Dental Provider Agrees To Settle Allegations Of Improper Billing Of TennCare
KNOXVILLE, Tenn. – The United States Attorney’s Office announced today that Dr. Don Flanagan, D.D.S., and his affiliated companies, Dental Center, Inc. and Dental Center, P.C. d/b/a Cloudland Dental (“Cloudland Dental”), have agreed to pay $1,500,000 to resolve allegations that they knowingly and improperly submitted false claims for dental services to TennCare in violation of the False Claims Act (“FCA”) and the Tennessee Medicaid False Claims Act (“TMFCA”). Franci Raines, who was formerly employed as Cloudland Dental’s Business Manager, also agreed to resolve similar allegations against her.
TennCare requires that dentists apply for and receive approval before billing for services rendered to beneficiaries. This approval process, which is known as credentialing, requires, among other things, that applicants submit relevant information about their educational background, licensure status, insurance coverage, as well as information about any criminal history, malpractice claims, and state board disciplinary history. The credentialing process is intended to ensure that beneficiaries receive the highest quality of care from competent providers who have been vetted prior to rendering services.
Dr. Flanagan formerly owned Cloudland Dental, which operated dental clinics located in Chattanooga, Cleveland, Crossville, and Sweetwater. The settlement resolves allegations that, from January 2015 through February 2019, Cloudland Dental knowingly submitted, or caused to be submitted, to TennCare claims for payment that falsely identified Dr. Flanagan as the rendering provider for services that were actually rendered by uncredentialed dentists who were ineligible to bill TennCare, at Cloudland Dental’s offices located in Cleveland, Crossville, and Sweetwater.
“When healthcare providers agree to participate in federal healthcare programs such as TennCare, they must adhere to the requirements of the program just like everyone else. The credentialing requirement for participating providers is not a mere formality; rather, it is an important requirement that is intended to ensure that services are rendered by qualified providers. Today’s settlement should send a message to all providers who participate in government sponsored healthcare programs that they must follow the rules when they elect to participate in publicly funded programs,” said United States Attorney Francis M. Hamilton III.
This settlement is the result of a collaborative effort between the U.S. Attorney’s Office for the Eastern District of Tennessee, the U.S. Department of Health and Human Services, Office of Inspector General, the Tennessee Attorney General’s Office, 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 private individual (known as a “relator”) to sue on behalf of the government for false claims and to share in any recovery. The relator’s share of the recovery in this case will be $255,850.
Assistant U.S. Attorney Joseph C. Rodriguez represented the United States.
The claims settled by this agreement are allegations only, and there has been no determination of liability.