Audit: State overspent on dental work for jobless
October 7, 2014
LAS VEGAS — A state program meant to fix the teeth of people with disabilities and give them the confidence to land a job got out of hand in some rural areas in Nevada, leading to nearly a million dollars in overspending over four years, state auditors said.
A legislative audit of the Nevada Department of Employment, Training and Rehabilitation, released this week, pinpointed its Ely office as the biggest culprit. The report found that 41 percent of clients at that Rehabilitation Division office had dental work covered, compared to about 5 percent of clients statewide, and some participants received no other job-preparation services aside from dentistry.
"Dental work can be a necessity for people to get employment," said Dennis Perea, acting director of the department. But "we believe we were disproportionately spending. No question about it."
The problem went undetected for years, auditors said, because vocational rehabilitation counselors stationed around the state can authorize expenses up to $6,000 without getting a supervisor's approval. Also, oversight was lax, and dentists and employers were referring people to the department for the sole purpose of getting dental care.
"In those small towns, the word travels fast," Perea said.
From fiscal years 2009 to 2013, 332 people working through the Ely vocational rehabilitation office received dental work; the average person received more than $1,100 in care. The top three offices — Ely, Reno Town Mall and Northern District — accounted for 62 percent of the department's statewide spending on dental services, even though they only accounted for 23 percent of the state's total participants.
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State officials sent letters to three dentists in Ely, telling them that dental problems alone could not be considered a disability that qualifies people for the vocational rehabilitation program. A counselor at the office has retired, Perea said, and a new counselor has been instructed to increase scrutiny of dental spending.
Expenditures for 2014 are down, auditors said, but Ely is still the biggest expense for the program.
Perea said his agency is considering lowering the $6,000 threshold, but it hasn't yet decided how low it should go. Many expenditures by the vocational rehab program overall exceed $2,000, he said, and it could be burdensome for a small handful of supervisors to approve so many expense requests from about 40 vocational counselors.
The true test of whether the program's high spending is appropriate will come when officials analyze how many people who received care got a job as a result of their spruced-up smiles, Perea said.
Most patients working through the program have severe dental issues and need teeth pulled, dentures or partials, said Cassie Hanson, office manager for dentist Shannon Michael Sena, whose Ely office is located next to the department's office.
The work often costs $5,000 and up, she said, but the trade-off is more confidence.
"If they can be pain-free and comfortable and confident, they're able to have the chance to succeed," Hanson said.