Dentist agrees to pay $1.5 million for improper TennCare billing

Dentist agrees to pay $1.5 million for improper TennCare billing

Dr. Don Flanagan knowingly submitted TennCare claims that recognized Flanagan because the supplier when it was truly uncredentialed dentists offering companies.

KNOXVILLE, Tenn. — America Legal professional’s Workplace for the Japanese District of Tennessee introduced on Tuesday that native dental supplier Dr. Don Flanagan and former enterprise supervisor Franci Raines have agreed to pay $1.5 million to resolve allegations of knowingly and improperly submitting false claims for dental companies to TennCare.

Flanagan previously owned Cloudland Dental, which had places in Chattanooga, Cleveland, Crossville and Sweetwater, in keeping with the Legal professional’s Workplace.

The settlement resolves allegations that from January 2015 by February 2019, Cloudland Dental knowingly submitted, or triggered to be submitted, TennCare claims for cost that falsely recognized Flanagan because the supplier for companies that had been truly carried out by uncredentialed dentists who had been ineligible to invoice TennCare on the Cleveland, Crossville and Sweetwater Cloudland Dental workplaces. 

TennCare requires dentists to use for and obtain approval earlier than billing for companies. This approval course of, which is named credentialing, requires that candidates submit related details about their academic backgrounds, licensure standing, insurance coverage protection and extra. The credential course of is meant to make sure that beneficiaries obtain the very best high quality of care from suppliers who’ve been vetted, the DA’s Workplace stated. 

This settlement was prompted by a lawsuit filed in 2019 by a whistleblower.

“When healthcare suppliers comply with take part in federal healthcare packages akin to TennCare, they have to adhere to the necessities of this system similar to everybody else. The credentialing requirement for collaborating suppliers is just not a mere formality; quite, it is a vital requirement that’s supposed to make sure that companies are rendered by certified suppliers. In the present day’s settlement ought to ship a message to all suppliers who take part in government-sponsored healthcare packages that they have to observe the foundations once they elect to take part in publicly funded packages,” United States Legal professional Francis M. Hamilton III stated. 

This settlement is the results of a collaborative effort between the U.S. Legal professional’s Workplace for the Japanese District of Tennessee, the U.S. Division of Well being and Human Companies, Workplace of Inspector Normal, the Tennessee Legal professional Normal’s Workplace and the Tennesee Bureau of Investigation. 

Share this content: