s Medicaid program, known as MassHealth. MassHealth annually provides access to healthcare services for approximately two million eligible children, families, people over 65, and people with disabilities, all of whom have low or moderate incomes. In fiscal year 2024, MassHealth program expenditures totaled $20.1 billion, of which approximately 39% was paid by the Commonwealth. These Medicaid program expenditures represented approximately 33% of the Commonwealth’s total annual budget.

According to Section 420.421 of Title 130 of the Code of Massachusetts Regulations, MassHealth pays for medically necessary dental services provided to its members. Dr. Snehal Pingle, Dr. Yuan Fu Shek, and Dr. Ke Wang, certified MassHealth dental service providers and dentists at Dental Arts Lawrence, together received a total of $13,998,338 for dental services provided to MassHealth members during the audit period, as detailed in the table below.

Summary of Dental Claims

Fiscal YearNumber of Members ServedNumber of Claims (Dr. Pingle, Dr. Shek, and Dr. Wang)MassHealth Payments
2020              2,932            30,634$     2,126,701
2021              3,092            43,483      3,241,425
2022              3,301            43,487      4,062,402
2023              4,004            47,029      4,567,811
Total          13,329*          164,633$ 13,998,339**

*      The total number of 13,329 members served includes members who were served one or more times during the four years featured in this table. The number of unique members served across all four years was 6,476.

**    Discrepancy in total is due to rounding.

Dental Services

All dentists who participate in MassHealth must comply with regulations disseminated by the program. MassHealth pays participating providers who provide quality dental services, file accurate claims, and comply with applicable MassHealth regulations for eligible MassHealth members. Such services include, but are not limited to, diagnostic, radiographic, preventive, restorative, endodontic, periodontal, and prosthodontic services. During the audit period, Dr. Snehal Pingle, Dr. Yuan Fu Shek, and Dr. Ke Wang provided the following types of dental services to MassHealth members:

Type of Dental ServiceNumber of Claims (Dr. Pingle, Dr. Shek, and Dr. Wang)MassHealth Payments
Diagnostic/Radiographic         43,641$  1,261,544
Preventative         26,718     1,243,679
Restorative         84,679     9,536,215
Endodontic            1,526        804,456
Periodontal            2,500       313,938
Prosthodontic               788        411,158
Other            4,781        427,348
Total       164,633$ 13,998,338
  • Diagnostic/Radiographic: These services include oral evaluations, screenings, and assessments, which, depending on the specific type of service, members may receive at least once or twice per calendar year. Members may receive oral evaluations as a result of routine dental care, oral or systemic disease, or complaints. Radiographs are taken as an integral part of diagnosis and treatment planning.
  • Preventive: These services include teeth cleanings, oral hygiene instruction, fluoride treatments, sealant applications, and space maintainer introductions, which are provided when premature tooth loss may lead to loss of dental arch integrity.1
  • Restorative: These services include tooth restorations, crowns, posts, and cores.
  • Endodontic: These services include pulpotomies (which involve the surgical removal of a portion of the innermost layer of the tooth) and root canals.
  • Periodontal: These services include the treatment of gums, bones, and tissues that support teeth.
  • Prosthodontic: These services include dentures and partial plates.
  • Other: These services include the surgical removal of teeth and emergency treatments.

MassHealth only pays for dental services when participating dentists maintain complete documentation and records of patients who are MassHealth members. Participating dentists must maintain all members’ records for a period of at least four years after the dates of services provided.

MassHealth strives to improve eligible members’ access to quality dental care and improve oral health and wellness for members. In order to do so, MassHealth has disseminated and referenced regulations to all participating providers regarding the documentation requirements for members’ dental records.

1.    Dental arch integrity refers to a jaw that has all teeth in place, no gaps, and in which the opposite arches fit together correctly. 

Date published: April 2, 2025

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