State Finds Medicaid Scam In Children’s Dental Clinics With One Bellaire Location

The state announced today it recovered $546,000 from a civil Medicaid fraud lawsuit that has ties to a national children’s dental clinic chain with a Bellaire-area location.

The Wild Smiles Dental Center in the 5700 block of Bellaire Boulevard belongs to a national chain called Small Smiles, which has clinics across the country.

“They’re all involved,” said Tom Kelley, spokesman for the Texas Attorney General’s office. “Essentially they were billing for practices that were not medically necessary”

An investigation by the Texas Attorney General’s office revealed that Small Smiles performed unnecessary work on Medicare-eligible children and then the clinic’s management company, FORBA Holdings, submitted reimbursement claims from Medicaid.

Texas Attorney General Greg Abbott settled a lawsuit with FORBA Holdings and will recover $546,000, including $214,588 that will be returned to the state treasury. It’s part of a multi-state settlement agreement valued at $24 million.

According to a statement, because FORBA submitted Small Smiles’ reimbursement claims, it is financially responsible when its clients charged the taxpayers for non-reimbursable services. The Medicaid-funded reimbursements at issue covered a range of dental services for low-income children that were either unnecessary or performed in a manner that did not conform to recognized standards of care.

These treatments included baby root canals, crown placements, administering anesthesia – which included nitrous oxide – and performing tooth extractions, fillings and sealants.

Under the settlement, FORBA consented to a five-year corporate integrity agreement with the Office of the Inspector General of the U.S. Department of Health and Human Services. The agreement provides for the implementation of a quality-control program that will promptly detect unlawful conduct in the future. In addition, external reviewers will monitor FORBA’s quality of care and methods of reimbursement.

Small Smiles clinics will also improve services consistent with recognized standards of care.