The Hippocratic Oath should ensure that healthcare professionals adhere to a particular moral and ethical code, streamlining their behavior to an excellent standard. Breaching this promise leads to less than stellar healthcare practices, a decrease in the quality of services provided, and even medical fraud, punishable by law (Whistleblower Attorneys, 2016). Such deceptive practices may most often target Medicaid as a federal program aimed to help those who are eligible for assistance. The case of Benevis LLC and Kool Smiles dental clinics is a direct example of companies exploiting government-provided funds at the expense of their clients (“Dental management company Benevis,” 2018). Thus, deconstructing the case and tracing its legal process, filed charges, and the punitive outcome may help outline the repercussions of healthcare-related legal malpractice. Furthermore, the development of the case should help delineate the justification of the reached settlement between the two companies and the US Justice Department.
As a professionally ethical issue, the Benevis and Kool Smile dental clinics case center on the problematic practice of doing too much of a seemingly good thing. Scheduling their clients for “medically unnecessary pulpotomies (baby root canals), tooth extractions, and stainless steel crowns” became their pathway for attracting heightened Medicaid funding (“Dental management company Benevis,” 2018). Furthermore, Kool Smiles, affiliated with Benevis through the reception of various administrative and business management services from them, sought out federal payout for unperformed contracts, preying off poorer population segments (“Dental management company Benevis,” 2018; Meldrum, 2018). Citizens, whom Kool Smiles had previously employed, initiated the lawsuits against it (“Dental management company Benevis,” 2018). Thus, the actions of those aware of the Clinics’ internal workings brought its malpractice to attention.
Contemporary mechanisms that exist for filing charges against fraudulent medical companies concern themselves with the protection of citizens who help raise such matters for judgment. The False Claims Act allows such spotters to protect themselves by filing cases on the US government’s behalf, concurrently raising the importance of their charges (“Dental management company Benevis,” 2018). Under the same act, the Department of Justice received allegations of Kool Smiles submitting false claims for government consideration (Meldrum, 2018). Charges for both “services not rendered” and the performance of procedures unneeded by clients fall under fraudulent behavior, as well as a potential waste of funds and even patient abuse (Cassady, 2016, p. 150). Therefore, conscientious citizens informing the Department of Justice of such practices allowed preventing not only the suffering of future dental clients, most of whom would be children but also the hurtful misallocation of Medicaid funding.
Since Benevis and Kool Smiles received the funding, which they claimed to require payment for, returning the money became a legal issue. While the committed acts constitute two of the most common frauds committed by healthcare providers, they, nonetheless, require the involvement of “the combined efforts of local, state, and federal investigative agencies” (Kratcoski, 2018, p. 121). Thus, the two guilty entities received a punishment of “$23.9 million, plus interest,” which was to be redistributed between the US government, individual states, and the involved whistleblowers (“Dental management company Benevis,” 2018). These consequences chastise Benevis and Kool Smiles and create a positive incentive for those who wish to bring such malpractices to light, creating a dually armed system (Cassady, 2016). Advancing the idea of fraudulence as an offense that the government can punish may help set a positive example within health care.
With the amassed evidence of medical malpractice, ranging from false claims to the exploitation of clients for financial gain, Benevis and Kool Smile merely received a penalty aimed to return their illegally gained profit. Since some researchers cite the 2010 Affordable Care Act as a point of increasing federal scrutiny, the unearthing of such fraud in 2018 by civilian means, despite the existence of government-backed mechanisms, seems surprising (Cassady, 2016; Kratcoski, 2018). Therefore, even with interest, this punitive action does not seem reflective of the committed medical malpractices, such as fraudulence, waste, or abuse (Cassady, 2016). The assigned punishment, considering the carried out misconduct, seems to account only for the aspect of fraud, wholly avoiding the ethical problem of executing unneeded procedures on children. As such, the outcome is only justified if it can be confined to financial misconduct.
The Benevis LLC and Kool Smiles dental clinics case is exemplary of the power held by witnesses, even with a government that is interested in unearthing fraudulent behavior. Without the filed allegations of previously employed citizens, Kool Smiles may have continued their detrimental practices without repercussion. Furthermore, even with an investigation that proved the occurring fraud, the assigned consequences were concerned only with reimbursing the diverted Medicaid funding. The Department of Justice did not discuss compensation for those families who may have been affected by the clinics’ activities. Thus, the role of employees, who have the potential to report such schemes before they may seriously affect anyone, cannot be underestimated. Healthcare professionals with strong ethics become crucial for the creation of a better medical setting.
References
Cassady, M. (2016). Stay out of trouble. In M. M. Okuji (Ed.), Dental benefits and practice management: A guide for successful practices (pp. 147-168). Ames, IA: John Wiley & Sons.
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. (2018). Web.
Kratcoski, P. C. (2018). Fraud and corruption in the healthcare sector in the United States. In P. C. Kratcoski & M. Edelbacher (Eds.), Fraud and corruption: Major types, prevention, and control (pp. 109-124). Cham, Switzerland: Springer.
Meldrum, K. L. (2018). Everyone hates going to the dentist! Are dental service organizations taking the bite out of managing a dental practice in Indiana? Indiana Health Law Review, 16(1), 147-171. Web.
Whistleblower Attorneys. (2016). Healthcare fraud – Billing for services not rendered.Web.