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Kool Smiles agrees to pay $24 million to settle false claims allegations

Kool Smiles.jpg

A chain of dental clinics has agreed to pay about $24 million in civil penalties to settle allegations that it submitted Medicaid claims for unnecessary dental procedures on children.

A U.S. Justice Department statement Wednesday said the federal government would receive more than $14 million of the settlement reached by Marietta, Georgia-based Benevix LLC and its Kool Smiles clinics. Texas and 16 other states will share almost $10 million, and three whistleblowers will share more than $2.4 million of the settlement.

Federal prosecutors accused Benevis and Kool Smiles of performing the medically unnecessary procedures on children between January 2009 and December 2011.

The federal investigation was triggered by five lawsuits filed by would-be whistleblowers in Connecticut and West Texas.

Kool Smiles has a location on South 14th Street in Abilene.

Kool Smiles, in response to a KTXS request, issued the following statement:

Benevis, and its affiliate Kool Smiles, have voluntarily entered into a settlement with the U.S. Department of Justice (DOJ) and various State Attorneys’ General to end the government’s seven-year long False Claims Act (FCA) investigation relating to services provided from 2009 to 2011.

The settlement agreement with the government does not relate to any claims regarding the quality of the dental care provided to patients. Importantly, the settlement does not include any admission or determination of wrongdoing by the companies, their employees or any Kool Smiles dentists. In fact, the companies strongly disagree with the government’s allegations.

The investigation largely focused on professional disagreements between qualified dentists in determining the appropriate level and cost of the care. For perspective, the government disagreed with the care provided in less than one percent of the procedures billed during the reviewed period.

The government’s own data, as well as independent, third-party research and analysis conducted by experts, disprove the allegations. A recent study by respected healthcare economists Dobson DaVanzo & Associates found Kool Smiles dentists provided fewer total dental services per Medicaid patient than non-Kool Smiles providers. It also found this resulted in the government paying significantly less per Medicaid patient for dental services provided by Kool Smiles dentists than it pays for Medicaid patients treated by non-Kool Smiles dentists.

The companies are disappointed that reasonable disagreement between dentists can become a FCA case. However, given the seven years and significant expense already incurred, as well as the anticipated additional time and expense associated with lengthy litigation, the companies believe putting this matter behind them was the best option for their dentists, team members and the patients they serve.

The companies have complete confidence in Kool Smiles dentists and the quality and level of care they provide, and are proud to support the ongoing work of Kool Smiles dentists as leading providers of dental care for underserved communities nationwide.

Since 2002, Kool Smiles has been serving underserved communities, and today Kool Smiles provides needed dental care through more than two million patient visits per year, many of whom would not otherwise have access to dental care. In addition, Kool Smiles dentists have provided more than $128 million in uncompensated dental care to treat patients and families who did not have access to Medicaid dental benefits or other dental insurance, and could not afford to pay. The companies will continue to work toward expanding access to quality dental care for all families.


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