On August 8, 2024, the Department of Veterans Affairs (VA) Office of Inspector General (OIG) released a Report on Unauthorized Community Care Dental Procedures Risked Improper Payments (for veterans.)

This Report (VA OIG 23-00749-171) projected that the VA will improperly pay $325.5 million for 847,800 unauthorized dental procedures performed by community dentists between Fiscal Year (FY) 2022 and FY 2025.

The VA has already paid $139.1 million in unauthorized dental procedures between FY 2022 and FY 2023. The OIG Report estimates that the VA will pay $186.4 million during FY 2024 and FY 2025 if it does not reduce payments for these unauthorized dental procedures.

The VA offers dental care to a wide range of eligible veterans. These include service-connected medical conditions or disabilities and have service-connected medical conditions that are aggravated by dental conditions.

Other categories of veterans who are considered eligible for dental services are veterans who have been recently discharged or are experiencing homelessness.

A VA-eligible veteran may receive local community care dental services if they fall within one (1) of the three (3) specific criteria.

First, if they do not live near a Veterans Health Administration (VHA) facility or, second, if they are expected to experience lengthy wait times for an appointment. Third and lastly, if community dental care is in the veteran’s best medical interest.

During FY 2022, the OIG Report stated, 607,000 veterans received dental care at VA facilities. A total of 186,500 veterans received dental care at non-VA dental care facilities in the community.

Between FY 2018 and FY 2022, VA-supplied dental care costs have increased by sixty-five (65%) percent and Community Care dental costs have increased by one hundred and seventy-three (173%) percent.

The VA projects a rise in the number of veterans seeking dental care as the number of post-9/11-era veterans increases and the veteran population ages.

The $139.1 million unauthorized dental procedure costs during FY 2022 and 2023, cited in the OIG Report, fell within three categories. First, major unapproved changes to disabled veterans’ treatment plans; and second, minor changes to treatment plans that exceeded VHA’s maximum allowed during a rolling 12-month period.

The third category was the referrals that did not specify the authorized dental procedure codes as required.

According to the OIG Report, the VA paid an estimated $134.8 million for 289,400 unauthorized dental procedures that constituted major changes to the treatment plans of over 137,300 veterans.

Of these unauthorized procedures, 120,600 of the major changes to the treatment plan of 52,900 veterans would not have been approved by the VA if community dentists had sought the required VA authorizations.

Specifically, the VHA facility dental chiefs indicated that the major procedures were “unnecessary or not in the best interest of the patient.”

The OIG Report projected that the VA would make improper estimated payments of $54.5 million for 63,000 veterans, where 267,500 unauthorized minor community dental procedures exceeded the veterans’ rolling 12-month $1,000 threshold.

The OIG has made five (5) recommendations to resolve the situation in the future. These recommendations focus on “strengthening the prepayment adjudication and post-payment review process” as well as “ensuring preauthorization requirements are followed.”

My Opinion: The OIG should be commended for this comprehensive and detailed report on the existing cost of dental care for our veterans. Their analysis is apparent.

Briefly stated: the VA (and taxpayers) are paying more to non-VA Community Care dentists (in the private sector) and they are performing unauthorized and costly dental procedures.

For example, from FY 2022 to FY 2023, the VA paid $139.1 million to private-sector dentists for unapproved dental procedures. It is impossible to determine how many of these procedures, would be authorized if they were properly submitted to the VA for approval.

Dental care for our veterans is a vital medical service. But it is only a small portion of the medical services that the VA is required to deliver to veterans.

The VA must address the issue of unauthorized billing by private-sector dentists and follow the recommendations contained in the OIG Report.

However, Congress also has a responsibility in this issue.

During the 117th Congressional Session, a bill was introduced authorizing the VA to establish a pilot program to form a liaison with six (6) dental schools with the goal of recruitment of more VA dentists. It was not passed. This bill should be reintroduced.

Dental care is only being provided to a small segment of our veterans. It should be provided to all veterans, but the sad reality is that VA lacks the necessary manpower and financial resources to accomplish this goal.

Making VA referrals to Community Care (private sector) dentists, whose costs have increased from FY 2018 to FY 2022 by 173 percent, may not be the feasible answer – especially with the number of unauthorized and costly dental procedures they have generated.

BioSketch: John Plahovinsak is a 32-year retired Army veteran, who has served from 1967 to 1999. He is the Disabled American Veterans (DAV) Department of Ohio Hospital Chairman and Adjutant of Chapter #63 (Clermont County). He can be reached at: plahovinsak@msn.com.