January 10, 2018

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, agreed to pay $23.9 million to settle allegations of violating the False Claims Act by submitting false claims for payment to state Medicaid programs for medically unnecessary dental services performed on children insured by Medicaid.  According to the government, Benevis and Kool Smiles clinics located throughout 17 states 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 government further alleged 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.  The allegations originated in five whistleblower lawsuits filed under the qui tam provisions of the False Claims Act.  Three of the whistleblowers — former Kool Smiles employees Adam Abendano, Poonam Rai, and Robin Fitzgerald — will receive a whistleblower award of more than $2.4 million from the proceeds of the government’s recovery. DOJ

Tagged in: FCA Federal, FCA State, Medicaid, Provider Fraud, Whistleblower Case, Whistleblower Rewards,