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 (DOJ) announced the settlement last month. It’s very sad to learn that the claims involved medically unnecessary dental services performed on children.
Kool Smiles dental clinics and their parent company, Benevis, formerly known as NCDR, based in Marietta, Georgia, violated the federal False Claims Act (FCA) 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.
It appears that 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 that the clinics ignored complaints about the practice from their own dentists.
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. 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.
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