KNOXVILLE, Tenn. – The United States Attorney’s Business office introduced now that Dr. Don Flanagan, D.D.S., and his affiliated firms, Dental Center, Inc. and Dental Heart, P.C. d/b/a Cloudland Dental (“Cloudland Dental”), have agreed to pay back $1,500,000 to take care of allegations that they knowingly and improperly submitted fake claims for dental solutions to TennCare in violation of the Bogus Claims Act (“FCA”) and the Tennessee Medicaid Fake Promises Act (“TMFCA”). Franci Raines, who was formerly utilized as Cloudland Dental’s Company Manager, also agreed to solve similar allegations versus her.
TennCare needs that dentists utilize for and acquire acceptance before billing for expert services rendered to beneficiaries. This approval approach, which is identified as credentialing, needs, amongst other issues, that applicants post pertinent info about their instructional track record, licensure standing, coverage protection, as perfectly as information and facts about any felony background, malpractice promises, and state board disciplinary heritage. The credentialing approach is meant to ensure that beneficiaries get the best high-quality of care from knowledgeable companies who have been vetted prior to rendering services.
Dr. Flanagan previously owned Cloudland Dental, which operated dental clinics positioned in Chattanooga, Cleveland, Crossville, and Sweetwater. The settlement resolves allegations that, from January 2015 by February 2019, Cloudland Dental knowingly submitted, or caused to be submitted, to TennCare promises for payment that falsely identified Dr. Flanagan as the rendering provider for services that were being really rendered by uncredentialed dentists who were being ineligible to bill TennCare, at Cloudland Dental’s places of work found in Cleveland, Crossville, and Sweetwater.
“When healthcare companies agree to take part in federal health care systems these types of as TennCare, they ought to adhere to the demands of the software just like everyone else. The credentialing requirement for taking part providers is not a mere formality rather, it is an important need that is intended to make certain that expert services are rendered by experienced providers. Today’s settlement really should deliver a information to all vendors who take part in government sponsored healthcare applications that they have to stick to the policies when they elect to participate in publicly funded courses,” mentioned United States Legal professional Francis M. Hamilton III.
This settlement is the result of a collaborative work among the U.S. Attorney’s Workplace for the Eastern District of Tennessee, the U.S. Division of Health and Human Companies, Business of Inspector Common, the Tennessee Lawyer General’s Office environment, and the Tennessee Bureau of Investigation. The investigation that preceded the settlement was prompted by a lawsuit filed in 2019 under the qui tam or “whistleblower” provisions of the FCA and TMFCA, which permit a non-public particular person (identified as a “relator”) to sue on behalf of the federal government for bogus claims and to share in any restoration. The relator’s share of the restoration in this scenario will be $255,850.
Assistant U.S. Legal professional Joseph C. Rodriguez represented the United States.
The statements settled by this arrangement are allegations only, and there has been no willpower of legal responsibility.