KNOXVILLE, Tenn. — The United States Attorney's Office for the Eastern District of Tennessee announced on Tuesday that local dental provider Dr. Don Flanagan and former business manager Franci Raines have agreed to pay $1.5 million to resolve allegations of knowingly and improperly submitting false claims for dental services to TennCare.
Flanagan formerly owned Cloudland Dental, which had locations in Chattanooga, Cleveland, Crossville and Sweetwater, according to the Attorney's Office.
The settlement resolves allegations that from January 2015 through February 2019, Cloudland Dental knowingly submitted, or caused to be submitted, TennCare claims for payment that falsely identified Flanagan as the provider for services that were actually performed by uncredentialed dentists who were ineligible to bill TennCare at the Cleveland, Crossville and Sweetwater Cloudland Dental offices.
TennCare requires dentists to apply for and receive approval before billing for services. This approval process, which is known as credentialing, requires that applicants submit relevant information about their educational backgrounds, licensure status, insurance coverage and more. The credential process is intended to ensure that beneficiaries receive the highest quality of care from providers who have been vetted, the DA's Office said.
This settlement was prompted by a lawsuit filed in 2019 by a whistleblower.
“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,” United States Attorney Francis M. Hamilton III said.
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 Tennesee Bureau of Investigation.