Audit finds $1 million in state Medicaid overpayments
CARSON CITY — An audit of the state Medicaid program released Monday identified more than $1 million in overpayments and improper billings.
Legislative Counsel auditors identified $780,000 in overpayments for behavioral health claims, and $285,000 in overpayments and improper billings for dental claims.
The audit of the Division of Health Care Financing and Policy, which administers the Medicaid program, was reviewed by the Legislative Commission’s Audit Subcommittee.
Examples of overbilling included a dentist who submitted 4,177 claims, or 48 percent of all claims statewide, for “emergency treatment of dental pain — minor procedure” in fiscal years 2012 and 2013.
Unlike other providers, this dentist submitted multiple claims for the same patient on the same day. For example, 24 claims for the treatment of dental pain were submitted for one patient on the same day. Auditors estimate the dentist was overpaid by nearly $124,000.
The same dentist also submitted 4,442, or 21 percent of claims statewide, for oral/facial photographs. Auditors found the dentist typically submitted many claims for photographs of the same patient on the same day. Auditors estimated the dentist was overpaid more than $67,000 for this in fiscal years 2012 and 2013.
The agency is now investigating the dentist, who was not named in the report.
Assemblywoman Maggie Carlton, D-Las Vegas, the chairwoman of the subcommittee, said the dentist needs to be held accountable. Any excess payments could have been used to treat other Medicaid recipients, she said.
If evidence of fraud it uncovered by the agency, the information will be turned over to the state attorney general’s Medicaid Fraud Unit.
During the two years reviewed in the audit, about 980,000 claims were paid for dental work totalling $61 million. Overall, dental claims represent about 1.7 percent of the division’s health care expenditures.
The behavioral health overpayments resulted from the division computer system’s failure to process claims according to policy, the audit said.
“Although the division has strengthened its oversight of Medicaid payments since our last audit in 2008, we identified certain areas where improvements are needed,” the audit said.
Auditors made six recommendations to fix the problems, all of which were accepted by the agency.
Contact Sean Whaley at swhaley@reviewjournal.com or 775-687-3900. Find him on Twitter: @seanw801.