Office of the Attorney General
Dental Management Company Pays $24 Million in National Settlement over Fraud Allegations
Attorney General Jack Conway today announced that Kentucky has joined 22 other states and the federal government to settle allegations against FORBA Holdings, LLC., a dental management company that provided management services to Small Smiles dental clinics nationwide. FORBA manages one dental clinic in Kentucky, Small Smiles of Louisville, P.S.C.
Under the agreement, FORBA agreed to pay the participating states and the federal government $24 million, plus interest, to resolve allegations that it caused bills to be submitted to these state’s Medicaid programs for medically unnecessary dental services performed on children insured by Medicaid. Medicaid is funded jointly by the federal and state governments. Kentucky’s total portion of the recovery is $123,693.14, of which approximately $44,000 goes to reimburse the state’s Medicaid program.
General Conway’s office, along with other attorneys general and the Department of Justice, alleged that FORBA was liable for causing the submission of claims for reimbursement for a wide range of dental services provided to low-income children that were either medically unnecessary or performed in a manner that failed to meet professionally-recognized standards of care. These services included performing pulpotomies (baby root canals), placing crowns, administering anesthesia (including nitrous oxide), performing extractions, providing fillings and/or sealants and inappropriately using behavior management techniques to restrain child patients.
In addition, as part of the settlement, FORBA has agreed to enter into an expansive five-year Corporate Integrity Agreement with the Office of Inspector General of the Department of Health and Human Services. The agreement provides for procedures and reviews to be put in place to avoid and promptly detect conduct similar to that which gave rise to this matter. Specifically, FORBA must engage external reviewers to monitor its quality of care and reimbursement. In addition, the chief dental officer must develop and implement policies and procedures to ensure that the Small Smiles clinics provide services consistent with professionally recognized standards of care.
The investigation was initiated by three whistleblower lawsuits filed under the qui tam provisions of the False Claims Act. These actions are pending in the United States District Court for the District of Maryland, the Western District of Virginia, and the District of South Carolina.