A pediatric dentist, his dental service organization (DSO), and 13 affiliated practices will pay $753,457 to resolve allegations that dentists performed unnecessary "baby root canals" on kids and billed Medicaid for them, according to New York and U.S. authorities.
Dr. Barry L. Jacobson, the CEO of the pediatric DSO HQRC Management Services, which now is doing business as PDS Management Solutions, along with 13 affiliated pediatric practices in New Jersey and New York, agreed to the settlement to resolve accusations that they violated the False Claims Act, according to a release issued by the U.S. Attorney's Office for the District of New Jersey.
"It is unconscionable that medical professionals were willing to perform unnecessary dental procedures on children simply to make money," U.S. Attorney Philip Sellinger said in the release. "Recovering their ill-gotten gains only begins to undo this damage."
Also, the settlement, which is the result of a joint investigation between the U.S. Attorney's Office and the New York Attorney General's Medicaid Fraud Control Unit, resolves allegations that the defendants provided inaccurate servicing provider information on claims submitted to Medicaid-managed care organizations.
The allegations came to light when former employee, Lauren Simpson, initially made the allegations in a lawsuit filed under the whistleblower provisions of the U.S. and New York False Claims Acts. Since the act permits private parties to sue for false claims on behalf of the U.S. and to share in any recovery, Simpson will receive $135,622 from the federal and state shares of the settlement, according to a press release from the New York Attorney General.
The settlement resolves accusations that some HQRC dentists performed medically unnecessary pulpotomies on pediatric patients. Certain dentists purportedly performed baby root canals on primary teeth despite there being no dental decay in the inner third of the dentin, according to the releases.
Additionally, Jacobson and HQRC admit that in some instances between 2011 and 2018, affiliated dentists performed and billed Medicaid for pulpotomies that were not supported by the medical records maintained at the dental practices. Furthermore, the defendants admit that in some cases between 2011 and 2014, HQRC made billing errors on claims submitted to New York and New Jersey Medicaid contractors that resulted in inaccurate servicing provider information on claims for services performed at three of its locations.
Jacobson is the founder and owner of affiliated pediatric practices in New York, New Jersey, and Vermont. The following New Jersey practices are part of the settlement agreement:
- Pediatric Dentistry of Paterson
- Pediatric Dentistry of Teaneck
- Pediatric Dentistry of Wykoff
The following New York practices are part of the settlement:
- Pediatric Dentistry of Flushing
- Pediatric Dentistry of the Bronx
- Pediatric Dentistry of Valley Stream
- Pediatric Dentistry of Brooklyn (Avenue U)
- Pediatric Dentistry of Brooklyn (Boro Park)
- Pediatric Dentistry of Monsey
- Pediatric Dentistry of Kingston
- Pediatric Dentistry of Albany
- Pediatric Dentistry of Malone
- North Country Pediatric Dentistry
"Dr. Jacobson and HQRC allegedly performed unnecessary and invasive dental procedures on children to line their own pockets," New York Attorney General Letitia James said in the release. "My office will not tolerate any instance of medically unnecessary procedures performed on vulnerable Medicaid beneficiaries."