MEQUON, Wisc. -- June 30, 2015 -- "The abuse of children enrolled in Medicaid dental programs is a continuing problem that needs to be addressed." This is the core message Craig Kasten, founder of Scion Dental and John Schaak, the company's new president, emphatically delivered during a recent webinar for members of the National Health Care Anti-Fraud Association® (NHCAA).
In their presentation "Potential for Abuse in Patient Restorative Services," Kasten and Schaak began by explaining the important differences between working with Medicaid and commercial dental plans. Scion Dental has more than 20 years of experience in Medicaid dental benefit administration and continues to lead the industry through its focus on innovative program management, exceptional technology, strategic provider and member outreach, and bottom-line results. The company also offers commercial benefit management services, giving it first-hand experience with both types of plans.
After setting this baseline, Kasten and Schaak then detailed several heartbreaking stories of children who had likely been abused by unscrupulous dental providers. Included were instances of children being painfully over-treated, sometimes without even the benefit of anesthesia, as a way of increasing dental provider revenue at the expense of Medicaid. The majority of these examples were taken from Scion Dental's own proprietary research, while others were ripped from the headlines of local and national media or chronicled in the reports following recent investigations by the U.S. Senate and the Office of the Inspector General.
"What makes this abuse particularly tragic is these young patients usually have no other options for dental care since only 15 percent of dentists participate in Medicaid dental programs overall," Kasten said. "In addition, their parents rely upon these dentists for their professional opinion and their guidance in making decisions about their child's dental care. These and other factors put children at tremendous risk from dentists who choose to take advantage of the system, especially since they know it can be difficult for payers to spot patterns of repeat fraud and abuse without the right tools to detect abuse."
The final section of the presentation offered a three-part game plan that NHCAA members and other healthcare and insurance executives can follow to discover and help prevent fraudulent and abusive practices. The plan includes education about the abuses and how to recognize them, industry collaboration between the NHCAA, the American Dental Association (ADA) and others to develop and enforce sanctions, and the use of technology-aided solutions to discover and prevent instances of abuse.
Among the technologies recommended is the use of a web-based portal that can generate profiles showing the frequency with which a given dentist provided a particular service, or services, within specific age bands compared to other Medicaid dentists in their area, or across the U.S. These age-banded profiles make it easier to spot those dentists who are exceeding the national average so they can be investigated and, if found guilty of wrongdoing, appropriately sanctioned. At the same time, they will also help identify those dentists who do a great job in providing services to the Medicaid program.
"The fee-for-service reimbursement system continues to reward over treatment at the expense of many dentists who do a terrific job in rendering care to this vulnerable population," Kasten said. "Taking advantage of anyone seeking care for financial gain is not just illegal; it is morally and ethically wrong. But taking advantage of children from under-served populations, and putting them through this type of unnecessary suffering, is simply unconscionable. Yet it goes on because certain providers have been able to hide in the shadows."
"We hope that by showing how technology can shine a bright spotlight on those perpetrating fraud and abuse, and highlighting those doing it right, we can help ensure the children of Medicaid beneficiaries are receiving the same level of care we all want for all of our children. We thank the NHCAA for the opportunity to make this presentation to their membership and look forward to working with them on this issue in the future," Kasten added.
About Scion Dental
Scion Dental, part of the SKYGEN USA family of companies that specialize in benefit management, is a distinguished dental administration company focused on bringing next-generation claims management and technology solutions together for government entities and commercial payers that enable them to improve process efficiencies, achieve compliance, and dramatically reduce the cost of delivering benefits. Because of dedicated workflows focused on preventing fraud and abuse, millions of people, including America's children, receive the quality dental care they need. Scion Dental joins sister companies Wonderbox Technologies, Vestica Healthcare, American Therapy Administrators, Ocular Benefits and now, Hylis Pharmacy Solutions to comprise the SKYGEN USA brand. To learn more, visit www.sciondental.com.