The Medicaid Dental Center, a privately owned chain of dental clinics in North Carolina formerly known as Smile Starters and Carolina Dental Center, will pay more than $10 million to resolve allegations that it fraudulently billed the North Carolina Medicaid program for unnecessary dental services performed on indigent children.
The government has alleged that MDC and its ownership, including Michael A. DeRose and Letitia L. Ballance, are liable under the False Claims Act for submitting claims for reimbursement for performing pulpotomies that were not medically necessary.
Pulpotomies are only necessary in pediatric dental cases when an infection in a tooth spreads into the pulp chamber of the tooth, requiring the pulp's removal. This procedure is often referred to as a "baby root canal."
According the U.S. Department of Justice, MDC also submitted claims for reimbursement for placing stainless steel crowns that were not necessary and for failing to obtain informed consent for all medical procedures and services.
The settlement is limited to claims submitted to the North Carolina Medicaid program and does not involve any other states.
"These dentists subjected their child patients to invasive and sometimes painful procedures, often for the sake of obtaining money from the North Carolina Medicaid program," said Jeffrey S. Bucholtz, the acting Assistant Attorney General for the department's civil division.
Under consent orders filed with the North Carolina Board of Dental Examiners, each of the dentists agreed not to contest allegations. And as part of the settlement, the Office of Inspector General for the U.S. Department of Health and Human Services has expressly reserved its exclusion authority against MDC, DeRose and Ballance.
"Healthcare professionals who abuse their positions and engage in excessive treatment regimens and excessive billing practices will not be tolerated," said Gretchen C.F. Shappert, U.S. Attorney for the Western District of North Carolina. "The North Carolina Medicaid Program was not created for self-enrichment. It is a public trust. Individuals who use their professional skills to take advantage of that trust will be investigated and held to account for their actions."