Medicaid is a massive government program that provides coverage to millions of low-income and vulnerable patients every year. With any program so large, however, unscrupulous companies take their chances at filing overinflated or blatantly false bills.
An egregious example of this was Kool Smiles, a national children’s dental chain. According to the U.S. Justice Department, Kool Smiles was performing unnecessary procedures—tooth extractions, root canals, or pretend root canals—on their young patients and billing Medicaid. In all, the chain was found to have submitted false claims in 17 states, and ordered to pay back $24 million.
Let’s face it: legal matters can be difficult to understand. Latin phrases, like “qui tam,” only add another layer of complexity and keep people from understanding the legal system created to serve them.
But we’re going to demystify part of it today.
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