DCH Statement Concerning Possible Class Action
Lawsuit Regarding Medicaid Dental Services
No child in our Medicaid or PeachCare for KidsTM programs has lost dental benefits or been
dropped from the program due to the contract disputes between Kool Smiles, P.C. and the care
management organizations (CMO), Peach State Health Plan and WellCare of Georgia.
The Georgia Department of Community Health (DCH) will thoroughly investigate all the allegations received from parents/guardians of patients and other dentists concerning poor care delivery received from Kool Smiles, P.C.
The Department will also investigate allegations and concerns reported to DCH including but not
limited to:
o Patterns of “over-utilization of services” and questions raised about the appropriateness of
care delivered
o “Unusual patterns of patient restraint”(such as use of restraining boards for children) and
sedation vs. Traditional Pain Management (usage of Nitrous Oxide or IV sedation)
compared to other dentists and normal averages
o “Over-utilization of stainless steel crowns” in children compared to other dentists and
normal averages
o “Lower use of preventive care” (i.e.: fewer sealants used to prevent cavities per patient
treated) compared to other dentists
o “Over-utilization of X-rays” compared to other dentists and normal averages
The adequacy of the dental networks for both Peach State Health Plan and WellCare of Georgia
are closely monitored and assessed by DCH.
August 22, 2007
In March 2007, the DCH Inspector General began an audit of Kool Smiles, P.C., which precedes
the current contract termination between the CMOs and the provider. Until the audit is complete, the Department will offer no comment on that investigation.
DCH offers no comment during pending litigation. If included in the lawsuit, the State of Georgia
will be represented by the Attorney General’s Office. Inquiries should be directed to the AG’s
office.
According to Georgia Families records:
o 24,000 or five percent of current WellCare of Georgia members have received services
from Kool Smiles, P.C. since implementation of the Georgia Families program
o 20,500 or seven percent current Peach State Health Plan members have received services
from Kool Smiles, P.C. since implementation of the Georgia Families program
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