An audit from the HHS Office of Inspector General found Parkland Hospital in Dallas improperly received $743,582 in Medicare payments due to erroneous hospital outpatient dental services.
The OIG looked at more than 1,000 of Parkland's Medicare claims related to outpatient dental services provided between 2010 through 2011 and then slimmed it down to a random sample of 100 claims. Generally, Medicare does not reimburse for dental services. According to the OIG: "For hospital outpatient dental services to be covered, they must be performed as part of a procedure or service covered by Medicare." For example, Medicare would reimburse for the removal of teeth prior to radiation treatment for jaw diseases, but it would not reimburse removal due to simple decay.
Of the 100 claims examined, 98 did not comply with Medicare coverage requirements, according to the OIG. Most of Parkland's errors were bills to cover extractions due to tooth decay. Parkland also billed Medicare for partial or full mouth X-rays, which are excluded from Medicare.
The 778-bed Parkland said the errors occurred because it did not have written Medicare billing policies and procedures in place for dental services. The OIG said Parkland must refund all Medicare funds and establish a system to better monitor dental service claims. Parkland officials agreed with all of the OIG's comments.
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