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DOJ: Kool Smiles dental clinics to pay $23.9 million, allegedly submitted false claims

Posted at 11:25 AM, Jan 10, 2018

A national dental chain linked to two child deaths in Arizona will have to pay nearly $24 million to the United States government and 17 states for allegedly submitting false claims to state Medicaid programs.

DOJ officials announced Wednesday that the agency has settled False Claims Act allegations against dental company Benevis LLC and more than 130 affiliated Kool Smiles dental clinics. 

The DOJ alleged that between January 2009 and December 2011, Kool Smiles clinics in 17 states knowingly submitted false claims for unnecessary baby root canals, tooth extractions and stainless steel crowns. 

"Billing Medicaid programs for dental procedures that are not necessary contributes to the soaring costs of healthcare," said Acting Assistant Attorney General Chad A. Readler. "When healthcare providers put vulnerable patients at risk by performing medically unnecessary procedures to achieve financial goals, we will take action."

ABC15 has actively been looking into Kool Smiles in Arizona, and has discovered two deaths tied to procedures performed at the Yuma office. The deaths are not connected to Wednesday’s settlement. 

ABC15 first told you about Zion Jay Gastelum earlier this month, after the 2-year-old died following a visit to Kool Smiles in Yuma.

Zion's uncle told ABC15 the child's parents took him to Kool Smiles on December 16, 2017 for a crown and filling, and somehow either during or after the process, it appears Zion stopped breathing.  

According to family, Zion was transported to Yuma Regional Medical Center and then flown to Maricopa County, where he died several days later. 

ABC15 confirmed the Maricopa County Medical Examiner's Office is handling the case and the cause and manner of death remain pending. 

A second death linked to the same dental office was also uncovered. 

Francisca Lares, the mother of 4-year old Lizeth Lares, says her child died after a dental procedure in February of 2016.

According to the family, the four-year-old girl went into Kool Smiles for dental treatment to deal with an abscess, a tooth was pulled, and then she started showing signs of fever. 

The family took her back to the dentist the next day, but was sent home, and reportedly told that the girl would be fine.

According to court papers, the child died a few days later. 

Benevis released the following statement to ABC15: "Benevis, and its affiliate Kool Smiles, have voluntarily entered into a settlement with the U.S. Department of Justice (DOJ) and various State Attorneys' General to end the government's seven-year long False Claims Act (FCA) investigation relating to services provided from 2009 to 2011.  

The settlement agreement with the government does not relate to any claims regarding the quality of the dental care provided to patients. Importantly, the settlement does not include any admission or determination of wrongdoing by the companies, their employees or any Kool Smiles dentists.  In fact, the companies strongly disagree with the government's allegations. 

The investigation largely focused on professional disagreements between qualified dentists in determining the appropriate level and cost of the care.  For perspective, the government disagreed with the care provided in less than one percent of the procedures billed during the reviewed period. 

The government's own data, as well as independent, third-party research and analysis conducted by experts, disprove the allegations. A recent study by respected healthcare economists Dobson DaVanzo & Associates found Kool Smiles dentists provided fewer total dental services per Medicaid patient than non-Kool Smiles providers. It also found this resulted in the government paying significantly less per Medicaid patient for dental services provided by Kool Smiles dentists than it pays for Medicaid patients treated by non-Kool Smiles dentists.

The companies are disappointed that reasonable disagreement between dentists can become a FCA case.  However, given the seven years and significant expense already incurred, as well as the anticipated additional time and expense associated with lengthy litigation, the companies believe putting this matter behind them was the best option for their dentists, team members and the patients they serve.

The companies have complete confidence in Kool Smiles dentists and the quality and level of care they provide, and are proud to support the ongoing work of Kool Smiles dentists as leading providers of dental care for underserved communities nationwide. 

Since 2002, Kool Smiles has been serving underserved communities, and today Kool Smiles provides needed dental care through more than two million patient visits per year, many of whom would not otherwise have access to dental care.  In addition, Kool Smiles dentists have provided more than $128 million in uncompensated dental care to treat patients and families who did not have access to Medicaid dental benefits or other dental insurance, and could not afford to pay. The companies will continue to work toward expanding access to quality dental care for all families."