Dental Provider And Associated Individuals Agree To Resolve Allegations Of Improper Billing Of TennCare

KNOXVILLE, Tenn. – The United States Attorney’s Office announced today that Dr. Michael Sawaf and his affiliated company Premier Dental Group PLLC of Knoxville, f/k/a Orthodontic Designs by Michael Sawaf, PLLC (“PDG”), have agreed to pay $985,541 to resolve allegations that they knowingly and improperly submitted false claims for dental services to TennCare in violation of the False Claims Act (“FCA”) and the Tennessee Medicaid False Claims Act (“TMFCA”).  Erin Ferdowsi and Reja Ferdowsi, both of whom were affiliated with PDG, also agreed to resolve similar allegations against them.

TennCare prohibits billing for services that are not provided, upcoding claims to receive higher reimbursements to which a provider is not entitled, and billing for unnecessary services.  TennCare also requires that dentists apply for and receive approval to participate in the TennCare program before billing for services rendered to beneficiaries.  The credentialing process is intended to ensure that beneficiaries receive the highest quality of care from competent providers who have been vetted prior to rendering services.

Dr. Sawaf owns and sees patients at PDG, a dental and orthodontics clinic located at 303 S. Concord Street, Suite 323, in Knoxville, TN.  Erin and Reja Ferdowsi operated, managed, and/or worked at PDG.  The settlement resolves allegations that, from January 1, 2016, through December 31, 2020, PDG knowingly submitted, or caused the submission of, false claims to TennCare for payment relating to various dental procedures.  The settlement also resolves allegations that, between August 14, 2019, and September 11, 2019, PDG knowingly submitted, or caused the submission of, claims for payment to TennCare that falsely identified credentialed dentists as the rendering provider for services that were actually rendered by uncredentialed dentists who were ineligible to bill TennCare.

This settlement is the result of a collaborative effort between the U.S. Attorney’s Office for the Eastern District of Tennessee, the Federal Bureau of Investigation, the Tennessee Attorney General’s Office, and the Tennessee Bureau of Investigation.  The investigation that preceded the settlement was prompted by a lawsuit filed in 2020 under the qui tam or “whistleblower” provisions of the FCA and TMFCA, which permit a private individual (known as a “relator”) to sue on behalf of the government for false claims and to share in any recovery.  The relators’ share of the recovery in this case is $182,325.

Assistant U.S. Attorney Joseph C. Rodriguez represented the United States.

The claims settled by this agreement are allegations only, and there has been no determination of liability.

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