UPDATE: Indiana Dental Practice & DSO Shell Out $5.1 Million Over Medicaid False Claims Allegations

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UPDATE:  TDMR has received a copy of the ImmediaDent and Samson Partners press statement from Samson Partners vice-president of marketing Stephen Valenti.  It is at the bottom of our story in full.

Indiana-based ImmediaDent and DSO Samson Dental Partners of Kansas have agreed to pay the federal government and Indiana some $5.139 million to resolve false claims allegations of Medicaid fraud.

Largest dental Medicaid provider in three states

ImmediaDent has nine offices in the state and a total of 33 locations in Indiana, Kentucky and Ohio.  According to a statement to Louisville Business First from Stephen Valenti, vice president of marketing for Samson Dental, ImmediaDent is the largest dental provider to Medicaid patients in those three states.

Allegedly submitted false billings

The accused companies allegedly improperly billed Indiana’s Medicaid program for dental services.  Specifically, according to the DOJ press release:

The companies are accused of submitting false claims for payment to Indiana’s Medicaid program between January 1, 2009, and September 30, 2013. Both companies are alleged to have submitted false claims to Indiana’s Medicaid program by (1) improperly billing simple tooth extractions as though they were surgical extractions and (2) improperly billing Scale and Root Planings (otherwise known as “deep cleanings”) that were either not performed or not medically necessary. Additionally, SDP is accused of violating Indiana’s law prohibiting the corporate practice of dentistry by improperly influencing ImmediaDent’s medical professionals and staff by rewarding production, disciplining employees for not meeting production objectives, and directing personnel in a manner which compromised clinical judgment.

Companies maintain they did nothing wrong

However, Valenti, in his statement to the media, says:

“The settlement agreement that Samson and ImmediaDent have entered into is not a concession of any wrongdoing by Samson Dental Partners or ImmediaDent, their employees or dentists. To the contrary, the companies strongly disagree with the assertion that they knowingly did anything improper.

“However, after almost four years of litigation and significant expense already incurred, the companies have concluded that their collective energies are better focused on continuing their expansion efforts, and working to provide the best care possible to patients.”

Whistleblower was fired back in 2012

The original allegations of Medicaid fraud were made by Dr. Jihaad Abdul-Majid who filed a qui tam action back on February 20, 2013.  The complaint states:

While working as a dentist at ImmediaDent Urgent Dental Care (“ImmediaDent”) clinics, Dr. Jihaad Abdul-Majid, DDS (“Relator) [Licensed to practice dentistry in Indiana and Kentucky. Defendants employed Dr. Abdul-Majid as a dentist from July 2011 to March 2012] discovered that ImmediaDent was operating its dental practices in a manner that perpetrated dental Medicaid fraud against the federal TRICARE program and the Medicaid programs of Indiana, Kentucky, and Ohio … Dr. Abdul-Majid observed and suspected various types of fraud, including fraudulent billing, excessive and unnecessary treatments of unsuspecting patients, and a sustained pressure by non-dentists in management positions to place corporate profits over patient care by exerting undue influence on dental care decisions. Dr. Abdul-Majid refused to participate in the fraud and tried to stop it or speak out against it internally on numerous occasions. In the end, Dr. Abdul-Majid’s anti-fraud efforts caused ImmediaDent to fire him.

Refuse to enter Corporate Integrity Agreement

The companies have refused to enter into a Corporate Integrity Agreement which requires compliance measures and monitoring by OIG.  So OIG “has determined that in the absence of such oversight, the companies pose a continuing high risk to the Federal health care programs and their beneficiaries.”

According to Valenti’s statement to Louisville Business First, the company has “continued to improve its compliance programs, an effort he [Valenti] says predates the complaint.”  A copy of their compliance plan is available online.

DOJ warning

The DOJ press release includes a pretty stern warning to Medicaid providers.

“Let this be a warning to health care organizations that the United States government is watching, and will continue to watch for false claims no matter how large or small,” said United States Attorney Russell M. Coleman.

“The United States Attorney’s office is protecting the taxpayers’ dollars every day with the help of our state and local partners.”

Samson Dental Partners and ImmediaDent release

SamsonDentalPartners_ImmediaDent-of-Indiana_Statement

11 Responses

  • Systemic issue with all large dental group practices….even those who do not have a connection to DMOs. Whenever you employ a tactic of rewarding dentists for increasing productivity and/or discipline for the lack of productivity, you encourage over-treatment/over-billing. Texas Medicaid dentistry could have a 100 qui tam lawsuits like like this. Money is the driver, not the genuine care for the patient.

    • First of all, you mean DSOs, not DMOs. Every dentist and every dental practice, and for that matter, every business in the United States is paid and rewarded based on production. No production, no money except in a communist state. Perhaps you are suggesting a Bolshevik revolution, comrad.

      • Not suggesting that at all….and thank you correcting my typo (DSO). Production makes a ton of sense in most industries and businesses because it’s normally not putting a patient at risk or robbing from the taxpayer. In dentistry it’s become a joke. How can “encouragaged production” be in the best interest of the patient? The dentists have a “carrot” dangling in front of them to “look and find” for more decay to justify the pulpotomies/SSC, resin restorations, extractions, root planing and scaling vs. prophy, etc. If the “carrot” does not result in dental overtreatment, then the opposite happens; the dentists claim for work they never did like upcoding from sealants to resin restorations. How many times do you think it’s legit to to claim that a 12 year old really received 4 quadrants of fillings (20+). The dental groups are paying questionable companies to illegally solict on their behalf to get these patients in their offices to treat or just bill as much as possible. It’s only getting worse. Why don’t you look into it a little more, you might be surprised and possibly improve your education on the matter.

        • Your fixation on dentistry is bizarre. Any business or healthcare professional can cheat clients or insurance plans or the government. Those are individual cases, not representative everyone in a whole industry or profession, as you make out. If you have evidence of such activity currently being done as you mention, you should name names and report it to the authorities, not skulk around anonymously trying to vilify the entire profession. For your education, because apparently you have not read the articles here, this website is about trumped-up allegations against over 400 Medicaid dentists which were not true and were used by government officials and their private contractor to hide their own incompetence and attempt to scapegoat and bankrupt those dentists so the state could avoid paying back Medicaid monies to the federal government. The ruse didn’t succeed (except a number of dentists were bankrupted defending themselves) although people, apparently such as yourself, sought to make money from those allegations as either inept expert witnesses or lawyers seeking a big payday.

          • This a strawman argument. The legal action ended. This does not prove the innocence of 400 dentists accused of Medicaid fraud. Further, TMDR continues to imply many dentists were driven to.bankruptcy – without any verifiable names, numbers or proof.

            Joe Knows is fixated on dentistry because this Texas Medicaid DENTISTS For Reform. If you want to talk.about fraud in other industries, then you need a new name.

  • Thank you Beans! You’re exactly right. TDMR has the ability to look deeper into what is going on with the Medicaid dentists they defend, but probably a little afraid of what they will find. 400 dentist went bankrupt (I doubt it)! These dentists went to dental school and knew what a severe (key word) handicapping (key word) labio lingual malocclusion was. They also know what a filling is and what a sealant is. When the State took action on the orthodontia, the providers and their counsel used fancy lawyering to justify how straight teeth met that definition and then fooled the judges (not hard to do). They have no one to blame but themselves. I have spoken to several orthodontists who were in the Medicaid program at that time and they found very few cases that truly met the definition the State set forth for payment of braces. Why did some dentist choose NOT to exploit the system and others did. Simple. MONEY. They exploited a vulnerability in the State’s system (that Xerox and the State clearly share blame), which is akin to walking into a store and taking what you want merely because the employee is in the bathroom. TDMR can make it out to be whatever they want, and they will.

    • Two beans in a pod. Geez, that is what Jack Stick used to say. The truth is that it was a bait & switch by the HHSC and Xerox. They needed a scapegoat for their incompetence.

  • Once again a hypocrite speaks! Again a non Medicade provider ready to bash those who do. Explain why you don’t provide Medicaid services? Probably your in the hip pocket of those lawyers that represent those against actual providers.

  • Please do consider that there are lots of passionate dentists here who only aimed to help and perform their profession in as fair as possible to their clients.

  • Immediadent has closed permanently in New Albany Indiana and I’ve still been being charged for a monthly plan

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