Relator Fees and Settlements by Dentists and Dental Clinics

In January of 2018, Benevis LLC and more than 130 of its affiliated Kool Smiles dental clinics agreed to settle with the United States and participating states for a total a total of $23.9 million to resolve allegations that they knowingly submitted false claims for payment to state Medicaid programs for medically unnecessary dental services performed on children insured by Medicaid. The United States alleged that the Kool Smiles clinics located throughout 17 states knowingly 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.  See DOJ Press Release dated January 10, 2018.

In January of 2017, the three Whistleblowers (including two represented by Attorney Rusty Tucker) received $1,521,000 of the settlement proceeds when MB2 and other Defendants agreed to pay the United States and the State of Texas $8.45 million for alleged violations of the federal False Claims Act (FCA) and the Texas Medicaid Fraud Prevention Act (TMFPA). Three lawsuits were resolved (including two lawsuits where Attorney Rusty Tucker was the attorney for the Whistleblowers) with this settlement alleging that MB2 knowingly submitted claims for children’s dental services which were either not performed or were provided after false identification was used. The claims also involved illegal kickbacks to Medicaid beneficiaries and their families, marketers and marketing entities. See Texas Attorney General Press Release dated January 12, 2017.

In June of 2016, four dental clinics of the Texas Smile Magic chain agreed to settle Medicaid Fraud charges for a total of $4.5 million. It was alleged that Smile Magic defrauded the Texas Medicaid program by performing unnecessary or excessive dental services on young children, billed Medicaid for dental services never-performed, targeted young Medicaid beneficiaries through improper financial incentives, and used paid recruiters to round up poor kids to be used to commit Medicaid fraud. Attorney Rusty Tucker was the attorney for the Whistleblower who received a majority of the Whistleblower award.

In January of 2015, a community health center agreed to pay $3.35 million to the State of Washington to settle claims that it overbilled Medicaid for thousands of dental appointments.  The Washington Attorney General contended that between 2010 and 2014, the health center billed fluoride treatment, which can be performed by an assistant as part of a patient’s regular six-month checkup, as a stand-alone appointment with a dentist or hygienist.  In addition, the health center also allegedly billed for appointments that exceeded the number of exams allowed per patient under Medicaid. See Press Release, Office of the Attorney General, State of Washington, Sea Mar Health Centers to Pay $3.35 Million in Attorney General’s Office Investigation of Improper Billing (Jan. 16, 2015).

In March of 2012, All Smiles Dental Center, Inc. and its former majority owner, Richard Malouf, D.D.S. (collectively “All Smiles”), agreed to pay the U.S. and State of Texas $1.2 million to resolve allegations that they violated the civil False Claims Act and Texas Medicaid Fraud Prevention Act, announced U.S. Attorney Sarah R. Saldaña of the Northern District of Texas. The U.S. and Texas contend All Smiles caused “unbundled” and other improper claims to be submitted to the Texas Medicaid program for orthodontic-related items and services between 2004 and 2007. See Press Release March 21, 2012, U.S. Attorney U.S. District Court for the Northern District of Texas.