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Criminal Law: The Case Against Benevis and Kool Smiles Dental Clinics

Essay Instructions:

Case: Criminal Law
Please view the following video:
Whistleblower Attorneys. (2016, January 7). Healthcare fraud – Billing for services not rendered. [Video file]. Retrieved from https://www(dot)youtube(dot)com/watch?v=1ZB2fueXn9g
Benevis and Kool Smiles Dental Clinics have joined the ranks of medical professionals and businesses found guilty of defrauding the government. Using the background reading as well as other sources, research the case against this company. After completing your research, please respond to the following questions.
Discuss the case against Benevis and Kool Smiles Dental Clinics. Be sure to explain the relationship between the two.
What were the actual charges filed against them?
What was the punishment?
Discuss the final outcome of the case. Was it justified? Be sure to cite reliable sources to support your analysis.
Length: Submit a 3-page paper.
Berke, D. M. (2016). Drive-by-doctoring: Contractual issues and regulatory solutions to increase patient protection from surprise medical bills. American Journal of Law and Medicine, 42(1), 170-189. http://dx(dot)doi(dot)org/10.1177/0098858816644720
Computers, software; minimizing Medicare fraud internally. (2015). State & Local Health Law Weekly, 23.
DuBois, J. M., Walsh, H. A., Chibnall, J. T., Anderson, E. E., Eggers, M. R., Fowose, M., & Ziobrowski, H. (2017). Sexual violation of patients by physicians: A mixed-methods, exploratory analysis of 101 cases. Sexual Abuse: A Journal of Research and Treatment. ePub. Retrieved from: http://journals(dot)sagepub(dot)com/doi/pdf/10.1177/1079063217712217
Hospitals sued: Claims of sexual abuse, harassment. (2016, April 1) Healthcare Risk Management, 38(4). Retrieved from the Trident Online Library.
Kim, C. J. (2014). The trial of Conrad Murray: Prosecuting physicians for criminally negligent over-prescription. American Criminal Law Review 51(517). Retrieved from: http://www(dot)americancriminallawreview(dot)com/files/3214/0943/7056/Kim.pdf
Licensed professional counselors sentenced for roles in $9.5 million fraudulent billing health care fraud scheme to siphon and steal money from workers' compensation program. (2016). Lanham: Federal Information & News Dispatch, Inc.
New Jersey Board of Medical Examiners imposes 5-year suspension on former prison doctor whose ‘gross negligence’ contributed to the death of state prison inmate in 2009 (2016, Aug 04). US Fed News Service. Retrieved from the Trident Online Library.
Showalter, J. S. (2015) Chapter 1: The Anglo-American legal system. In The law of healthcare administration. Chicago: Health Administration Press.
Showalter, J. S. (2015) Chapter 15: Fraud laws and corporate compliance. In The law of healthcare administration. Chicago: Health Administration Press.
Teegardin, C., Robbins, D., Ernsthausen, J., & Hart, A. (2016) Doctors & sexual abuse. The Atlanta Journal-Constitution. Retrieved from: http://doctors(dot)ajc(dot)com/
U.S. Department of Justice (2016, July 6). Dental management company Benevis and its affiliated Kool Smiles Dental Clinics to pay $23.9 million to settle False Claims Act allegations relating to medically unnecessary pediatric dental services. Retrieved from: https://www(dot)justice(dot)gov/opa/pr/dental-management-company-benevis-and-its-affiliated-kool-smiles-dental-clinics-pay-239
Optional Reading
Benevis, Kool Smiles to pay $23.9 million in settlement with Department of Justice. (2018, Jan 12). ADA News. Retrieved from https://www(dot)ada(dot)org/en/publications/ada-news/2018-archive/january/benevis-kool-smiles-to-pay-239-million-in-settlement-with-department-of-justice
Dance, S. (2014, Sep 03) Dando won’t face trial: Sexual assault charges dropped; doctor gives up his state license. The Baltimore Sun. Retrieved from the Trident Online Library.
Metrick, B. (2017, Mar 02). Doctor guilty of sexual assault, drugging. Public Opinion. Retrieved from the Trident Online Library.
Sanderson, S. (2018, Jan 26) Casper doctor found guilty of sexually assaulting patients. Casper Star Tribune. Retrieved from: http://trib(dot)com/news/local/crime-and-courts/casper-doctor-found-guilty-of-sexually-assaulting-patients/article_e323fd54-ad21-5681-a70e-639d589274f0.html#tracking-source=home-top-story-1
Temecula doctor convicted of 25 charges in sexual assault case. (2017, March 1). Temecula Patch. Retrieved from: https://patch(dot)com/california/temecula/temecula-doctor-convicted-25-charges-sexual-assault-case
Twohey, M. (2010, Apr 30) Women charged rape; doctor still practiced: Since 2000, 7 women have accused Dr. Bruce Sylvester Smith of sexual assault. Chicago Tribune. Retrieved from: http://www(dot)chicagotribune(dot)com/lifestyles/health/chi-100430doctor-story.html

Essay Sample Content Preview:

Criminal Law
Name
BHA 310 SLP3
Instructor
Institution
Date
The case against Benevis and Kool Smiles Dental Clinics
Benevis is a dental service and Management Company that operates the Kool Smiles dental clinics is an affiliate dental chain. Kool Smiles submitted false medical claims related to the Medicaid programs where there were unnecessary dental services on children. The company filed false medical claims in Georgia and other states. There were also payments for services that were not performed. The False Claims Act allegations related to the pediatric dental services in the period January 2009 and December 2011 (DOJ, 2018). Kool Smiles clinics incentivized dentists to generate more revenues based on the procedures performed by rewarding those who met the production goals through cash bonuses. Despite the overutilization of dental services among some of the Kool Smiles clinics, there was still emphasis on medically unnecessary dental procedures.
Providers get federal fund reimbursement after providing the best care the patients, but Kool Smiles defrauded Medicaid and exploited the vulnerable and economically disadvantaged children. The U.S. Justice Department reported that there were federal fraud charges involving a federal insurance program where Benevis and Kool Smiles clinics operating in 17 states knowingly provided false claims (DOJ, 2018). One of the most common forms of healthcare fraud is medical providers submitting claims for services that were not rendered (Whistleblower Attorneys., 2016). There were routine cavities that required minimal work and by filing a federal lawsuit, there was focus on the culpability of Benevis and more than 100 Kool Smiles clinics implicated in the healthcare fraud. The government paid Kool Smiles providers for dental services that were supposedly performed on children insured by Medicaid.
The actual charges filed against them
The actual charges were false billing claims over unnecessary dental services on children that were insured through Medicaid. Kool Smiles Dental Clinics fraudulently billed Medicaid programs, where the programs were intended to provide comprehensive dental services and oral health for kids below three years of age. There were false claims submitted to the state Medicaid programs and Kool Smiles was paid for pediatric dental services that were unnecessary or not provided at all. In other words, the healthcare providers got federal funds reimbursement for services not rendered and failed to provide adequate dental health care to the vulnerable and economically disadvantaged children.
The Medicaid health coverage insures children, and there were unnecessary dental services on the children, which was aimed at defrauding the Medicaid insurance program. Medicaid fraud involving the report of false billing expenses and seeking reimbursement for unnecessary procedures performed are all p...
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