Dental Clinics are First on OIG’s “High Risk” List

November 16, 2018 | Margarita Christoforou | Fraud and Abuse | Litigation | Medicare and Medicaid

Two dental care companies are the first entities to be placed on the new High Risk – Heightened Scrutiny list created by the U.S. Department of Health and Human Services’ Office of Inspector General (OIG) for providers that pose a significant risk to federal healthcare programs and beneficiaries.  Each of the companies settled with the government over fraud allegations but refused to enter into a corporate integrity agreement (CIA).

ImmediaDent of Indiana, which operates nine dental care practices, and Kansas-based Samson Dental Partners, which provides administrative support services to ImmediaDent, agreed to pay a total of more than $5 million to resolve allegations that they improperly billed Indiana’s Medicaid program for dental services. The U.S. Department of Justice (DOJ) had alleged that the companies billed for routine tooth extractions as though they were surgical extractions, and for deep cleanings that were either not medically necessary or not actually performed at all. The DOJ announced the settlements on November 6, 2018.

Although they agreed to the settlement, the two companies refused to enter into a CIA which would have required them to adhere to certain compliance measures and monitoring by the OIG. The OIG determined that without this additional oversight, the companies posed a continued high risk to federal healthcare programs and their beneficiaries, warranting their inclusion on the newly created list.

While entities listed will not be excluded from federal healthcare programs, their inclusion on the list is intended to serve as a warning to patients and potential business partners.

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