WRAL Investigates

Dentists left holding bills for services to pregnant women

Posted February 15, 2016

— It's all about smiles for Dr. Raleigh Wright and the staff at Lane and Associates dental practice, but the thought of dealing with Medicaid turns that smile into a frown.

"It's frustrating," Wright says.

His practice is one of hundreds across North Carolina that received a letter from the state asking for money back for treatments delivered under the auspices of the health insurance program for the poor and disabled.

Years after Wright and other dentists did work for pregnant women they believed were eligible for Medicaid services, the state is asking to be repaid. The charges vary from a couple hundred dollars into the thousands.

"That's why other providers don't want to use Medicaid because it's too many hoops to jump through. It's too much difficulty," Wright said.

The state reviewed the dental records and found the women got their services after they gave birth. Medicaid for Pregnant Women pays only for services rendered during pregnancy. It's billing the dentists for the services.

"In some cases, it might be a couple thousand bucks per office," Wright said. "Others it's maybe $400 or $500 in an office. It's not huge amounts, but it's a lot of effort to even try to appeal it."

State records shows that the dentists tried to do the right thing. They checked a state computer system which listed each patient as part of MPW. The state keeps women in the program for postpartum medical care, but their dental care does not qualify.

Dave Richard, deputy secretary of medical assistance for the Department of Health and Human Services, which oversees Medicaid, acknowledges that the system is complicated.

"I would never say being a Medicaid provider is an easy thing to do," he said.

Still, he says, the burden is on the dentists to verify that a patient is still pregnant.

"I don't know if there's more we could have asked them to do," Richard said. "Maybe at the time our systems weren't working properly, or maybe they did get bad advice. We don't view this as a provider doing something wrong. We view it as a mistake made."

DHHS is using a contractor, PCG, to review patient records, suggest where money can be recouped and handle dentists' appeals.

Knicole Emanual, a lawyer who has dealt with other state Medicaid cases, says it's not fair to put the burden on the dentists.

"The dentists that are my clients went on the Web and verified the patient was Medicaid-eligible for the dental services," she said. "Then they asked the patient if they were pregnant, and then they performed the services.

"I think what sticks out is the state is going after dentists for not making sure their patients were pregnant anymore," she said. "A dentist is not going to know whether a patient is pregnant or not. You're not going to pee in a cup going to the dentist's office."

Richard said the dentists have not necessarily done anything intentionally wrong.

"We have an obligation in our contract ... with the state and state taxpayers to make sure what we pay for are the things that are legitimate expenses for the Medicaid program," he said.

While Emanuel vows to fight for her clients who she thinks were unfairly targeted, Wright is throwing in the towel.

"After the first several appeals that we made, we just stopped appealing, and we just cut them a check and move on because we know there's no sense in appealing," he said.

Wright said a state representative told him he could bill the patients for their treatment, but that, too, seemed like a dead end.

"The patients, they couldn't afford it then. They're not going to be able to afford it now," he said.


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  • Kim Schrock Feb 23, 2016
    user avatar

    Patient fraud should be handled by the Sheriffs department. The Dentist should send the bill to the Patient. If the bill is not paid by court time then jail. Simple as that.

  • Tom Haywood Feb 16, 2016
    user avatar

    I agree that this is a patient fraud problem, not a dentist problem. How in the world is a dentist supposed to verify that a prospective patient is pregnant? Are they supposed to perform pregnancy tests at the office?

    This is a government program; a person either is or is not on a government list of pregnant women eligible for dental care. If it's not possible to keep the list up to date, then perhaps the law that created this program is flawed and needs to be modified.

    Why are we not committing the resources to go after the ones who truly have the burden of understanding the law under which they seek help?

    If you seek help from Obamacare that you are not entitled to, who is on the hook to repay the money later that you were not entitled to get? It's not the insurance companies (nor should it be) ... it's you.

    Stop trying to address patient fraud by bleeding the service providers. (and I am not now and never have been a dentist)

  • Matt Wood Feb 16, 2016
    user avatar

    View quoted thread

    I'm pretty sure a dentist asks a routine health history of the patient. The point of this article is that the patients received care AFTER they gave birth, so either the patient committed fraud, the dentist did, or both. The dentists should sue the patients.

  • Bobby Broadwell Feb 15, 2016
    user avatar

    For the first time in my 58yo life... most workplaces won't buy a good dental insurance and middle age middle class people are walking around toothless because it costs way too much to go to a dentist. So I feel really sorry for the poor dentists... and their lobby.

  • Chance Loria Feb 15, 2016
    user avatar

    There is no way a dentist would know if a patient is pregnant. The state should go after the patient for fraud; for using a benefit they knew they were not entitled to. Better yet, the state should update their computers showing the correct benefits at the time.