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Dentists Bill Medicaid for Unnecessary Procedures on Children

A dental clinic called Kool Smiles with several locations across 17 states has been performing unnecessary baby root canals and tooth extractions on children and then billing Medicaid.

The Justice Department has reached a settlement of $23.9 million over the False Claims Act for Kool Smiles’ infractions. They state that Kool Smiles sent in false claims to Medicaid because they insisted that the procedures were necessary. They also found that the dentists gave children stainless steel crowns when they didn’t need them and charged for root canals that they didn’t do.

Kool Smiles has 130 offices across Arizona, Arkansas, Connecticut, Georgia, Indiana, Kentucky, Louisiana, Maryland, Massachusetts, Mississippi, New Mexico, Oklahoma, South Carolina, Texas, Virginia, and Washington, D.C. It’s been noted that people who take advantage of federal programs like Medicaid are the reason healthcare costs rise.

The culture of Kool Smiles led to number of procedures because it punished dentists who didn’t do enough in a given time frame. Dentists who didn’t do enough procedures were labeled unproductive and suffered financially. The productive dentists were rewarded with bonuses, so they had an incentive to perform more unnecessary procedures in the name of being a productive employee. Offices had scorecards to keep track of company goals and to make sure they were making enough money and doing enough procedures.

The settlement agreement showed that dentists from Kool Smiles made complaints about the procedures, but they were ignored. Three people who brought these issues to light will receive about $2.4 million dollars from the federal part of the settlement, which in total is $14 million. The states that Kool Smiles affected will get $10 million.

Now, Kool Smiles states that they’re committed to helping give people quality dental care in underserved communities. They say that without them, many people would go without dental care.

While it’s terrible that Kool Smiles took advantage of their patients, this settlement is sending a clear message to those who would commit fraud. Companies that break the law run the risk of being held accountable and they’ll have to face a major lawsuit, pay millions in damages, and lose consumer trust that could affect the company in the future. This might dissuade companies from fraudulently submitting claims and increasing the cost of healthcare.

If you or a loved one has been injured from someone else’s negligence, the Solomon Law Group can help. Get in touch with us today.

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