For those of you who would rather run a marathon seven days a week vs going to a dentist...........
If you would like more info, Prime Video has a, "whistleblower" series.
Kool Smiles whistleblower cases, there was a significant federal investigation involving former Kool Smiles employees and dentists.
- In January 2018, the U.S. Department of Justice announced that Benevis and more than 130 affiliated Kool Smiles clinics agreed to pay $23.9 million to resolve False Claims Act allegations involving Medicaid billing. (Department of Justice)
- The government alleged that, from 2009–2011, clinics submitted claims for medically unnecessary pediatric dental procedures, including pulpotomies, extractions and stainless-steel crowns, and in some cases billed for procedures allegedly never performed. (Department of Justice)
- The investigation was initiated by five whistleblower/qui tam lawsuits. Three former Kool Smiles employees—Adam Abendano, Poonam Rai, and Robin Fitzgerald—received more than $2.4 million collectively from the federal share of the settlement. (Department of Justice)
- The government also alleged that dentists were pressured through production targets, discipline, and cash bonuses tied to revenue, and that complaints about overutilization were ignored. (Department of Justice)
- Separately, a Kool Smiles dentist in Texas, Tuan “Terry” Truong, pleaded guilty to making false patient-record entries that resulted in Medicaid being billed for procedures he had not performed. He was sentenced to 18 months in federal prison. (Department of Justice)
An important legal distinction: the $23.9 million settlement resolved allegations; Benevis and Kool Smiles did not admit liability in that civil settlement. (Department of Justice)
