Kool Smiles to pay $23.9M in DOJ settlement for performing ‘medically unnecessary’ procedures on children: 5 insights


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Atlanta-based Kool Smiles agreed to pay $23.9 million in a settlement with the Department of Justice for allegedly submitting false Medicaid claims, according to Frontline.

Here are five insights:

1. The false Medicaid claims were allegedly for “medically unnecessary” procedures on children, including infant root canals, tooth extractions and stainless steel crowns. The DOJ also alleges Kool Smiles filed claims for root canals that were never performed.

2. Kool Smiles is accused of allegedly filing false Medicaid claims between January 2009 and December 2011 throughout the 17 states the dental group has clinics located in.

3. The DOJ accused Kool Smiles of developing a payment method that allegedly awarded dentists based on revenue gained while punishing dentists who were seen as “unproductive.”

4. More than 130 affiliated Kool Smiles clinics will pay more than $14 million to the federal government and more than $9 million to the states Medicaid programs.

5. Kool Smiles continues to deny the allegations. The dental group argued the government reimbursed their Medicaid patients less than other providers.

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