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The national pediatric dental chain Kool Smiles and an affiliated business have agreed to pay $24 million to settle claims that they fraudulently billed Medicaid programs around the country for root canals, crowns and other unnecessary work on poor children. (Travis Heying / AP) | Image and caption via Hartford Courant

National dental chain Kool Smiles will pay $24 million to settle allegations that it and an affiliate routinely billed Medicaid for root canals and other unnecessary work performed on impoverished children.

As reported in the Hartford Courant, the case against Kool Smiles came into being by way of whistleblowers. A Connecticut dentist was among a handful of professionals who complained to authorities, saying the chain rewarded ‘productive’ dentists and gave bonuses for expensive, profitable, and often unnecessary treatments.

Eight whistleblowers across the United States told prosecutors that Kool Smiles treated ‘routine cavities in baby teeth with extractions, root canals and streel crowns.’ And in other cases, the business billed Medicaid for work that wasn’t never even done.

Michael Greenwald, as quoted in the Courant, says he tipped off authorities to stop what he called “appalling practices” at one Connecticut clinic. Greenwald, writes the paper, briefly worked for a Kool Smiles office in his home state after returning home from abroad.

Greenwald’s lawyer, James P. Brennan, said his client relayed anecdotes which come across as urban myths – dentists wrapping children in tight bundles, aiming hair dryers at their privates to alleviate urination caused by excess pain.

And Brennan says Kool Smiles clinics were encouraged to recommend as many unnecessary treatments as they could. Since the families of poor children don’t often return for follow-up visits, as many procedures as possible would be crammed into the course of a single visit, often forcing children into spending uncomfortable amounts of time sitting exposed.

A spokesman for Benevis –a firm which provides management services for Kool Smiles – denied any improper treatment on the part of the business’s dentists.

“The settlement agreement with the government does not relate to any claims regarding the quality of the dental care provided to patients. Importantly, the settlement does not include any admission or determination of wrongdoing by the companies, their employees or any Kool Smiles dentists. In fact, the companies strongly disagree with the government’s allegations.”

“The investigation largely focused on professional disagreements between qualified dentists in determining the appropriate level and cost of the care. For perspective, the government disagreed with the care provided in less than one percent of the procedures billed during the reviewed period,” said the spokesman, as quoted by the Courant.

Nevertheless, U.S. Attorney John H. Durham, of the District of Connecticut, issued a fiery condemnation of Kool Smiles supposed misdeeds.

“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.”

Sources

Dental Chain Will Pay $24M To Settle False Billing Claims Over Unnecessary Work On Children

Kool Smiles clinics paying $23.9 million settlement

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