Page 31 - 2021 AGD ADVOCACY
P. 31
Medicaid Dental Provider Audits
• Under the ACA, the Medicare Recovery Audit Contractor (RAC)
program was extended to Medicaid.
• The RAC program allows private contractors to demand patient
records and conduct audits on providers while retaining a percentage
of any refunds collected.
• Inherently flawed system, since independent contractors are not
necessarily specialists who understand dentistry and they are
incentivized to find “fraud” and “unnecessary treatment”
• Peer-to-peer auditing would be a better approach, as well as a
mandate that auditors adhere to industry policies and guidelines
consistent with clinical guidelines
