Welcome to DU!
The truly grassroots left-of-center political community where regular people, not algorithms, drive the discussions and set the standards.
Join the community:
Create a free account
Support DU (and get rid of ads!):
Become a Star Member
Latest Breaking News
General Discussion
The DU Lounge
All Forums
Issue Forums
Culture Forums
Alliance Forums
Region Forums
Support Forums
Help & Search
Health
Related: About this forumDental Management Company Benevis and its Affiliated Kool Smiles Dental Clinics to Pay $23.9 Million
https://www.justice.gov/usao-ct/pr/dental-management-company-benevis-and-its-affiliated-kool-smiles-dental-clinics-pay-239Department of Justice
U.S. Attorneys Office
District of Connecticut
FOR IMMEDIATE RELEASE
Wednesday, January 10, 2018
Dental Management Company Benevis and its Affiliated Kool Smiles Dental Clinics to Pay $23.9 Million to Settle False Claims Act Allegations Relating to Medically Unnecessary Pediatric Dental Services
WASHINGTON The Justice Department announced today that it has settled False Claims Act allegations against dental management company Benevis LLC (formerly known as NCDR LLC) and more than 130 of its affiliated Kool Smiles dental clinics for which Benevis provides business management and administrative services. Under the agreement, Benevis and the Kool Smiles clinics will pay the United States and participating states a total of $23.9 million, plus interest, to resolve allegations that they knowingly submitted false claims for payment to state Medicaid programs for medically unnecessary dental services performed on children insured by Medicaid.
(snip)
The United States alleged that between January 2009 and December 2011, Benevis and Kool Smiles clinics located throughout 17 states knowingly submitted false claims to state Medicaid programs for medically unnecessary pulpotomies (baby root canals), tooth extractions, and stainless steel crowns, in addition to seeking payment for pulpotomies that were never performed. The United States alleges that Kool Smiles clinics routinely pressured and incentivized dentists to meet production goals through a system that disciplined unproductive dentists and awarded productive dentists with substantial cash bonuses based on the revenue generated by the procedures they performed. According to the governments allegations, Kool Smiles clinics ignored complaints from their own dentists regarding overutilization. In addition, the United States further alleged that Kool Smiles clinics located in Texas knowingly submitted false claims to the Texas Medicaid Program for First Dental Home (FDH), a program intended to provide a comprehensive package of dental services aimed at improving the oral health of children under three years of age. These clinics are alleged to have submitted false claims for FDH services that were not fully provided.
Of the $23.9 million to be paid by Benevis and its affiliated Kool Smiles clinics, the federal government will receive a total of $14,244,073.49, plus interest, and a total of $9,655,926.51, plus interest, will be returned to individual states, which jointly funded improper claims submitted to state Medicaid programs.
(snip)
The governments investigation was initiated by five lawsuits filed under the whistleblower provision of the False Claims Act, which permits private citizens to file suit on behalf of the United States for false claims and share in a portion of the governments recovery. Four of the cases are currently pending in the District of Connecticut and one is pending in the Western District of Texas. As part of todays resolution, three of the whistleblowersformer Kool Smiles employees Adam Abendano, Poonam Rai, and Robin Fitzgeraldwill receive payments totaling more than $2.4 million from the federal share of the settlement.
(snip)
InfoView thread info, including edit history
TrashPut this thread in your Trash Can (My DU » Trash Can)
BookmarkAdd this thread to your Bookmarks (My DU » Bookmarks)
0 replies, 1067 views
ShareGet links to this post and/or share on social media
AlertAlert this post for a rule violation
PowersThere are no powers you can use on this post
EditCannot edit other people's posts
ReplyReply to this post
EditCannot edit other people's posts
Rec (0)
ReplyReply to this post