Samson Dental Partners and ImmediaDent of Indiana have settled a whistleblower (qui tam) fraud case with the Department of Justice for $5.1 million with no admission of wrongdoing. The Medicaid fraud whistleblower, Dr. Jihaad Abdul-Majid, will receive $925,000 plus expenses.
ImediaDent operates nine dental care practices in Indiana. Samson Dental Partners, headquartered in Kansas City, Mo, provides administrative and other support services to ImmediaDent.
The US Justice Department and the Medicaid Fraud Control Unit of the Office of the Indiana Attorney General alleged that, between January 1, 2009, and September 30, 2013:
- Samson Dental Partners engaged in the corporate practice of dentistry in violation of Indiana state law by exerting obtrusive influences over ImmediaDent’s medical professionals and staff by rewarding production and disciplining for not meeting production objectives and directing personnel in a manner that compromised clinical judgment.
- Samson Dental Partners and ImmediaDent upcoded simple tooth extractions and improperly billed them as surgical extractions.
- Samson Dental Partners and ImmediaDent improperly billed for scaling and root planing (deep cleaning) when they were not performed or medically necessary.
This case is somewhat unique in that the alleged violations under Indiana false claims acts and federal false claims acts primarily involved adult Medicaid, not children’s Medicaid services. Often, fraud allegations will involve dental services never rendered, but billed for. Other cases involve allegations of excessive and/or needless service.
In 2010, for example, FOBRA Holdings agreed to pay the federal government and participating states $24 million plus interest to resolve allegations of unnecessary medical services insured by Medicaid, including pulpotomies, crown placement, anesthesia administration including nitrous oxide, extractions, and fillings and/or sealants.
In 2017, MB2 Dental Solutions and 21 pediatric dental practices affiliated with it agreed to pay the federal government and the State of Texas Medicaid program $8.45 million to resolve allegations that they upcoded preventive sealants and preventive resin restorations to definitive resin restorations, which require dental caries (tooth decay) into dentin, again usually billed on children.
And in January of 2018, Benevis and its Kool Smiles clinics agreed to pay the federal government and participating states $23.9 million plus interest to resolve allegations that they knowingly submitted false claims for payment to state Medicaid programs for medically unnecessary dental services such as pulpotomies, extractions, and stainless steel crowns performed on children insured by Medicaid.
As states expand dental Medicaid coverage to include adult beneficiaries, methods of attempting to defraud the Medicaid program will become ever more creative. Further, this particular legal action in Indiana included claims of the unlicensed and unlawful practice of dentistry by corporate management. Under most state statutes, unlicensed personnel may not lawfully direct clinical care.
Dr. Davis practices general dentistry in Santa Fe, NM. He assists as an expert witness in dental fraud and malpractice legal cases. He currently chairs the Santa Fe District Dental Society Peer-Review Committee and serves as a state dental association member to its house of delegates. He extensively writes and lectures on related matters. He may be reached at mwdavisdds@comcast.net or smilesofsantafe.com.
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