On January 20, 2010, the Department of Justice announced that it reached a settlement with FORBA Holdings, a dental management company that provides business management and administrative services to 69 dental clinics nationwide under the name Small Smiles Centers. Under the settlement agreement, FORBA agreed to pay the United States and participating states $24 million to resolve allegations that it caused bills to be submitted to state Medicaid programs for medically unnecessary dental services performed on children insured by Medicaid. The government alleged that FORBA was liable for causing the submission of claims for reimbursement for a number of different dental services provided to low-income children that were either medically unnecessary or were performed in a manner that failed to meet professionally recognized standards of care, including pulpotomies, placing crowns, administering anesthesia, performing extractions and providing fillings and/or sealants. In the Department of Justice press release, Assistant Attorney General for the Civil Division of the DOJ Tony West, stated “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 judgment of healthcare professionals and puts corporate profits ahead of patient safety.” The Department of Justice press release indicates that the investigation of the individual dentists involved is ongoing and that FORBA is cooperating with the investigation by providing information about dentists who may have violated professional standards. http://www.justice.gov/opa/pr/2010/January/10-civ-052.html

This case should serve as a reminder to providers that billing the Medicare or Medicaid programs for medically unnecessary services violates the False Claims Act. In addition, this case demonstrates that conduct involving particularly vulnerable populations, such as low-income children, is considered particularly egregious and will be prosecuted by the government.