A group of dentists has filed suit against the city of Chicago over a program that offers dental services to Chicago Public Schools students, accusing the city of charging dentists illegal fees to participate in the program and then requiring dentists to provide free services, even to students whose parents have insurance to cover the cost.
The School-Based Oral Health (SBOH) program is operated by the city through the Chicago Department of Public Heath (CDPH), according to the lawsuit.
The city and the public health department, "have a history of operating the SBOH Program in an illegal manner and of taking advantage of the SBOH providers," says the suit, filed in Cook County Circuit Court on Sept. 8 by the Chicago Association of School Dentists.
Providers were previously charged an administrative fee to participate in the program, the suit said.
"However, the City and CDPH did not provide any administrative services to the SBOH Providers in exchange for the administrative fee," the suit says. "The City and CDPH thereby effectively profited from the SBOH Providers’ participation in the program."
In 2022, the Illinois Public Aid Code was amended to bar the city from charging such administrative fees in the future, the suit states.
"The City and CDPH continue to operate the SBOH Program in a manner that places the SBOH providers at risk of violating federal and state laws," the dentists allege in the suit.
The dentists are now required to participate in the Illinois Medical Assistance Program operated by the Illinois Department of Healthcare and Family Services, the suit alleges.
"Specifically, the agreement requires SBOH Providers to provide services to students who are covered by Medicaid/All Kids for a fee, while providing the same services to other students at no charge," the suit says. "If a student is uninsured or not covered by Medicaid/All Kids, the agreement still requires that services be provided but 'shall be deemed donated by the [p]rovider.'”.
However, all Illinois Medicaid providers are required to comply with the the Illinois Public Aid Code and its regulations, the suit states.
Illinois Health and Family Services (HFS) in its handbooks for providers, "clearly establish that Medicaid providers cannot bill HFS for services that are also available free of charge," the suit says.
The city also prohibits providers from contacting the students' parents or guardian to verfiy if they have insurance or Medicaid coverage, the suit states.
"Due to the fact that SBOH Providers are prevented from verifying eligibility based on the terms of the Agreement, they are, in effect, being forced to provide services to students free- of-charge who have insurance solely because they were not allowed to contact the student’s parent or guardian for further information," the suit states.
By providing free services some students, SBOH providers are therefore, "risking their eligibility to participate in Medicaid/All Kids by participating in the SBOH Program," the suit states.
It asks the court to rule that the portion of the agreement requiring SBOH Providers to provide free services to students who are not covered by insurance or Medicaid/All Kids is illegal.
The plaintiffs are represented by attorneys Jenna E. Milaeger and Kathleen M. Lanagan, of the Goldberg Law Group, of Chicago.