DENVER — Colorado Attorney General John Suthers announced today that the state will receive more than $1.2 million as part of a $24 million multistate settlement with FORBA Holdings, LLC, a dental management company that provided management services to Small Smiles dental clinics nationwide. The agreement resolves allegations that starting in 2006, FORBA caused bills to be submitted to the state for medically unnecessary dental services performed on children covered by Medicaid.
FORBA had been suspected of submitting claims for reimbursement for a wide range of dental services that were either medically unnecessary or performed in a manner that failed to meet professionally recognized standards of care. The services included performing pulpotomies (baby root canals), placing crowns, administering anesthesia, performing extractions, providing fillings or sealants, and using inappropriate techniques to restrain child patients.
The 23-state settlement resulted from three whistleblower lawsuits filed in Maryland, Virginia and South Carolina federal courts. The Office of the Attorney General’s Medicaid Fraud Control Unit facilitated Colorado’s participation in the multistate settlement.
As part of the settlement, FORBA has agreed to make quarterly payments to the states over five years and to submit to a corporate-integrity agreement, which will permit the states and federal government to monitor the company’s quality and standards of care, as well as any claims the company submits for reimbursement under state and federal programs.
Colorado’s participation in the settlement was only possible through collaboration with the Colorado Department of Health Care Policy and Financing’s Program Integrity Section and the help of agents from the U.S. Department of Health and Human Services’ Office of the Inspector General.
The State of Colorado pays out roughly $3.7 billion per year for medical care, including children’s dental services, for nearly 700,000 qualified recipients. The 14-member Medicaid Fraud Control Unit investigates and prosecutes providers suspected of defrauding the Colorado’s Medicaid program. The Medicaid Fraud Control Unit also investigates and prosecutes cases involving the physical and financial abuse of seniors and other residents of federally funded long-term care facilities.