Pediatric Medicaid Fraud Settlement
According to the Department of Justice, The United States settled False Claims Act allegations against FORBA Holdings LLC, the parent company of the pediatric dentistry chain, Small Smiles Dental Centers.
Forba manages 69 clinics in 22 states serving over 500,000 children of low-income families.
The Tennessee-based Forba corporation agreed to pay $24 million (plus interest) to the federal government and 22 states to resolve allegations that it submitted fraudulent bills to state Medicaid programs for medically unnecessary services for kids such as “baby root canals.”
As outlined in a DOJ Press Release, the government’s investigation was initiated by three whistle-blower lawsuits by private citizens, provisions of the False Claims Act enabling private parties to sue on behalf of the USA and share in any financial recovery.
Daniel R. Levinson, Inspector General of the U.S. Department of Health and Human Services said, “We will not tolerate Medicaid providers who prey on vulnerable children and seek unjust enrichment at taxpayers’ expense.”
Tony West, Assistant Attorney General for the Civil Division of the Department of Justice added, “We have zero tolerance for those who break the law to exploit needy children. Illegal conduct like this endangers a child’s well-being, distorts the judgments of health care professionals, and puts corporate profits ahead of patient safety.”
Forba Chairman and CEO Michael Lindley issued a statement:
“Today the federal government, in coordination with 21 states and the District of Columbia, announced a settlement with FORBA that is the result of months of collaboration between our company and its regulators. It encourages us to remain the nation’s premier provider of dental care for low-income children across the nation and is a historic agreement, which brings a conclusion to the investigation of our services at both the state and federal levels.”
“Despite implications to the contrary in the government’s press release, we entered into the settlement to avoid the delay, uncertainty, inconvenience and expense of litigation, and did not admit any liability.”
“It also allows us to stay focused on children’s oral health, proceed with plans for growth and continue to expand access to care for communities across the country.”
Timothy J. Heaphy, U.S. Attorney for the Western District of Virginia remarked, “In this case, FORBA put greed and profits before the well-being of children. It endangered the health and safety of innocent children and defrauded the taxpayer of millions of dollars. Today’s settlement addresses these egregious acts and sends a clear message that Medicaid fraud will be expeditiously addressed by this Department.”
The Justice Department’s total recoveries in False Claims Act cases since January 2009 have topped $3 billion.
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