Policy on Third-Party Payor Audits, Abuse, and Fraud
Purpose
Pediatric dentists provide dental services covered by the Medicaid program and other third-party payors. The auditing process can discourage provider participation in state Medicaid and insurance programs due to excessive burdens on practitioners, provider profiling, and unfounded claims of fraud and abuse. The American Academy of Pediatric Dentistry (AAPD) supports efforts to eliminate insurance and Medicaid abuse and encourages fair and reasonable audit practices. This policy is intended to help AAPD members understand the insurance audit process and provide guidance on audit management.