Dental chain with Arizona locations to pay $24M in false claims settlement
Jan 10, 2018, 6:10 PM | Updated: Jan 11, 2018, 8:24 am
(Google Maps photo)
(Google Maps photo)
PHOENIX — A national dental chain with multiple locations in Arizona has agreed to pay about $24 million to the U.S. government in a deal that will settle false claims allegations against the company.
Kool Smiles and its parent company Benevis said in a statement that it has “voluntarily entered” into a settlement with the Department of Justice and various state attorney generals to end a seven-year long False Claims Act investigation. The investigation was related to services provided from 2009 to 2011.
“The DOJ has alleged that Kool Smiles was knowingly submitting false claims for unnecessary dental procedures on children,” said KTAR News 92.3 FM‘s legal expert Monica Lindstrom.
“The DOJ says that Kool Smiles was causing children to have unnecessary procedures on their teeth and then it would turn around and bill Medicaid for those procedures.”
The government took up issue with this because, Lindstrom said, Kool Smiles can only bill Medicaid if the procedures are “medically necessary.”
“By submitting claims that these procedures were medically necessary, Kool Smiles was stealing from the U.S. government and many state governments.”
In the statement, Kool Smiles said the agreement does not relate to claims regarding the quality of care or does not include any admission of wrongdoing by its employees.
“In fact, the companies strongly disagree with the government’s allegations,” the statement read.
The company was already in hot water: ABC15 found two deaths tied to procedures at Kool Smiles’ location in Yuma, Arizona.
One involved an incident in December, when a 2-year-old reportedly stopped breathing during an operation and died several days later. The other occurred in 2016, when a 4-year-old went to the facility to treat an abscess and died a few days later after showing signs of a fever.
Lindstrom said this settlement is not connection to those deaths.
“There’s no causal connection that has been proven yet between what happened to those kids and those being unnecessary, so this is basically about fraud,” she said.
“Kool Smiles is saying to these kids and their parents, who don’t know any better, ‘Hey, your kid needs a root canal,’ and then it would bill Medicaid. So it was taking advantage of these kids, their parents and Medicaid.
“The two cases where the kids have died, we don’t know if what they were doing was medically necessary or not. You can make a logical assumption that they died because they were not medically necessary, but they could’ve died even if it was.”
KTAR News’ Corbin Carson has contributed to this report.
