Roanoke Virginia Small Smiles Report

WDBJ 7 Roanoke, Virginia
February 25, 2010

News7 has discovered a local dental clinic that caters to low-income children was at the center of a national fraud investigation.

The parent company of Small Smiles recently agreed to a $24 million settlement regarding those allegations.

A former Roanoke Small Smiles employee triggered the national investigation. This employee was one of three whistleblowers that lead to a two-year investigation.

Jan Broetsky believes her son, Stephen, may have been one of the victims.

She was surprised what a Small Smiles dentist recommended for her five-year-old son during a visit in September.

"They told me Stephen had three severe cavities. All three were so severe that they needed root canals and they would also need silver crowns," said Jan.

When Stephen was three-years-old, the same Small Smiles office performed two fillings on him.

"Of course I felt like a bad mom," said Jan.

So, Jan Broetsky decided to get a second opinion just days later from dentist David Bittel, who is not affiliated with Small Smiles. She also brought him Stephen's x-ray from Small Smiles.

"The medicaid was the reason I went to small smiles. For me to get that second opinion cost me 100 plus dollars. But I was just so convinced my son had been intentionally misdiagnosed and it turned out to be true," said Jan

In his report, Dr. Bittel stated, "I see no decay anywhere that can be detected with explore or visually or with dental floss,".

He told News7, he's now been contacted by the Department of Health Professions as part of an investigation into the mother's complaint against Small Smiles.

As far as Stephen's case with the small smiles office in Roanoke, the chief dental officer reviewed his records. He released his findings to News7, which basically agreed with the original diagnosis from Small Smiles.

"There is no doubt in my mind I'm not the only person they are doing this to," said Jan.

The U.S. Attorney for the Western District agrees she is probably not the only parent.

" A lot of cases we documented those procedures were not necessary. Yet they performed them anyway and billed medicaid, "said U.S. Attorney Timothy Heaphy.

Heaphy was involved in the government's investigation of the Small Smiles office in Roanoke and helped negotiate a settlement with the parent company FORBA.

"Children are obviously especially vulnerable. The prospect that children were administered anesthesia that they didn't need or had that invasive dental surgery that was unnecessary, it's shocking and disappointing," said Heaphy.

But Small Smiles Parent company, FORBA has admitted no fault. A statement following the national settlement said, "Despite implications to the contrary in the government's press release, we entered into the recently announced settlement to avoid the delay, uncertainty, inconvenience, and expense of litigation, and did not admit any liability."

FORBA's practices were still concerning to U.S. Attorney Heaphy.

"There were strong incentives in place that the company acknowledged that forced unscrupulous people in facilities like in Roanoke to cheat. To get more of that public money," he said.

As part of the national settlement, Small Smiles' parent company FORBA has to follow some new guidelines. Which includes having a third party monitor its practices.

The government's investigation against individual Small Smile dentists is still ongoing.

We are not sure if that includes any of the dentists from the Roanoke location.

Parents should contact the OIG Hotline to report concerns. For more information click here.

Here are the finding of the Great Dr. Adair after he reviewed the patient's chart, x-ray and consulted with the Roanoke Small Smiles Dentist:

"The cavities on the two upper baby first molars (teeth #B and I) are large and clearly evident on the x-rays. One of them (#B) had been restored previously, and the filling had failed because of the patient's decay rate. Given that failure and the size of the cavities in these small teeth, a stainless steel crown would by an appropriate way to restore these teeth.
"The cavity on the mesial surface (side of tooth facing the front of the mouth) of the lower second baby molar (#K) is smaller, but it is evident on the x-ray as a vertical line in the enamel of that surface, which is adjacent to the baby first molar next to it. This cavity could not be detected without an x-ray. Even though it is small on the x-ray, clinical science tells us that it is larger in the mouth than on the film.
"Given this child's history of decay, and given that other surfaces of #K were also diagnosed with decay, a stainless steel crown would be an appropriate way to restore this tooth. A filling could also be done, but it would have a higher likelihood of failure."

Dr. Steven Adair, Chief Medical Officer

What I always find telling are the comments after the story has run.

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Lisa Says: Well GOODIE!! I took my granddaughter there2 times & the last time I was there, I felt VERY uncomfortable about their practice. They do the check up & then tell you to initial here, here & sign there but they DON'T tell you what you are initialing or signing. So, being a nosey old woman, I asked them about it & they told me that she needed 2 fillings & to have a front tooth capped. I didn't see the need since she was almost at the age where she will loose her baby teeth, so I took her to another dentist for a second opinion, he found NO CAVITIES, agreed with me that her baby teeth will come out soon, no capping was necessary!
We had already been through he 77 with two other "cavities" she had to have filled. They restrained her, drugged her & it traumatized her against any other dental visits. I am so glad I took her to another dentist!! This place is fleecing the government & making money off of unnecessary procedures!!!
Most parents are just wanting to do the best they can for their kids & have little knowledge about dental process so they just allow the "professional" to advise!! ASK QUESTIONS!!! ASK FOR PROOF!! Yes, it does make a difference!!

Here is a link so you can read all about FORBA's New Practices, but I thought they were great before paying the government $24 million dollars and being forced to sign a Corporate Integrity Agreement, among other things. Guess they really did SUCK!