How Medicaid audits hurt children in my home state

In April, 2014, 300 dentists throughout Nebraska, many specializing in children, received a letter from a contractor for Medicaid. The letter warned they would be subjected to a RAC audit.  

I was among those dentists. 

RAC stands for the Recovery Audit Contractor program, which started with Medicare, then was extended to Medicaid under the Affordable Care Act. It enables private contractors to demand patient records, conduct audits on providers, and collect a percentage of any refunds.  

In Nebraska, the audit aimed to scrutinize how frequently we performed cleanings for Medicaid patients. For every patient seen more frequently than every six months, we would have to refund a $22 reimbursement for “excessive” teeth cleaning.  

So began an ordeal for the one-third of all dentists in Nebraska who care for low-income Medicaid patients. The episode is a cautionary tale about government overreach. 

A recent report from the U.S. Department of Health and Human Services injects fresh urgency into the issue, finding 75 percent of children on Medicaid in four states – California, Indiana Louisiana and Maryland – are not getting required dental care. The report calls for the Centers for Medicare Medicaid to work with states to identify barriers preventing providers from

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