Audit of the Office of Medicaid (MassHealth) - Review of Claims Submitted by Dental Arts Lawrence: Dr. Snehal Pingle, Dr. Yuan Fu Shek, and Dr. Ke Wang (April 2, 2025)

This is a state audit of MassHealth dental claims submitted by three dentists at Dental Arts Lawrence from July 1, 2019 through June 30, 2023.

“The purpose of this audit was to determine whether Dr. Snehal Pingle, Dr. Yuan Fu Shek, and Dr. Ke Wang properly billed MassHealth for dental services and maintained documentation in members’ dental records to support these services.”

The audit began after a referral from the State Auditor’s Bureau of Special Investigations, which looks into possible fraud, improper payments, or wrongful receipt of public benefits.

“This audit was initiated as the result of a referral from OSA’s Bureau of Special Investigations.”

MassHealth is a major public program funded partly by Massachusetts taxpayers, so billing errors can affect public money and trust in the program.

“As with any government program, public confidence is essential to the success and continued support for public expenditures, such as the state’s Medicaid program.”

For an ordinary resident, the issue is whether public healthcare dollars are being spent only on properly documented and allowed services.

“This makes less funding available to pay for valid, allowable claims through the MassHealth program.”

The auditors found 5 sampled claims without all required provider information and 3 sampled claims, totaling $215, for restorations that were not allowed under MassHealth rules.

“Dr. Snehal Pingle, Dr. Yuan Fu Shek, and Dr. Ke Wang of Dental Arts Lawrence were paid for more than one tooth restoration on the same members’ teeth and teeth surfaces within a 12-month period in 3 of the 131 dental claims, totaling $215.”

MassHealth said it will review the sampled claims, recover overpayments if it finds rule violations, and consider whether system updates are needed.

“MassHealth plans to review the 131-claim sample that the OSA reviewed for this audit.”

Beyond the specific $215 issue, auditors flagged a broader concern: Dental Arts Lawrence had many repeat restorations on the same tooth surfaces soon after the 12-month limit expired, raising questions MassHealth should review.

“The high rate of restorations on the same member, same tooth, and same surface makes the medical necessity of the procedure questionable and creates a concern for the quality of care provided to MassHealth members, especially considering the fact that 92% of all MassHealth claims over a four-year period occurred on days when the treating dentists reported that they worked at least 12 hours.”

MMIS is the computer system MassHealth uses to process claims and store claim-related data.

“MMIS is the claim processing and data warehouse system that MassHealth uses.”