Whistleblower, a news program on the CBS television network, educated many viewers about fraud, waste, and abuse in our nation’s dental Medicaid program. Its initial investigative report focused on alleged healthcare fraud perpetrated on a national basis by Kool Smiles Dental, a chain of children’s dental Medicaid clinics.
A Pattern of Corruption
Benevis, which is Kool Smiles Dental’s management company, settled false claims allegations with the Department of Justice for $23.9 million in January of this year with no admission of wrongdoing. Kool Smiles Dental, part of the FFL Partners private equity portfolio, has grown to more than 120 clinics in 15 states and the District of Columbia despite alleged wrongdoing including the deaths of pediatric patients.
On June 25, 2018, President Trump signed the bipartisan Whistleblower Protection Coordination Act, which provides additional protections for whistleblowers who work with government authorities to expose fraud, waste, abuse, and corruption. Sponsor Senator Chuck Grassley (R-IA) also was a key author of the earlier Senate Joint Staff Report on the Corporate Practice of Dentistry in the Medicaid Program of July 2013.
The Senate report highlighted a year-long investigation of corporate dental clinics allegedly abusing and defrauding the Medicaid program. Children allegedly were mistreated, and unlicensed corporate management made clinical decisions instead of doctors. The report also specifically investigated Kool Smiles Dental as well as other large-scale clinical operations.
Other corporate dental chains and management companies such as FORBA Holdings, Ocean Dental, and MB2 Dental Solutions that focus on Medicaid patients also have settled with the Department of Justice over allegations of defrauding taxpayers. But unlike these cases, the Kool Smiles settlement didn’t require enforcement of a corporate integrity agreement (CIA).
The Health and Human Services Office of Inspector General (HHS-OIG) will generally provide oversight in cases of settlement for False Claims Act violations. A CIA usually is imposed for a five-year period. In exchange for non-exclusion from government programs, the alleged violating party agrees to:
- hire a compliance officer or committee;
- develop written policies and standards;
- implement a comprehensive employee training program;
- retain an annual independent review organization;
- establish a confidential disclosure program;
- restrict employment of ineligible persons;
- report overpayments;
- report relevant events and investigations including legal proceedings;
- provide the HHS-OIG annual and ongoing reports on implementation and compliance.
Obviously, CIA compliance is both costly and time consuming.
The Kool Smiles Dental settlement also didn’t see any nondisclosure agreements signed by the relators, who are the parties other than the plaintiffs upon whose information, knowledge, and relation of facts are brought forth by the government in the legal action. In other words, the relators are the whistleblowers. Thus, the relators in the Kool Smiles Dental action were free to discuss the case and their experiences. For example, former Kool Smiles Dental dentists and relators Dr. Poonam Rai and Dr. Michael “Mick” Greenwald were featured on Whistleblowers.
Greenwald and relator and former Kool Smiles Dental office manager Robin Fitzgerald also have spoken with Dentistry Today. “Dr. Mick,” as his patients often call him, now has a private practice in Connecticut. Fitzgerald has left the dental field and continues to live in Texas. During these discussions, Greenwald expressed his concern about the vulnerabilities of recent dental graduates.
“[They] graduate from dental school, get wooed by an enticing offer to immediately start making huge sums of money. [Recent grads] get brainwashed by slick upper-level management that ‘this is how you do it in the real world’ and convinced that ‘prophylactic restorations,’ pulpotomies, and crowns are in the patients’ best interest,” Greenwald said.
Greenwald also said that “prophylactic restorations” were dishonest and unethical services for restoring teeth that have stains or deep grooves and pits but no actual dental caries. He further explained that “crowns” are stainless stell crowns that too often are placed on teeth that are nearly ready to exfoliate or on teeth demonstrating minimal to no dental caries. And, he’s worried about corporate dentistry’s abuse and indoctrination of junior colleagues.
“[They are] tethered to weekly production goals and bonuses. They have penalties hung over their heads for not hitting those goals. They’re never taught to ‘cultivate your garden,’ meaning developing a professional relationship with their patients,” Greenwald said.
“They work in a culture where the end justifies the means and have a belief system that grows into one of apathy, selfishness, and greed. You have the makings of a successful pawn to a machine whose mantra is purely production at whatever cost, most likely leaning towards gray area judgement to downright fraud,” Greenwald said, also elaborating on what it takes to be a whistleblower.
“One requires the experience and insight to recognize fraud. Have the self-respect, empathy, and duty to stand up against economic fraud and what essentially constitutes assault and battery, greed, plain old stupidity, as well as theft from every taxpaying citizen, and you have a whistleblower,” Greenwald said.
“You have a duty to the patient, the taxpayer, the profession, and yourself to not sit on the sidelines and watch the trainwreck, but rather stand up for victims. There is a greater good, and each and every one of us has a responsibility in some way to be active, ethical members in society in one way or another, be it helping someone get that can of beans off the shelf that is out of their reach in the supermarket, being a role model for your children, going the extra mile for a patient who can’t afford that fee ‘written in stone,’ as well as knowing right from wrong and doing something about it,” Greenwald said.
Fitzgerald once truly believed she could make a difference from the inside of Kool Smiles Dental and create positive change from that vantage. Today, she’s fully disillusioned.
“I feel very frustrated that Kool Smiles continues operating the same way they always have. In fact, it’s worse now. There are pediatric dentists, anesthestiologists, and orthodontists. A simple slap on the wrist is certainly not the outcome I expected,” she said, adding that she has documentation that she wants to share but is fearful of company retaliation. Noting that a corporate compliance plan wasn’t even put in place, she feels that her whistleblowing did not have a positive impact.
“I would like to speak with Congress regarding this issue, in particular, Senator Grassley, as he was simply flat out lied to by Kool Smiles, and I have the documents to share to prove it,” Fitzgerald said.
“A good whistleblower is credible and provides the government with inside information—preferably documented with emails, memos, reports, and/or records—that would help to prove the fraud at issue,” said Tom Carson, spokesperson for the US Attorney’s Office for Connecticut.
In the settlement agreement between the Department of Justice and Benevis, doing business as Kool Smiles Dental, the public got a rare glimpse at dental whistleblowers because non-disclosure agreements weren’t a requirement at settlement. These citizens can face enormous stress because the legal cases usually go on for years.
They also may be threatened by management. They may be blackballed by their respective industries or professions. They generally face serious loss of income. Former friends and colleagues may reject and shun them. Whistleblowers, then, represent true American heroes who serve the public welfare.
“I’ve been asking every president since Ronald Reagan to hold a Rose Garden ceremony to honor these brave men and women. Not a single one of them has taken me up on it,” said Grassley.
“Just think about it. Tens of billions of dollars in funds lost to fraud and corruption have been recovered,” Grassley continued. “Untold amounts of government waste and misconduct have been exposed. It’s all because of the whistleblowers.”
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 Santa 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 smilesofsantafe.com.
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