Dr. Don Flanagan, TennCare False Claims, Tennessee 2019

Grimy Times has learned of a major settlement in a case involving TennCare, the state’s Medicaid program. Dr. Don Flanagan, along with his affiliated companies, Dental Center, Inc. and Dental Center, P.C. d/b/a Cloudland Dental, have agreed to pay $1,500,000 to resolve allegations of improper billing of TennCare.

The allegations stem from a period between January 2015 and February 2019, during which Cloudland Dental knowingly submitted false claims to TennCare for services rendered by uncredentialed dentists. Dr. Flanagan, who formerly owned Cloudland Dental, was allegedly identified as the rendering provider for these services, despite not being credentialed to do so.

The credentialing process is intended to ensure that beneficiaries receive high-quality care from competent providers who have been properly vetted. However, in this case, Cloudland Dental allegedly circumvented this process, resulting in false claims being submitted to TennCare.

The 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 Tennessee Bureau of Investigation.

Franci Raines, a former employee of Cloudland Dental, has also agreed to resolve similar allegations against her. The relator’s share of the recovery in this case will be $255,850.

Assistant U.S. Attorney Joseph C. Rodriguez represented the United States in this case. The claims settled by this agreement are allegations only, and there has been no determination of liability.

Dr. Don Flanagan and his affiliated companies must adhere to the requirements of TennCare, just like all other participating providers. The credentialing requirement is not a mere formality, but rather an important requirement intended to ensure that services are rendered by qualified providers.

Grimy Times will continue to monitor this case and provide updates as more information becomes available.

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