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ACA's Medicaid Audit Program Well-Intended but Flawed, American Dental Association Tells Senate Committee Roundtable

July 09, 2014

Contact Information:
Telephone: 202.789.5166
Email: raibler@ada.org

Washington, D.C., July 9, 2014—An Affordable Care Act provision allowing private contractors to demand patient records and conduct audits on providers is having a negative effect on some Medicaid dental programs, a pediatric dentist from Nebraska told a Senate panel today. 

Dr. Jessica Meeske, representing the ADA, participated in a roundtable discussion hosted by the Senate Special Committee on Aging at which committee members heard about the problems associated with the Medicare and Medicaid Recovery Audit Contractor (RAC) programs. While the ADA supports efforts to reign in fraud in Medicaid, it believes the RAC program as currently operated is seriously flawed.

RAC audits “lack transparency and an opportunity for feedback due largely to a breakdown in communication,” Dr. Meeske said. “I fear that the impact may negatively affect dental services for this population.”

RAC auditors seem oblivious to standards of care, even if they are spelled out in a state’s Medicaid provider manual. For instance, Dr. Meeske reports that auditors in Nebraska are requesting records for pediatric patients who have teeth cleanings more frequently than every six months, even though the provider manual allows the treating dentist the flexibility to schedule more cleanings, depending on the patient’s risk of decay. Because audits can lead to hefty fines and payment recoupments, it’s crucial that they be conducted transparently and with good communication between providers and auditors, something lacking in the current system.

Dentists are being hit with unreasonable fines and payment recoupments not only in Nebraska, but in other states as well. A non-profit dental clinic in Maine recently reported that a RAC auditor identified a $186 overpayment (later identified as a simple error) and subsequently levied a $23,856 fine.

“The dentists followed the rules as they were written and promulgated…in the best interest of serving our patients,” Dr. Meeske said, referring to the situation in Nebraska. “We were reimbursed by the state for services rendered per the rules set forth at the time of our participation. The RAC auditors are chasing the wrong rabbit. It is the system that is broken, not the providers.”

Also participating in the roundtable discussion were representatives from the American Hospital Association, the U.S. Government Accountability Office, Gorski Healthcare Group, among others. Chad Janak, vice president of audit operations for Connolly Healthcare provided the recovering audit contractor perspective. 

Dr. Meeske earned her doctorate of dental surgery from the University of Missouri, and a specialty certification in pediatric dentistry and a Master’s of Science degree in Dental Public Health from the University of Iowa. Dr. Meeske also serves as an adjunct faculty member of pediatric dentistry at the University of Nebraska College of Dentistry.

About the ADA

The not-for-profit ADA is the nation's largest dental association, representing 159,000 dentist members. The premier source of oral health information, the ADA has advocated for the public's health and promoted the art and science of dentistry since 1859. The ADA's state-of-the-art research facilities develop and test dental products and materials that have advanced the practice of dentistry and made the patient experience more positive. The ADA Seal of Acceptance long has been a valuable and respected guide to consumer dental care products. The monthly The Journal of the American Dental Association (JADA) is the ADA's flagship publication and the best-read scientific journal in dentistry. For more information about the ADA, visit ADA.org. For more information on oral health, including prevention, care and treatment of dental disease, visit the ADA's consumer website MouthHealthy.org