The American Academy of Pediatric Dentistry, American Dental Association, Nebraska Society of Pediatric Dentistry and Nebraska Dental Association are troubled by the growing number of Medicaid pediatric dental audits in Nebraska that are harming children’s access to oral care, the organizations told the state’s Medicaid agency in a Nov. 6, 2019 letter. The letter said that the audits have led to “unfortunate outcomes detrimental to the program’s goal of improving oral health access for children of low-income families.” The organizations said they believe that dental auditors were not basing their reviews on AAPD’s accepted clinical recommendations and were “second-guessing clinical decision-making by pediatric dentists absent appropriate peer review by a dentist with equivalent educational training.” The audits have questioned the use of stainless steel crowns in children at high caries risk, many with signs of severe decay on multiple teeth, and requested significant refund of payments for alleged inappropriate treatment.
The dental organizations asked the Nebraska Division of Medicaid and Long-Term Care to halt the audits and require all future Medicaid dental auditors to utilize dental profession clinical guidelines, best practices and policies of the appropriate specialty organization, and require contracted auditors to utilize licensed dentists of equivalent education and training as the dentists being audited and to have experience in treating Medicaid patients.
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Click here to read the letter.