Texas chain to pay $8.45M to settle Medicaid fraud case

The U.S. Department of Justice announced an $8.45 million Medicaid fraud case settlement with a Texas dental company and its affiliated practices.

Dental firm MB2 Dental Solutions and 19 pediatric dental practices affiliated with the company have agreed to pay the U.S. and the Texas Medicaid program to resolve Medicaid fraud allegations.

The case against the company alleged that for six years, from January 1, 2009, to December 31, 2014, the company and its affiliates submitted claims to the Texas Medicaid Fee for Service Program for single-surface fillings that were not provided, according to the U.S. Attorney's Office for the Northern District of Texas. The company's actions were revealed by a former employee.

The settlement also resolves allegations that the company did the following:

• Paid kickbacks to Medicaid beneficiaries and their families, marketers, and marketing entities, a violation of the Anti-Kickback Statute.
• Used erroneous Medicaid provider numbers misrepresenting the dentists performing the pediatric procedures.

The company has also agreed to enter a five-year corporate integrity agreement with the U.S. Department of Health and Human Services Office of Inspector General. This agreement means an independent review organization will assess each year whether the company's federally reimbursed claims were correctly coded, medically necessary, and appropriately documented.

Five dentists who are owners or part owners of the company and affiliated practices agreed to pay $250,000 each to resolve the claims against them individually. The company's head of marketing will pay $100,000 to resolve his alleged personal liability.