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OIG Excludes Pediatric Dental Management
Chain From Participation in Federal Health
Care Programs

April 3, 2014

CSHM, LLC, formerly known as FORBA Holdings and Church Street Health Management (CSHM), signed an Exclusion Agreement that bars CSHM from participating in Medicare, Medicaid, and all other Federal health care programs for a period of 5 years, Daniel R. Levinson, Inspector General of the U.S. Department of Health and Human Services, announced today. The exclusion is based on CSHM's alleged material breaches of its Corporate Integrity Agreement (CIA) with the Office of Inspector General (OIG). CSHM manages and operates the national chain of Small Smiles Dental Centers, which provides services primarily to children on Medicaid. CSHM's corporate predecessor entered into the CIA in 2010, as part of the resolution of a False Claims Act case involving allegations that the company had provided dental services to children on Medicaid that were medically unnecessary or failed to meet professionally recognized standards of care.

To minimize immediate disruption of care to the hundreds of thousands of children treated at CSHM clinics and to enable an orderly, controlled shutdown of the company or divestiture of its assets, the exclusion will be effective on September 30, 2014. CSHM waived its right to appeal this exclusion in any judicial forum.

"CSHM has committed repeated and flagrant violations of its obligations under the CIA—violations that put quality of care and young patients' health and safety at risk," said Inspector General Levinson. "This exclusion underscores our commitment to enforcing our integrity agreements designed to promote quality of care and protect patients in Federal health care programs." Mr. Levinson said that this exclusion "makes clear to the provider community that OIG closely monitors our CIAs, critically evaluates providers' representations and certifications, and will pursue exclusion actions against providers that fail to abide by their integrity agreement obligations."

On March 7, 2014, OIG issued a Notice of Exclusion to CSHM based upon numerous material breaches of its obligations under the CIA. CSHM failed to report serious quality-of-care reportable events, take corrective action, or make appropriate notifications of those events to the State dental boards as required by the CIA, OIG found. CSHM also failed to implement and maintain key quality-related policies and procedures, comply with internal quality and compliance review requirements, properly maintain a log of compliance disclosures, and perform training as required by the CIA. Finally, CSHM submitted a false certification from its Compliance Officer regarding its compliance with CIA obligations.

This exclusion marks the culmination of a series of alleged failures by CSHM and its corporate predecessors to comply with its CIA. Under the CIA, an independent quality monitor conducted more than 90 site visits and reviews to monitor CSHM's compliance. Since the 2010 settlement, OIG repeatedly cited CSHM and took actions to address those violations, promote improved compliance, and maintain access to care for an underserved population. These actions included imposing financial penalties and forcing the divestiture of one of the company's clinics.

Despite these actions, CSHM remained in material breach of its CIA and OIG issued Notices of Intent to Exclude to the company in December 2013 and January 2014. In such cases, providers have the opportunity to demonstrate to OIG that they have cured, or are in the process of curing, the material breaches. CSHM represented to OIG that it would cure the material breaches. However, through meetings with CSHM and its Board of Directors and review of its written submissions, OIG determined that CSHM had failed to cure the material breaches and proceeded with the exclusion.

Until the exclusion goes into effect on September 30, 2014, an independent monitor will continue to monitor the quality of care being provided to patients at CSHM clinics. CSHM is required to inform patients at least 30 days before closing a clinic. CSHM is also required to keep State Medicaid agencies abreast of developments and provide monthly status reports to OIG. Any divestiture of assets by CSHM must be through bona fide, arms-length transactions to an entity that is not related to or affiliated with CSHM.

The Inspector General credited Special Agents from OIG's Office of Investigations, Miami Regional and Nashville Field Offices, with assisting in this investigation. OIG was represented in the investigation and litigation of this matter by Senior Counsel Felicia E. Heimer, Maame A. Gyamfi, Robert M. Penezic, and Tamara T. Forys, with assistance from Paralegal Mariel Filtz.

CSHM disputed OIG's determination that it was in material breach of the CIA.

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