August 31, 2012 — In 2010, the Small Smiles dental chain, owned by Church Street Health Management, settled government claims of dental Medicaid fraud for $24 million. Of that total settlement, $3.45 million went to the state of New York. The legal problems were not over for Small Smiles clinics in New York, however.
Families Accuse Small Smiles of Causing Emotional Nightmare for Sake of Dental Medicaid Fraud.
In 2011, a group of parents filed suit on behalf of their children who had been treated in New York Small Smiles dental clinics. The parents accused the New York clinics and their dentists of performing unnecessary, unsafe, and abusive treatments on their children between 2005 and 2009, so that their children have suffered an emotional nightmare. The defendants asked a New York judge to dismiss the lawsuits, arguing that the claims did not meet the appropriate legal standards.
According to Dr. Bicuspid, the judge has refused to dismiss the families’ claims, including claims for punitive damages. Although malpractice lawsuits normally do not include claims for punitive damages, the judge noted that the dentists’ actions amounted to “more than just malpractice.” The Small Smiles culture allegedly put revenue generation above quality dental treatment and patient well-being. The families also made a credible claim for battery because it appears that the dentists intended harmful contact with the children as part of the alleged rapid-revenue-generation scheme.
Small Smiles’ revenue generating efforts allegedly were targeted at maximizing Medicaid billing at the expense of young Medicaid beneficiaries. Of Small Smiles’ $161 million in revenues for 2011, over 90 percent came from the Medicaid program and the state Children’s Health Insurance Program. It seems that the children of poor families turned into cash cows for Small Smiles and other dental clinics.
Streamlining care was critical to maximizing billing, and so Small Smiles employees allegedly restrained children to speed up their treatment and convinced many families that it was the safer alternative to sedation. The parents now argue that their children are left with the fallout of an emotional nightmare that interferes with their ongoing medical care.
Whistleblowers Can Make a Difference and Stop Dental Medicaid Fraud.
Claims of dental Medicaid fraud have proliferated recently against dental chains like Small Smiles. These chains allegedly performed unnecessary, painful, and excessive dental treatments on children, sometimes restraining them to speed up treatment and maximize billings. Thousands of poor children across the country are believed to have been touched by this scandal. In the parents’ lawsuits, they assert that their children were treated by Small Smiles clinics between 2005 and 2009.
What could have stopped the allegedly dental Medicaid fraud sooner? What could have prevented the alleged abuse of at least some of these children? Stopping fraud in its early stages can be especially difficult without the help of a whistleblower. Someone with inside information on alleged fraud can focus governmental attention on suspicious activities long before the fraud would otherwise be apparent to federal authorities.
Because of their important role in helping fight dental Medicaid fraud, the False Claims Act’s qui tam provisions allow a whistleblower to file a lawsuit against wrongdoers on behalf of the government. The whistleblower is then entitled to a portion of the government’s recovery, if any.