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 really uncredentialed dentists offering providers.

KNOXVILLE, Tenn. — The US Lawyer’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 providers to TennCare.

Flanagan previously owned Cloudland Dental, which had areas in Chattanooga, Cleveland, Crossville and Sweetwater, based on the Lawyer’s Workplace.

The settlement resolves allegations that from January 2015 by way of February 2019, Cloudland Dental knowingly submitted, or brought on to be submitted, TennCare claims for fee that falsely recognized Flanagan because the supplier for providers that have been really carried out by uncredentialed dentists who have been ineligible to invoice TennCare on the Cleveland, Crossville and Sweetwater Cloudland Dental places of work. 

TennCare requires dentists to use for and obtain approval earlier than billing for providers. This approval course of, which is named credentialing, requires that candidates submit related details about their instructional backgrounds, licensure standing, insurance coverage protection and extra. The credential course of is meant to make sure that beneficiaries obtain the 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 applications resembling TennCare, they have to adhere to the necessities of this system similar to everybody else. The credentialing requirement for collaborating suppliers shouldn’t be a mere formality; relatively, it is a crucial requirement that’s supposed to make sure that providers are rendered by certified suppliers. Right now’s settlement ought to ship a message to all suppliers who take part in government-sponsored healthcare applications that they have to observe the foundations after they elect to take part in publicly funded applications,” United States Lawyer Francis M. Hamilton III stated. 

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