Pediatric dental management company settles with 23 states.  Texas Attorney General Greg Abbott resolved a civil Medicaid fraud investigation into dental management company FORBA Holdings, LLC. Under the $24 million multi-state settlement agreement, the attorney general recovered $546,000, including $214,588 that will be returned to the state treasury.

According to state investigators, FORBA operates a management company that handles billing and related services for dental practices. One of its primary clients is Small Smiles, which has pediatric dental clinics across the country. The states’ investigation into FORBA revealed that the defendant improperly billed Medicaid programs for pediatric dental treatments that were not medically necessary. Because FORBA submitted Small Smiles’ reimbursement claims, it is financially responsible when its clients charged the taxpayers for non-reimbursable services. The Medicaid-funded reimbursements at issue covered a range of dental services for low-income children that were either unnecessary or performed in a manner that did not conform to recognized standards of care. These treatments included baby root canals, crown placements, administering anesthesia – which included nitrous oxide – and performing tooth extractions, fillings and sealants.

Under the settlement, FORBA consented to a five-year corporate integrity agreement with the Office of the Inspector General of the U.S. Department of Health and Human Services. The agreement provides for the implementation of a quality-control program that will promptly detect unlawful conduct in the future. In addition, external reviewers will monitor FORBA’s quality of care and methods of reimbursement. Small Smiles clinics will also improve services consistent with recognized standards of care.

The states’ investigation stemmed from three whistleblower lawsuits that were filed under the federal False Claims Act. These legal actions are pending in federal courts in Maryland, Virginia and South Carolina.

A team representing the National Association of Medicaid Fraud Control Units participated in the investigation and conducted settlement negotiations with FORBA on behalf of the settling states.