Kool Smiles, a national chain of dental clinics located in 17 states, and Benevis, a company which provides billing support services for the chain, have agreed to pay $23.9 million to settle a whistleblower-initiated False Claims Act case alleging the company submitted false Medicaid claims for “medically unnecessary” procedures performed on children. Relators alleged that the improper billings included root canals on baby teeth, tooth extractions, stainless steel crowns, and root canal procedures that were never done.
They charged Kool Smiles with awarding “productive” dentists with cash bonuses based on revenue gained from costly dental procedures, while disciplining “unproductive” dentists for not billing enough. According to relators’ complaint, one five year old child underwent 12 pulpotomies and received crowns on 20 teeth over a two day period, and another child received 11 crowns in a single day. This is the second largest False Claims Act whistleblower recovery against a dental provider in U.S. history.