Feds: Upstate dental clinics among 133 accused of performing unn - FOX Carolina 21

Feds: Upstate dental clinics among 133 accused of performing unnecessary procedures on children

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Kool Smiles Dentistry in Greenville (Jan. 11, 2018/FOX Carolina) Kool Smiles Dentistry in Greenville (Jan. 11, 2018/FOX Carolina)

The U.S. Department of Justice said a $23.9 million voluntary settlement has been reached with Benevis LLC and Kool Smiles Dental Clinics after allegations surfaced claiming medically unnecessary services were performed on children.

According to officials, Kool Smiles clinics in 17 states submitted false Medicaid claims for "baby root canals," tooth extractions, stainless steel crowns and other procedures which were unnecessary for the pediatric patients between January 2009 and December 2011.

An investigation was launched after former Kool Smiles employees filed lawsuits under the whistleblower provision of the False Claims Act.

"Such claims include, but are not limited to, stainless steel crowns placed on primary teeth that were likely to exfoliate on their own without intervention or stainless steel crowns placed on teeth when no pain was reported," the settlement states.

The settlement also states pulpotomies, or the removal of part of the tooth pulp, were performed when less expensive and less intensive treatments would have been appropriate. The affected Kool Smiles Clinics are also accused of submitting claims for pulpotomies that were never performed.

More than 130 clinics operated by Benevis, including Kool Smiles locations in the Upstate, are part of the settlement. The following Upstate Kool Smiles locations are named in the documents:

  • 31112 North Main Street in Anderson
  • 3227 W. Blue Ridge Drive in Greenville
  • 629 Highway 28 Bypass in Anderson
  • 3 K-Mart Plaza in Greenville

Other South Carolina Kool Smiles clinics named in the settlement include locations in Sumter, Charleston, Columbia, Orangeburg and Rock Hill.

In a statement from Benevis, the company says the investigation focused "on professional disagreements between qualified dentists" in determining the necessity and cost of care. Benevis also said the settlement does not include any admission of wrongdoing and they "strongly disagree with the government's allegations."

The federal government will receive approximately $14.2 million of the settlement and $9.6 million will be returned to states that funded improper Medicaid claims. Three of the whistleblowers involved in the investigation will receive $2.4 million from the federal share.

“The allegations in these cases are particularly egregious because they involved medically unnecessary dental services performed on children,” said U.S. Attorney John H. Durham for the District of Connecticut.  “Exploiting needy children for financial gain is inexcusable."

Below is the full statement from Benevis, responding to the allegations:

Benevis, and its affiliate Kool Smiles, have voluntarily entered into a settlement with the U.S. Department of Justice (DOJ) and various State Attorneys’ General to end the government’s seven-year long False Claims Act (FCA) investigation relating to services provided from 2009 to 2011. 

The settlement agreement with the government does not relate to any claims regarding the quality of the dental care provided to patients. Importantly, the settlement does not include any admission or determination of wrongdoing by the companies, their employees or any Kool Smiles dentists.  In fact, the companies strongly disagree with the government’s allegations.

The investigation largely focused on professional disagreements between qualified dentists in determining the appropriate level and cost of the care.  For perspective, the government disagreed with the care provided in less than one percent of the procedures billed during the reviewed period.

The government’s own data, as well as independent, third-party research and analysis conducted by experts, disprove the allegations. A recent study by respected healthcare economists Dobson DaVanzo & Associates found Kool Smiles dentists provided fewer total dental services per Medicaid patient than non-Kool Smiles providers. It also found this resulted in the government paying significantly less per Medicaid patient for dental services provided by Kool Smiles dentists than it pays for Medicaid patients treated by non-Kool Smiles dentists.

The companies are disappointed that reasonable disagreement between dentists can become a FCA case.  However, given the seven years and significant expense already incurred, as well as the anticipated additional time and expense associated with lengthy litigation, the companies believe putting this matter behind them was the best option for their dentists, team members and the patients they serve.

The companies have complete confidence in Kool Smiles dentists and the quality and level of care they provide, and are proud to support the ongoing work of Kool Smiles dentists as leading providers of dental care for underserved communities nationwide.

Since 2002, Kool Smiles has been serving underserved communities, and today Kool Smiles provides needed dental care through more than two million patient visits per year, many of whom would not otherwise have access to dental care.  In addition, Kool Smiles dentists have provided more than $128 million in uncompensated dental care to treat patients and families who did not have access to Medicaid dental benefits or other dental insurance, and could not afford to pay. The companies will continue to work toward expanding access to quality dental care for all families.

Benevis is based in Marietta, Georgia. Other states involved in the settlement include: Georgia, Texas, Virginia, Massachusetts, Indiana, Louisiana, Connecticut, Mississippi, Arizona, Arkansas, Kentucky, Oklahoma, New Mexico, Washington and District of Columbia.

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