NOT the same as the Skygen/Health Plan SDF clawback audits
Liberty Dental is performing targeted audits for quality assurance purposes. Quality assurance is required by their state Medicaid contract.
There are two ways a dentist is selected for an audit. The first is a random selection. The second is due to outlier data from quarterly reports. Liberty compares utilization patterns by code for each provider to all other dentists in WV. The Liberty team will set up meetings with the audited dental office to discuss the data and practice patterns they are noting.
These audits are NOT financial claw back audits. If a patient grievance is involved in triggering an audit, then there is the possibility of a claw back – for example, if a provide indicated completion of a procedure, but it was not done; however, it was paid for – then a clawback will ensue.
