Dale G. Mayfield, DMD, resigned from the Georgia Board of Dentistry on January 23, at the request of Governor Nathan Deal.1 This action came in the immediate aftermath of the settlement between Kool Smiles Dental and its management company, Benevis, with the United States Department of Justice (USDOJ).2 Mayfield had served on the state’s dental regulatory board as an appointee of Deal since February 2016. He has been with Kool Smiles Dental since 2006 and serves there in the capacity of chief dental officer.
In the agreement between the USDOJ, Kool Smiles Dental, and Benevis, the defendants agreed to pay a settlement of $23.9 million. Acting Assistant Attorney General Chad A. Readler stated, “When healthcare providers put vulnerable patients at risk by performing medically unnecessary procedures to achieve financial goals, we will take action.”
The government’s case alleged Benevis and Kool Smiles Dental (multiple dental clinics located in 17 states) knowingly submitted false claims to state Medicaid programs for medically unnecessary pulpotomies (baby tooth root canals), tooth extractions, and stainless steel crowns, as well as services never provided. The defendants allegedly ignored their own doctors’ reports of overutilization of Medicaid services.
“The allegations in these cases are particularly egregious because they involved medically unnecessary dental services performed on children,” said US Attorney John H. Durham for the District of Connecticut. “Exploiting needy children for financial gain is inexcusable. The US Attorney’s Office in Connecticut is committed to aggressively pursuing healthcare providers that submit fraudulent claims to government healthcare programs.”
“Today’s settlement sends a very clear signal: Fraud in the federal healthcare system will not be tolerated,” said US Attorney John F. Bash for the Western District of Texas. “Especially when that fraud involves performing unnecessary procedures on kids—here, unnecessary baby root canals and tooth extractions, among other procedures—we will not hesitate to use every tool at our disposal to punish those who break the law.”
Kool Smiles Dental and Benevis issued a statement in disagreement with the government’s legal claims.3 “The companies are disappointed that reasonable disagreement between dentists can become a FCA [False Claims Act] 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 release further stated, “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 $23.9 million settlement of Benevis/Kool Smiles Dental is the second largest amount paid by a dental management Medicaid provider for alleged fraud, after the $24 million settlement between the USDOJ and FORBA Holdings (dba Small Smiles Dental).4 Both settlements share an anniversary approximately eight years apart.
Interestingly, Kool Smiles Dental founders Tu Tran, DDS, and Thien Pham, DDS, formerly worked for Small Smiles Dental, which has since dissolved into bankruptcy. This was precipitated by the US Health and Human Services Office of Inspector General (OIG) barring their participation in federal healthcare programs such as Medicaid.5
Daniel R. Levinson, Inspector General for the US Health and Human Services, stated relating to Small Smiles Dental in 2014, “This exclusion underscores our commitment to enforcing our integrity agreements designed to promote quality of care and protect patients in federal health care programs.”
Levinson said that this exclusion “makes clear to the provider community that OIG closely monitors our CIAs [corporate integrity agreements], critically evaluates providers’ representations and certifications, and will pursue exclusion actions against providers that fail to abide by their integrity agreement obligations.”
Mayfield not only serves as chief dental officer for Kool Smiles Dental headquartered in Georgia, but also is listed as a dentist in corporate online marketing for multiple Kool Smiles Dental clinics throughout Georgia6-8, Mississippi9-12, Indiana13-16, Texas17-21, Arizona22-23, and Oklahoma24. He maintains a valid dental license in each of these states, although it’s improbable he practices clinical dentistry for these multiple clinics in multiple states.
A search of public record National Provider Intentifier (NPI) numbers for Mayfield indicates his title as “president” for ownership of multiple Kool Smiles Dental clinics nationally.25 The same is true for Tran and for David Vieth, DDS, also listed as a Kool Smiles chief dental officer with online company data. Johnny Edwards, investigative reporter for the Atlanta Journal-Constitution, uncovered that “records filed with the Georgia Secretary of State’s office list him (Mayfield) as the CEO, CFO (chief financial officer) and secretary of a company called Kool Smiles PTC, PC, formed in 2007.”
Numbers of states have statues directly relating to the corporate practice of medicine and dentistry. In most cases, clinics must be owned and controlled by duly licensed and practicing professionals. Most states have laws designed specifically to prohibit the corporate practice of healthcare, as this is often viewed as contrary to the public interest. Determination of true beneficial dental clinic ownership and control can be a very cloudy issue, especially with a structure of multiple sandwiched corporations, and contract agreements stating one thing, but the effects of the contracts generating something entirely different.
Benevis, the management company for Kool Smiles Dental, is in the private equity portfolio of FFL Partners.26 FFL Partners began investing in Benevis in 2004, shortly after the founding of Kool Smiles Dental in 2002 by Tran and Pham. Both founders came to establish their initial children’s dental Medicaid clinic in East Lake, a neighborhood in Atlanta, and both came after working in the Small Smiles Dental clinic of “Smile High” in Denver, CO.27
1. Edwards J. Governor Forces Dentist off State Regulatory Board. The Atlanta-Journal Constitution, Jan 24, 2018; http://www.myajc.com/news/state–regional/governor-forces-dentist-off-state-regulatory-board/1zoc9hM2fmSQ66H0MGMMGL/
2. US Department of Justice. Dental Management Company Benevis and its Affiliated Kool Smiles Dental Clinics to Pay $23.9 Million to Settle False Claims Act Allegations Relating to Medically Unnecessary Pediatric Dental Services. Jan 10, 2018. https://www.justice.gov/opa/pr/dental-management-company-benevis-and-its-affiliated-kool-smiles-dental-clinics-pay-239
3. Benevis (press release). Statement Regarding Kool Smiles and Benevis Voluntary Settlement with U.S. Department of Justice. Jan 10, 2018. https://www.prnewswire.com/news-releases/statement-regarding-kool-smiles-and-benevis-voluntary-settlement-with-us-department-of-justice-300581064.html
4. US Department of Justice. National Dental Management Company Pays $24 Million to Resolve Fraud Allegations. Jan 20, 2010. https://www.justice.gov/opa/pr/national-dental-management-company-pays-24-million-resolve-fraud-allegations
5. US Health and Human Services-Office Inspector General. OIG Excludes Pediatric Dental Management Chain from Participation in Federal Health Care Programs. Apr 3, 2014; https://oig.hhs.gov/newsroom/news-releases/2014/cshm.asp
6. Kool Smiles of Decatur. General Dentists. https://www.mykoolsmiles.com/GA/dentist/Decatur
7. Kool Smiles of Forest Park. General Dentists. https://www.mykoolsmiles.com/GA/dentist/Atlanta-Forest-Park
8. Kool Smiles of College Park. General Dentists. https://www.mykoolsmiles.com/GA/dentist/Atlanta-College-Park
9. Kool Smiles of Jackson. General Dentists. https://www.mykoolsmiles.com/MS/dentist/jackson
10. Kool Smiles of Tupelo. General Dentists. https://www.mykoolsmiles.com/MS/dentist/tupelo
11. Kool Smiles of Hattiesburg. General Dentists. https://www.mykoolsmiles.com/MS/dentist/hattiesburg
12. Kool Smiles of Biloxi. General Dentists. https://www.mykoolsmiles.com/MS/dentist/Biloxi
13. Kool Smiles of Evansville. General Dentists. https://www.mykoolsmiles.com/IN/dentist/Evansville
14. Kool Smiles of Gary. General Dentists. https://www.mykoolsmiles.com/IN/dentist/gary-community-health-center
15. Kool Smiles of Highland. General Dentists. https://www.mykoolsmiles.com/IN/dentist/Highland
16. Kool Smiles of Terre Haute. General Dentists. https://www.mykoolsmiles.com/IN/dentist/Terre-Haute
17. Kool Smiles of Tyler. General Dentists. https://www.mykoolsmiles.com/TX/dentist/tyler
18. Kool Smiles of El Paso. General Dentists. https://www.mykoolsmiles.com/TX/dentist/El-Paso-Mesa
19. Kool Smiles of Abilene. General Dentists. https://www.mykoolsmiles.com/TX/dentist/abilene
20. Kool Smiles of Odessa. General Dentists. https://www.mykoolsmiles.com/TX/dentist/odessa
21. Kool Smiles of Lubbock. General Dentists. https://www.mykoolsmiles.com/TX/dentist/lubbock-50th-st-caprock
22. Kool Smiles of South Tucson. General Dentists. https://www.mykoolsmiles.com/AZ/dentist/south-tucson
23. Kool Smiles of Yuma. General Dentists. https://www.mykoolsmiles.com/AZ/dentist/yuma
24. Kool Smiles of Midwest City. General Dentists. https://www.mykoolsmiles.com/OK/dentist/midwest-city
25. Wikipedia. National Provider Identifier. https://en.wikipedia.org/wiki/National_Provider_Identifier
26. FFL Partners. Benevis. http://www.fflpartners.com/investments/benevis
27. Wikipedia. Kool Smiles. https://en.wikipedia.org/wiki/Kool_Smiles
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 Sante 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 email@example.com or smilesofsantefe.com.