Office of Medicaid (MassHealth) - Review of Dental Periapical Radiograph Claims Submitted by Dr. Najmeh Rashidfarokhi

This is a state audit of MassHealth payments to Dr. Najmeh Rashidfarokhi for a specific type of dental X-ray between July 1, 2010 and June 30, 2015.

“OSA has conducted an audit of dental periapical2 radiograph claims paid to Dr. Najmeh Rashidfarokhi for the period July 1, 2010 through June 30, 2015.”

The auditor chose this provider because her billing showed a higher share of periapical X-rays than other dental providers, which raised a concern worth checking.

“We selected Dr. Rashidfarokhi for audit because we determined that of all the radiographs4 she took during the audit period, periapical radiographs represented an average of 69.3%, whereas all other dental providers’ periapical radiographs averaged 51.5% of their total radiograph claims.”

MassHealth is a major public program paid for with taxpayer money, so improper payments can affect public trust and state spending.

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

If you are a Massachusetts taxpayer or MassHealth member, this audit is about making sure public healthcare dollars are spent only on services allowed by the rules.

“MassHealth annually provides access to healthcare services to approximately 1.9 million eligible low- and moderate-income children, families, seniors, and people with disabilities.”

The auditor says the dentist should repay about $267,251 and stop billing MassHealth for periapical X-rays that are not allowed.

“Dr. Rashidfarokhi should collaborate with MassHealth to repay the approximately $267,251 in improper payments she received for periapical radiographs.”

MassHealth said it would try to recover the overpayment, educate the dentist and staff, and monitor future claims for possible overuse.

“MassHealth’s Provider Compliance Unit will seek to recover the overpayment from Dr. Najmeh Rashidfarokhi once the final report has been issued.”

This was not a small paperwork issue: the audit estimated that most of the sampled claims were not allowed under MassHealth rules.

“Of these 60 claims, 54 were unallowable.”

A periapical radiograph is a dental X-ray that shows an entire tooth, from the top down to where it sits in the jaw.

“A periapical radiograph shows the whole tooth from the top to where the tooth is secured in the jaw.”