A dental management company and more than 130 of its affiliates in 17 states have agreed to pay $23.9 million plus interest to settle civil charges that they fraudulently billed the government for medically unnecessary dental services performed on children, the U.S. Department of Justice announced.
“The allegations in these cases are particularly egregious because they involved medically unnecessary dental services performed on children,” said John H. Durham, U.S. attorney for the District of Connecticut in a statement.
Kool Smiles dental clinics and their parent company, Benevis, formerly known as NCDR, based in Marietta, Georgia, violated the federal False Claims Act by billing state Medicaid programs for medically unnecessary baby root canals, tooth extractions and stainless steel crowns, as well as baby root canals that were never performed, according to the Justice Department.
During the scheme from January 2009 to December 2011, the Kool Smiles clinics also routinely pressured and incentivized dentists to meet production goals through a system that disciplined “unproductive” dentists and rewarded “productive” dentists with substantial cash bonuses based on the revenue generated by the procedures they performed, the DOJ said. The clinics ignored complaints about the practice from their own dentists, the agency added.
The claims resolved by the settlement were allegations only, and there was no determination of liability, according to the Justice Department.
A spokeswoman for Benevis did not immediately respond to an emailed request for comment on Friday afternoon.
Three whistleblowers who filed the False Claims Act lawsuits—former Kool Smiles employees Adam Abendano, Poonam Rai and Robin Fitzgerald—will receive a combined $2.4 million for their share of the recovery. Of the nearly $24 million payment, about $14.2 million will go to the federal government and about $9.7 million to the states, according to the DOJ statement.
Five lawsuits filed under the whistleblower provision of the False Claims Act started the investigation. Four cases are pending in the District of Connecticut and one is pending in the Western District of Texas, according to the news release.
Special Agent-in-Charge Phillip Coyne of the U.S. Department of Health and Human Services Office of Inspector General said: “It is intolerable when health care companies seek to boost profits by defrauding Medicaid and exploiting children.”
“Systematically performing and billing for medically unnecessary dental procedures undermines the well-being of these young patients, corrupts the impartiality of medical decision-making, and diverts money from taxpayer-funded health care programs designed to pay for legitimate medical needs.”
In Connecticut, the investigation was handled by Assistant U.S. Attorney Richard M. Molot.
The cases are: United States, et al., ex rel. Abendano v. NCDR, et al., 3:10-cv-1100 (JBA) (D. Conn.); United States, et al., ex rel. Greenwald v. Kool Smiles Dentistry, 3:10-cv-1100 (JBA) (D. Conn.); United States, et al., ex rel. Rai, et al. v. Kool Smiles Dentistry, 3:17-cv-834 (JBA) (D. Conn.); United States, et al., ex rel. Bowne v. KS-VAP, 3:16-cv-369 (JBA) (D. Conn.); and United States, et al., ex rel. Alves, et al. v. NCDR, SA-13-CV-0760H (W.D. Tex.).
Complete your profile to continue reading and get FREE access to BenefitsPRO, part of your ALM digital membership.
Your access to unlimited BenefitsPRO content isn’t changing.
Once you are an ALM digital member, you’ll receive:
- Breaking benefits news and analysis, on-site and via our newsletters and custom alerts
- Educational webcasts, white papers, and ebooks from industry thought leaders
- Critical converage of the property casualty insurance and financial advisory markets on our other ALM sites, PropertyCasualty360 and ThinkAdvisor
Already have an account? Sign In Now
© 2024 ALM Global, LLC, All Rights Reserved. Request academic re-use from www.copyright.com. All other uses, submit a request to [email protected]. For more information visit Asset & Logo Licensing.
Kristen Rasmussen
Kristen Rasmussen is an Atlanta-based reporter who covers corporate law departments and in-house attorneys.
