Several former employees of a chain of dental clinics brought forward evidence that the clinics were performing unnecessary dental procedures on children and billing Medicaid for the services. The whistleblowers filed five lawsuits under the False Claims Act to recover taxpayer money that was fraudulently obtained through an allegedly unlawful incentive plan, according to a statement from the Department of Justice (DOJ).
The whistleblowers say that the dental management company essentially set up a quota scheme and associated incentive plan to increase the use of procedures and boost revenues. Dentists were rewarded for unnecessarily extracting teeth, performing baby root canal procedures, providing stainless steel caps for children, and providing other unnecessary dental procedures for children according to the lawsuit.
According to the DOJ, the dental management company also sought reimbursement from Medicaid for some baby root canals — also known as pulpotomies –that were never performed. Dentists who did not meet production expectations received discipline.
Exploiting Children To Increase Profits
The incentive program apparently was designed to produce more revenues, involving procedures performed on children that were unnecessary. John H. Durham, the U.S. Attorney for the District of Connecticut, noted in a press release that, “Exploiting needy children for financial gain is inexcusable.”
The government recently announced that the dental management company and 130 affiliated clinics in 17 different states agreed to settle the whistleblower claims for $23.9 million. The defendants deny liability in entering into the settlement.
The government says that dentists in the clinics complained about overutilization, complaints that the clinics ignored. Three individuals who brought the information forward and filed the whistleblower lawsuits under the False Claims Act will receive more than $2.4 million, according to the DOJ announcement.