The following is a statement received from MB2 Dental Solutions, the Dallas-area dental service organization, that recently settled with federal and state authorities for a whopping $8.45 million over allegations of Medicaid fraud. A company representative told us that they at least wanted to let their colleagues know their reasons for the settlement.
It is TDMR’s long-standing position that such settlements, if indeed there is no admission of guilt or finding of innocence, are troublesome. We wrote about the Smile Magic settlement with Texas OIG in 2015 that “in TDMR’s opinion, this settlement and such settlements are a shame. They are unsatisfactory because although no wrong-doing is admitted to, the public perception is that there must have been something there. This affects not only the practice in question but also those under the hammer of similar allegations. That is why due process needs to be provided so providers can get their day in court and get cleared of such allegations without going bankrupt.”
The difference here is that the federal healthcare authorities are involved and sent out a press release, albeit an incorrect one naming several dental practices which were never involved in the case. This is something we haven’t seen before. It is the feds position quite obviously that the settlement, despite its wording otherwise, is a finding of guilt. To quote: “Today’s settlement demonstrates our unwavering commitment to protect the Medicaid program and the patients it serves from unscrupulous providers,” said U.S. Attorney Parker. “Providers who waste taxpayer dollars by billing for services that were not provided, or were otherwise improper, will be held accountable.”
“Civil Medicaid fraud”?
This is the trouble with “civil Medicaid fraud” period. Fraud is a criminal act with high standards of evidence and, in the end, a jury is supposed to determine the guilt or innocence of the accused when it goes to a trial unless the accused pleads guilty or the state drops the case from lack of evidence. Yet in”civil Medicaid fraud,” apparently, a settlement agreement that expressly excludes any determination of guilt or admission of such is taken as exactly that – a determination of guilt without the necessity of a trier of fact by the state and in the obverse by the company as a necessary business decision.
Where is the truth here?
Only company principals accused, no working dentists
A further noteworthy point is that those dentists in the MB2 clinics who allegedly did or did not do the fraudulent work on patients are not mentioned. They weren’t named, fined or excluded from Medicaid. Just the principals of the company were named and agreed to settle. Yet they didn’t do the actual billing or work and they weren’t excluded from Medicaid either.
Against Medicaid fraud but there is no admission of guilt, no exclusion from Medicaid or other federal programs
TDMR is against Medicaid fraud. We encourage and provide means for individuals to report Medicaid fraud to the authorities so it can be investigated and prosecuted.
Yet, here, despite years of investigation and prosecution, there was no finding or admission of guilt nor any exclusion from Medicaid for the company or any of its dentists.
Had there been, we wouldn’t be publishing this
In fact, that is why we are publishing this statement. Had there been such admissions or exclusions, we wouldn’t have given them the time of day.
The actual agreements with the state and the feds are both below. Read them and make up your own mind.
Here is the statement:
MB2 fully and voluntarily cooperated throughout the investigation, and agreed to resolve the allegations through a civil settlement, with neither an admission nor determination of liability. The disagreement with the government did not relate to the quality of patient care, but rather compliance with the ever-changing regulatory environment from 2009 to early 2012 (prior to managed care). This case began over 4 years ago due to a qui tam “whistleblower” lawsuit. Consistent with the civil settlement, the dental service organization has consistently denied any wrongdoing and believes its client offices acted in accordance with all applicable laws and regulations.
Put simply, this case was a war of attrition. Since its start in 2009, the leaders of the company and practitioners have been unable to conduct business as usual due to the significant expense and distraction caused by this case. The government has infinite resources and will wear a company down until, as a business owner it makes more financial sense to settle and be done. Government investigators are in no hurry to come to a conclusion and cases like these change hands many times over the course of years. The dental service organization in this case felt they could only move their business forward by proactively putting an end to what evolved into an unproductive discussion between lawyers. The settlement is less satisfying because clinicians were never given the opportunity to have a productive or constructive clinical discussion around the allegations. During the time of the investigation and following the settlement, there have been no lapses in payment, exclusion from the Medicaid program, or disruption of services to patients.
Whistleblower works for MCNA
Another fact that we did find out from multiple sources is that the whistleblower mentioned in the federal press release about the settlement, Veronica Garcia, has been and possibly continues to be a provider relations representative for MCNA responsible for corporate dentistry as indicated by the chart below given out by the MCNA dental director last year to dental stakeholders.022616-dental-stakeholder-presentation