AG halts shoddy billing practices by Small Smiles

LYNN – A dental care company with a branch in Lynn must pay back $24 million as part of an agreement with the attorney general’s office in 23 states, including Massachusetts, which resolves allegations that it submitted bills to the participating state’s Medicaid programs for medically unnecessary dental services performed on children.According to state Attorney General Martha Coakley, the agreement involves FORBA Holdings, a dental management company that provided management services to Small Smiles dental clinics nationwide.The children who received the unnecessary services were insured by Medicaid, which is funded jointly by federal and state governments. Under the agreement, FORBA agreed to pay the participating states and the United States $24 million, plus interest, to resolve allegations. As part of the deal, the Massachusetts Medicaid program will receive $1.4 million.”Our office will not tolerate companies that seek to illegally profit from the Medicaid program and those who engage in questionable patient care practices. It’s especially egregious when it’s directed at children,” Coakley said. “Our office will continue to work with the state’s Medicaid program, other law enforcement agencies and the federal government to identify and eliminate deceptive business practices that unlawfully divert funds from the Medicaid program.”Massachusetts alleged that FORBA was liable for causing the submission of claims for reimbursement for a wide range of dental services provided to low-income children that were either medically unnecessary or performed in a manner that failed to meet professionally recognized standards of care. These services included performing pulpotomies (baby root canals), placing crowns, administering anesthesia (including nitrous oxide), performing extractions, providing fillings and/or sealants, and inappropriately using behavior management techniques to restrain child patients.In addition to paying the $24 million, FORBA has agreed to enter into a five-year Corporate Integrity Agreement with the Office of Inspector General of the Department of Health and Human Services. The agreement provides for procedures and reviews to be put in place to avoid and promptly detect conduct similar to that which gave rise to this matter, said Coakley spokeswoman Jill Butterworth.Specifically, FORBA must allow inspectors to monitor its quality of care and reimbursement, while its chief dental officer develops and implements policies and procedures to ensure that the Small Smiles clinics provide services consistent with professionally recognized standards of care.The investigation began after three whistleblower lawsuits were filed under the False Claims Act. These actions are pending in the U.S. District Court for the District of Maryland, the Western District of Virginia and the District of South Carolina.