OIG opens fraud investigation into 4 Texas dentists

Fraud investigations based on statistical records analyses have been opened for four Texas dentists, according to a March 24 news release from the Texas Office of Inspector General.

OIG analyzes volumes of data to identify providers who are statistical outliers among their peers, according to the release. Investigators then evaluate additional records to determine whether an outlier's status is attributable to possible fraud, waste or abuse.

In July 2020, a review analyzed claims data from more than 5,500 dental providers. As a result, the OIG opened investigations on four providers.

One of the investigations involves a provider who billed for a client with 18 procedure codes, including resin restorations, crowns, pulpotomies and tooth removal — all performed on the same date of service and without anesthesia. Another claim involved a 3-year-old client with 31 procedure codes, including five resin restorations, crowns and pulpotomies.

Click here for more on why dental providers may be flagged for potential fraud.

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