Marietta-based Benevis, the company that operates Kool Smile dental clinics in low-income communities, has agreed to pay nearly $24 million to settle accusations of Medicaid fraud.
Prosecutors said Wednesday that for years the company had performed medically unnecessary dental procedures like root canals on children and billed taxpayers for the work. Whistleblowers in various states originally brought cases against the company.
In the federal lawsuit, two dentists alleged that they had “eyewitness information that the Kool Smiles dental practice empire was predicated upon a widespread, multipstate scheme to perpetrate dental Medicaid fraud ... using unsuspecting patients, primarily low-income children, in the process.”
The company came under scrutiny as early as 2007, when the Georgia Department of Community Health indicated it was investigating the company’s “patterns of over-utilization of services,” “unusual patterns of patient restraint,” “over-utilization of stainless steel crowns,” and the appropriateness of care the company delivered.
WellCare of Georgia, which managed the state’s Medicaid programs, found that a child treated by Kool Smiles was five times more likely to receive crowns and 40 percent more likely to have their teeth pulled or extracted, compared with other dentists.
The settlement covers 130 affiliated Kool Smiles dental clinics.
Of the payout from Benevis, the federal government will receive a total of $14 million and the other $10 million will be returned to individual states that funded improper claims submitted to state Medicaid programs, the Department of Justice said.
The feds said they would give $2.4 million of its payout to three Kool Smiles whistleblowers.
“It is intolerable when health care companies seek to boost profits by defrauding Medicaid and exploiting children," said Phillip M. Coyne, head of the U.S. Department of Health and Human Services inspector general’s office. “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.”
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