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Longview dental clinics part of $24M fraud settlement

From Staff and wire Reports
Jan. 11, 2018 at 12:09 a.m.

Kool Smiles on Judson Rd. Wednesday, January 10, 2018. (Les Hassell/News-Journal Photo)

A chain of dental clinics has agreed to pay about $24 million in civil penalties to settle allegations that it submitted Medicaid claims for unnecessary dental procedures on children. The allegations involved two Kool Smiles locations in Longview.

A U.S. Justice Department statement Wednesday said the federal government would receive more than $14 million of the settlement reached by Benevix of Georgia and its Kool Smiles clinics. Texas and 16 other states will share almost $10 million, and three whistleblowers will share more than $2.4 million of the settlement.

Federal prosecutors accused Benevis and Kool Smiles of performing the medically unnecessary procedures on children between January 2009 and December 2011.

The federal investigation was triggered by five lawsuits filed by would-be whistleblowers in Connecticut and West Texas.

A message to Benevis and Kool Smiles seeking comment drew no response Wednesday.

More than 130 Kool Smiles clinics were part of the allegations, including the Longview locations on Judson Road and Estes Drive, according to the Justice Department.

Benevis provides business management and administrative services for the dental clinics.

"Billing Medicaid programs for dental procedures that are not necessary contributes to the soaring costs of health care," Acting Assistant Attorney General Chad A. Readler of the Justice Department's Civil Division said in a statement. "When health care providers put vulnerable patients at risk by performing medically unnecessary procedures to achieve financial goals, we will take action."

The government said Benevis and Kool Smiles clinics in 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 also said Kool Smiles clinics routinely pressured and provided incentives to dentists to meet production goals through a system that disciplined "unproductive" dentists and awarded "productive" ones with substantial cash bonuses based on the revenue generated by the procedures they performed.

Kool Smiles clinics in Texas knowingly submitted false claims to the Texas Medicaid Program for First Dental Home, a program intended to provide dental services aimed at improving the oral health of children younger than 3.

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