In a significant healthcare enforcement development, Premier Dental Holdings, Inc., doing business as Sonrava Health, along with several affiliated dental management and service organizations, have agreed to pay $540,000 to the United States and the State of New Jersey. This settlement resolves allegations that the entities submitted false claims to government healthcare programs over a two-and-a-half-year period.
Who’s Involved?
The settlement includes the following parties:
- Premier Dental Holdings, Inc. d/b/a Sonrava Health
- Element Dental Partners Holdco, LLC
- Element Dental Partners, LLC
- Mid-Atlantic Dental Services Holdings LLC
- The Jersey Dental Group
These organizations operate or manage dental service providers that participate in federally and state-funded health care programs, including Medicare Part D and New Jersey’s Medicaid program known as NJ FamilyCare.
What Happened?
From January 1, 2021 through July 31, 2023, the government alleged that the defendants:
- Submitted or caused submission of claims for dental services performed by providers who lacked the required credentials with NJ FamilyCare or the applicable managed care organization.
- Improperly billed services using the National Provider Identifiers (NPIs) of credentialed dentists who did not actually perform the services.
- In some cases, services were both performed and billed by uncredentialed providers at the time the services were rendered.
These practices violated the rules of participation in both the Medicare Part D Program and NJ FamilyCare, which require accurate provider credentialing and truthful billing practices to ensure patient safety, quality of care, and program integrity.
Legal and Enforcement Context
The matter was investigated and resolved by the U.S. Attorney’s Office for the District of New Jersey, with Assistant U.S. Attorney Robert Toll leading the case on behalf of the federal government. The resolution underscores the federal government’s ongoing commitment to enforcing the False Claims Act and protecting public health care funds from fraudulent misuse.
While the settlement does not constitute an admission of liability by the defendants, it reflects a growing trend in federal enforcement actions targeting credentialing and billing compliance in dental and other outpatient provider networks.
Why It Matters
This case serves as a critical reminder to dental service organizations and managed care entities that:
- Credentialing compliance is not optional; it is a cornerstone of lawful participation in Medicare and Medicaid.
- Billing under another provider’s NPI, even with internal knowledge, may trigger liability under the False Claims Act.
- Health care providers should proactively monitor their credentialing systems and correct discrepancies before they result in government investigations or penalties.
As the healthcare enforcement landscape continues to evolve, providers must prioritize robust compliance infrastructure to avoid potential liabilities. The $540,000 settlement with Premier Dental Holdings and its affiliates is a timely example of how missteps in credentialing and billing practices can have serious legal and financial consequences.
