Management Company Pays $24 Million to Resolve Fraud Allegations
MD ( January 21, 2010) - Attorney General Douglas
F. Gansler announced today that Maryland has joined 22 other
states and the federal government to settle allegations against
FORBA Holdings, LLC., a dental management company that provided
management services to Small Smiles dental clinics nationwide.
Under the agreement, FORBA agreed to pay the participating
states and the federal government $24 million, plus interest,
to resolve allegations that it caused bills to be submitted
to state Medicaid programs for medically unnecessary dental
services performed on children insured by Medicaid. Medicaid
is funded jointly by the federal and state governments.
Maryland alleged that FORBA was liable for causing the submission of claims for
reimbursement for a wide range of dental services provided to low-income children
that were either medically unnecessary or performed in a manner that failed to
meet professionally-recognized standards of care. These services included performing
pulpotomies (baby root canals) and extractions, placing crowns, administering
anesthesia, providing fillings and/or sealants, and inappropriately using behavior
management techniques to restrain child patients.
of the recovery is $547,423. As part of the settlement, FORBA
has agreed to enter into an expansive
five-year Corporate Integrity Agreement with the Office of Inspector
General of the Department of Health and Human Services that requires
the implementation of new procedures and independent reviews. Specifically,
FORBA must engage external reviewers to monitor its quality of
care and reimbursement. In addition, the Chief Dental Officer must
develop and implement policies and procedures to ensure that the
Small Smiles clinics provide services consistent with professionally
recognized standards of care.
The investigation was initiated by three whistleblower lawsuits filed under
the qui tam provisions of the False Claims Act. These actions are pending in
the United States District Court for the District of Maryland, the Western
District of Virginia, and the District of 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. Attorney General Gansler would like
to thank Investigator Valerie Puig for her work on this case.