Jan. 16, 2018—Washington, D.C. Kool Smiles, a national pediatric dental chain, and Benevis agreed to pay almost $24 million to settle allegations that both companies defrauded Medicaid programs by performing unnecessary dental work on children. Thanks to whistleblowers reporting Medicaid fraud these disturbing allegations were taken seriously.
Several whistleblowers, including a dentist in Connecticut, alerted authorities that Kool Smiles allegedly offered bonuses to dentists who met production goals. In some cases, children who still had baby teeth were allegedly subjected to unnecessary dental treatments, including root canals and crowns. Benevis provides business and administrative services for Kool Smiles.
Lawsuits Alleged Unnecessary and Painful Dental Work Performed on Children
According to the Department of Justice’s Benevis and Kool Smiles fraud lawsuit, from January 2009 to December 2011, the two companies knowingly submitted false claims to 17 state Medicaid programs for dental procedures that were unnecessary. Those procedures included baby root canals, tooth extractions, and stainless steel crowns. Kool Smiles is also accused of claiming payment for root canals that were not performed.
Officials also accused Kool Smiles of punishing dentists that were deemed unproductive whilst also awarding productive dentists with cash bonuses based on how much money their procedures brought in. Finally, the government alleged Kool Smiles administrators ignored complaints about their practices made by their dentists.
Michael Greenwald, a whistleblower, and dentist in Connecticut reported that Kool Smiles dentists often wrapped patients in cocoons to prevent them from moving, and used a hairdryer to dry the children off if they wet themselves while undergoing treatment.
“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. The U.S. Attorney’s Office in Connecticut is committed to aggressively pursuing health care providers that submit fraudulent claims to government health care programs.”
Whistleblower Robin Fitzgerald told KYMA that working at Kool Smiles was “not a positive experience,” says her time there was frustrating and she had never seen a practice take such advantage of its patients.
Whistleblowers Brought Benevis and Kool Smiles Fraud Allegations to Light in Connecticut and Texas
Five lawsuits were brought in Connecticut and Texas under the whistleblower provision of the False Claims Act, which allows private citizens to file lawsuits on the government’s behalf. The provision also allows those whistleblowers to share in part of the money the government recovers. As part of the Kool Smiles fraud settlement, three of the whistleblowers will each receive more than $2.4 million.
“Today’s settlement sends a very clear signal: Fraud in the federal healthcare system will not be tolerated,” said U.S. Attorney John F. Bash for the Western District of Texas. “Especially when that fraud involves performing unnecessary procedures on kids—here, unnecessary baby root canals and tooth extractions, among other procedures—we will not hesitate to use every tool at our disposal to punish those who break the law.”
Of the $23.9 million, the federal government will receive $14,244,073.49 plus interest while individual states will split $9,655,926.51.
Arizona Kool Smiles Dentistry Linked to Two Deaths
Two children recently died after visits to the same Kool Smiles clinic in Yuma, Arizona. The first was a four-year-old who died in January 2016 after developing an infection following dental work. Her mother has filed a lawsuit alleging the dentist should have given the child proper treatment and a proper examination after the infection developed. In January of 2017, a two-year-old stopped breathing after getting a filling. He died four days later.
Dental Medicaid Fraud “Intolerable”
Calling Medicaid fraud “intolerable,” Special Agent in Charge Phillip M. Coyne, HHS-OIG, noted that billing for unnecessary dental procedures not only jeopardizes the well-being of young patients, it takes money from health care programs that are meant to treat patients with legitimate needs, putting those patients at risk of not obtaining medically necessary care.
“When providers accept federal funds for reimbursement, they have a duty and responsibility to provide the best care possible to the patient, especially when their patients are economically disadvantaged children,” said U.S. Attorney Ryan K. Patrick for the Southern District of Texas.
Whistleblowers Vital Weapons in Fight Against Fraud
Whistleblowers who come forward with knowledge of fraud against the government are vital to protecting the integrity of Medicare and Medicaid. We applaud the whistleblowers in this case who decided to bring these allegations to the government’s attention. Without them, these egregious claims might never have come to light.