In March 2014, OIG excluded CSHM, LLC (which managed and operated the
national chain of Small Smiles Dental Centers) from Medicare, Medicaid and all
other federal healthcare programs for at least five years because of its alleged
material breaches of its corporate integrity agreement (CIA) with OIG. This case
exemplifies the government’s increasing scrutiny of DSOs, which otherwise have
grown substantially in popularity in recent years, thanks largely to increased
private equity investment.
McGuireWoods attorneys Geoffrey Cockrell, Barton Walker, Amber Walsh, Holly Carnell
and John Saran, and summer associate John Harig,a discuss this case in a white paper titled “Compliance Best Practices for Dental Providers:
Recent OIG Activity Highlights Need for Robust Compliance Efforts
- As a result of the actions of a very small minority of the dental
industry, dental support organizations (DSOs) have come under increasing
- The need for DSOs (and dental practices, more generally) to build a
“culture of compliance” is more immediate in light of this heightened
- An effective compliance program begins by implementing policies and
procedures that focus on both quality of care and adherence to federal and
local laws and regulations.
- Each DSO should have a chief compliance officer who maintains
independence and has authority to effectively implement policies through
compliance liaisons at each facility.
- DSOs should conduct thorough training of staff on policies and
procedures, as well as continually review their training and compliance
programs to ensure effectiveness.
- DSOs should respond to and correct compliance issues timely and
- Compliance programs should be designed to ensure the quality and medical
necessity of care, in addition to billing accuracy.
- Various industry participants have already adopted strong compliance
programs. Further, the Association of Dental Support Organizations has
developed a model Code of Ethics for its DSO members.