The lawsuit alleged the Knoxville dental office put patients through unnecessary procedures and lied on claim forms to get more TennCare payments.
KNOXVILLE, Tenn. – The U.S. Attorney’s Office announced it reached a settlement in a 2020 lawsuit that alleged a Knoxville-area dental provider tried to falsify TennCare claims by using unqualified dental hygienists, coding procedures that weren’t necessary or actually performed, and treating patients like “cattle” in an effort to maximize profits.
According to the US Department of Justice, Dr. Michael Sawaf and his dental company, Premier Dental Group of Knoxville, agreed to pay nearly $1 million to settle allegations that they knowingly and improperly submitted false claims for dental services to TennCare. Erin Ferdowsi and Reja Ferdowsi are affiliated with the company and also agreed to settle similar charges.
The allegations contained in the lawsuit went deeper than just defrauding TennCare — alleging the dental provider potentially put children and other patients at risk and accusing them of malpractice.
Sawaf owns and sees patients at Premier Dental Group of Knoxville, formerly known as Orthodontic Designs by Michael Sawaf, which is located on Concord Street in the Marble City neighborhood near Tyson Park. Erin and Reja Ferdowsi were listed as financial investment partners with Premier Dental Group and also ran operations, which included monitoring day-to-day operations, patient schedules and revenue generated with a particular emphasis on government reimbursement “by any means necessary.” necessary”. to the lawsuit.
The DOJ said two whistleblowers came forward in September 2019 to report alleged wrongdoing in the government and said both were forced to resign as a result. Whistleblowers said this happened after the defendants learned they had reported the alleged fraud to the Tennessee Bureau of Investigation and others, saying they had to blow the whistle “much sooner than expected” after learning of an incident of “neglect of clearly” they said almost. killed a 9-year-old patient.
The two whistleblowers worked out of the Knoxville office as operations manager and clinical manager. They estimated that roughly 90% of the company’s gross revenue came from government programs, such as Medicaid and TennCare, and the remainder came from private insurance or self-pay.
“As a result of the deceptive practices and conduct described herein, Defendants have unlawfully and unlawfully received millions of dollars annually from government payees, and in fact, Defendant Erin Ferdowsi has said that the Knoxville office alone was a ‘ $11 million practice in 2018,” the lawsuit states.
The DOJ said the company submitted false claims to TennCare for payments related to various dental procedures. The settlement said between Aug. 14, 2019, and Sept. 11, 2019, the company falsely identified credentialed dentists as providing services to patients, but in fact, it said the services were performed by non-credentialed workers who were not qualified to billed to TennCare — such as dental hygienists and non-credentialed dentists.
In at least one case in July 2019, whistleblowers alleged that the Knoxville office had no credentialed dentists present in the building that day and that Erin Ferdowsi told the office to schedule patients to be seen by dental hygienists in the office.
However, he said the government’s claims were sent as if a credentialed dentist had seen them. The dentist named in the claims had resigned earlier that month, but the suit said they continued to file claims under their own names. The lawsuit said the dentist eventually sent a “cease and desist” email to the office.
The government also alleged that the defendants routinely coded the treatment of patients without regard to their safety or needs. The alleged activity involved codifying dental rehabilitation procedures — especially for younger patients — to justify the use of sedation, and then codifying the number of sedation units without actually using the listed amount to provide more government reimbursements from procedures. The government alleged that the defendants received $3,000 to $10,000 more per patient than they should have in some cases from TennCare and others.
“…if that much (sedation) had actually been used, especially for younger patients, then it would have seriously injured or even killed the patient,” the lawsuit said.
In other cases, the lawsuit alleged that the defendants lied to patients about their braces by unnecessarily extending the wear time for years beyond what they actually needed.
“As a result, Payor Government patients with braces were often kept in braces for up to six (6) years, when braces were only needed for two (2) years,” the lawsuit said.
The lawsuit likened the way the defendants treated their patients and ran their practices to a “mule system” to make the most money “by any means necessary,” saying Reja Ferdowsi often referred patients like “cattle”. and “herding” in and out of practice.
“Employees are held to very unrealistic, if not physically impossible, ‘quotas’ of patient and/or procedure volume on a daily and weekly basis, which is often up to 75 patients per dental hygienist in a single day and/or 117 patients for a dental treatment provider in a single day, and these rates encourage and result in the deceptive practices described herein,” the lawsuit states.
The issues allegedly came to the fore of the whistleblowers with the incident with the 9-year-old. The plaintiffs alleged that the child was not properly sedated after they intubated the child before the oral surgeon arrived at the office, saying the child began gargling his own blood and experienced bleeding and esophageal tenderness long after the surgery. They claimed that the patient’s mother was never told what actually happened and was instead told that it was “normal” for the child to experience bleeding.
The whistleblowers said they learned of the incident later that night and met with other employees to discuss the alleged misconduct, saying that’s when they decided to report the defendants’ conduct to contractor TennCare’s Fraud Department, DentaQuest and the Bureau of Investigation. Tennessee. .
The DOJ said the suit was filed in 2020 under whistleblower provisions, which allow a person to sue on behalf of the government for making false claims. The whistleblowers will receive more than $182,000 as part of the more than $985,000 settlement.
10News reached out to Premier Dental Group of Knoxville Monday evening for a statement about the settlement and lawsuit.
