In my time as a media professional in the dental industry, I have read a lot of dentist-authored articles about the difficulties of participating in government-managed programs such as Medicaid and CHIP. It’s clear that is a frustrating experience for dentists, who frequently cite abysmal reimbursement rates, huge administrative burdens, and other access-to-care challenges unique to this patient base.
These programs have limited budgets to serve their members, making the issue of fraud, waste, and abuse (FWA) even more of a priority. The Government Accountability Office, for example, found that approximately $36 billion dollars were made in improper reimbursements to Medicaid providers and suppliers. Dentistry has had its own scandals in addition to the conviction of individual providers—earlier this year, Benevis, a prominent DSO, settled Medicaid fraud accusations for $24 million dollars.
Third parties milking the cow and taking over providers practice rights and autonomy thru credentialing as they call. They are measuring provider procedures in money saving no patient outcome. a tooth could exfoliated early or late . caries is a focus of infection a month of infected caries in a tooth can bring lots of secondary effects throat infection intestinal infections , pain lots of kids think having tooth ache is a normal condition and they suffer . And removing exfoliating a tooth is not allow by the MCO it wont be paid. How make the last call then .
Would you do a RCT AND SSC Vs. a filling?, does it depends in long term remuneration for services and patient risk in having the need of further treatment on the same tooth and being not paid or doing preventive fillings in the spot and restorative filling as needs after . all these cuff providers hands by excusing in low cost and low beneficial patient treatment meaning do what you can for some no fair remuneration payment Vs. being the best providers for the third parties and get the bride for being good money saver.
The 16 teeth story is a mayor league .