Attorney General Troy King announced Friday Alabama will recover $463,028 for the Alabama Medicaid Agency. The Alabama Attorney General’s Office 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 United States $24 million plus interest to resolve allegations that it caused bills to be submitted to these states’ Medicaid programs for medically unnecessary dental services performed on children insured by Medicaid. Medicaid is funded jointly by the federal and state governments. The money from the settlement is restitution that will compensate for state and federal dollars spent for these unnecessary services.
“The allegations in this case are deeply troubling,” said King. “It is always important to protect Medicaid funds from being wasted on procedures that are not even necessary, when there are so many real and urgent needs to cover with these scarce resources. It is heartbreaking to think children endured painful and unnecessary dental care, and that parents made these hard decisions in what they thought were their children’s best interest.”
The attorneys general alleged 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 medically unnecessary or performed in a manner that failed to meet professionally-recognized standards of care. These services included performing pulpotomies (baby root canals), placing crowns, administering anesthesia (including nitrous oxide), performing extractions, providing fillings and/or sealants, and inappropriately using behavior management techniques to restrain child patients.
In addition to the financial restitution, the settlement includes other protective measures. 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. The agreement provides for procedures and reviews to be put in place to avoid and promptly detect conduct similar to that which gave rise to this matter. 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