May 2, 2014 — Both houses of Congress are now focused on dental Medicaid fraud and the drain it places on the federal coffers. Many inside employees are in an ideal position to help, but they may be completely unaware of their power to stop billing fraud schemes against the government. When whistleblowers bring a lawsuit against unethical dental management companies under the qui tam provisions of the federal False Claims Act, they may be eligible to receive to a significant portion of the government’s recovery.
Government Cites CSHM With Numerous Violations Involving Dental Quality of Care
CSHM, which runs 53 Small Smiles dental clinics in 19 states and the District of Columbia, will be ineligible to participate in Medicare and Medicaid for at least five years, the Office of the Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS) has announced. In an April 1, 2014 Exclusion Agreement, CSHM consented to the exclusion, waiving the right to appeal. The exclusion will begin on September 30, 2014.
CSHM has been cited with a number of violations, including the following:
- Failing to report events involving serious quality of care issues;
- Failing to keep disclosure logs that would allow the identification of practices involving a potential violation of law;
- Failing to create or enforce policies to inform parents when a patient is harmed; and
- Failing to implement a review process that requires participation from the chief dental officer, regional dentist or chief compliance officer.
The OIG’s action reportedly came swiftly on the heels of its recent criticism from congressional representatives who claimed that OIG had not taken action against clinics engaging in dental Medicaid fraud. A two-year Senate investigation had alleged that the Small Smiles chain of clinics made a practice of boosting company profits by performing unnecessary procedures on patients, often Medicaid eligible children.
Even so, the OIG’s Exclusion Agreement, applies only to CSHM, the management company that operates the Small Smiles dental clinics. The Agreement does not exclude the dental clinics or individual employees from participating in federally funded health care programs.
Dental Management Company Employees Collaborate to Stop Dental Medicaid Fraud
State Medicaid programs across the nation have been plagued with issues like those found at the Small Smiles chain of dental clinics. The qui tam lawyers at Waters & Kraus know how to work with state officials to put a stop to fraudulent billing schemes against Medicaid. Contact us by email or call 855.784.0268 to speak with a whistleblower lawyer about how you can help to protect Medicaid for those who need it.
