Member Article

In the last quarter of 2018, the Office of the Inspector General (OIG) announced that ImmediaDent of Indiana, LLC (ImmediaDent), which operates nine dental care practices, and Samson Dental Partners, LLC (SDP), which provides administrative support to Immediadent, have agreed to pay the United States and the state of Indiana $5.1 million to resolve allegations that they improperly billed Indiana’s Medicaid program.

The companies are accused of submitting false claims for payment to Indiana’s Medicaid program by (1) improperly billing simple tooth extractions as though they were surgical extractions and (2) improperly billing deep cleanings that were either not performed or not medically necessary.

This enforcement action follows a pattern of increasing actions against dental practices. This year, Benevis, LLC (Benevis), a dental management company, and its affiliated clinics, Kool Smiles Dental Clinics (Kool Smiles), paid the United States and participating states $23.9 million to resolve allegations they were billing Medicaid for unnecessary services performed. Also this year, a dentist in Los Angeles was indicted for an alleged health care fraud and identity theft scheme. The indictment included allegations that the dentist had billed Medicaid-funded Denti-Cal for dental procedures that were never performed. Additionally, late last year, a dentist in Upper Manhattan was indicted, in part, for also billing Medicaid for services that were never performed.

Even though dental practices have not historically been the subject of many enforcement actions, the federal government’s priority to hold accountable all health care entities acting outside the law has been made clear. In OIG’s announcement regarding the action against ImmediaDent and SDP, United States Attorney Russell M. Coleman was quoted as saying, “[l]et this be a warning to health care organizations that the United States government is watching, and will continue to watch for false claims no matter how large or small . . . The United States Attorney’s office is protecting the taxpayers’ dollars every day with the help of our state and local partners.”

Dental practices should heed these warnings and ensure their billing practices comply with state and federal law. Should you have questions concerning these enforcement actions or your practice’s billing protocols, please contact a member of Dinsmore’s Health Care Practice Group.¹

¹ All of the mentioned announcements regarding enforcement actions may be found at the following links:

ImmediaDent and SDP: https://www.justice.gov/usao-wdky/pr/51-million-dollar-settlement-reached-indiana-dental-firm-resolve-false-claims

Benevis and Kool Smiles: https://www.justice.gov/opa/pr/dental-management-company-benevis-and-its-affiliated-kool-smiles-dental-clinics-pay-239

Los Angeles Dentist: https://www.justice.gov/opa/pr/los-angeles-dentist-charged-health-care-fraud-scheme

Upper Manhattan Dentist: https://www.justice.gov/usao-sdny/pr/dentist-and-others-charged-medicaid-health-care-fraud-scheme-upper-manhattan-dental