Office of Medicaid (MassHealth) - Review of Dental Periapical Radiograph Claims Submitted by Sawan & Sawan, DMD

This is a Massachusetts State Auditor review of MassHealth payments to Sawan & Sawan, DMD for a specific kind of dental X-ray from July 1, 2010 through June 30, 2015.

“OSA has conducted an audit of dental periapical1 radiograph claims paid to Sawan & Sawan, DMD for the period July 1, 2010 through June 30, 2015.”

The auditor looked at this provider because its billing pattern showed a higher share of periapical X-rays than other dental providers, which raised a risk flag.

“We selected Sawan & Sawan, DMD for audit because we determined that of all the radiographs3 it took during the audit period, periapical radiographs represented an average of 69.5%, 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 matter to the state budget and public trust.

“Medicaid expenditures represent approximately 39% of the Commonwealth’s total annual budget.”

If you are a Massachusetts taxpayer or MassHealth member, this audit is about whether public healthcare dollars were spent properly and whether providers followed the rules.

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

The auditor recommended that the dental practice work with MassHealth to repay the estimated improper payments and improve its billing and recordkeeping.

“Sawan & Sawan, DMD should collaborate with MassHealth to repay the approximately $79,190 in improper payments it received for periapical radiographs.”

MassHealth said it would try to recover the overpayment after the final report and would monitor the provider’s future claims.

“MassHealth’s Provider Compliance Unit will seek to recover the overpayment from Sawan & Sawan, DMD once the final report has been issued.”

The issue was not just paperwork: auditors said some X-rays were billed during routine dental exams without the required signs of a specific dental problem.

“These 15 claims were for dental periapical radiographs performed as part of routine dental exams and were not part of a triennial full-mouth series of radiographs.”

A periapical radiograph is a dental X-ray that shows the whole 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.”