WFAA Posted on August 18, 2011 at 10:00 PM Updated today at 3:16 PM
DALLAS - Many parents know it can cost as much as $5,000 to put braces on a child's teeth. Despite the high cost, it's a financial sacrifice some families make for a child's appearance.
Rarely are braces a health issue. But, while some families struggle to pay for braces, under Medicaid in Texas, tens of thousands of children get braces for free.
Last year, Texas spent $184 million on braces under Medicaid. And while Texas spent as much as the rest of the nation combined, some states, like Michigan and Kansas, spent zero.
Assistant Attorney Generals Tony West and Lanny Breuer appear before the Judiciary Committee with a recap of funds recovered on behalf of the taxpayer in 2010. You can read the full statement here.
Needless to say, Church Street Health Management f/k/a FORBA Holdings and their Small Smiles dental clinics settlement came up in the statement. It was one year ago this month that Small Smiles settled an investigation which began in late 2007 with the Feds for $24 million, as well as settled with the state of NY for another $2 million.
According to the List of Excluded Individuals and Entities (LEIE) it was March 2010 before William A. Mueller, DDS, one of the founders of Small Smiles Dental Centers was excluded from the Medicaid program.
It was August 2010, before Michael A. DeRose, former DDS and another co-founder of Small Smiles Dental Centers was excluded. Why? Why did it take so long?
However, now that each of these individual are excluded, it would be illegal for either to hide under a stack of corporations concealing their ownership and control of any clinic or facility that bills Medicaid for services. Just saying.
It appears Hawaii is doing all it can to protect their citizens from Medicaid dental mills such as Small Smiles, Kool Smiles, Ocean Dental, and Western Dental.
Hawaii has a law in place that says “a dentist must own, maintain or operate an office for the practice of dentistry.” However the laws as they stand now do leave a “loop hole”, as in other states, that people like Michael DeRose of Small Smiles and Dr. Tran Pham of Kool Smiles seem to find a way to slither through.
Majority Leader Kirk Caldwell's HB 2301 bill to prohibit "interference in the practice of dentistry by an unlicensed person or entity" and prohibit "the practice of dentistry in a commercial or mercantile establishment"
Jeffrey Miyazawa, D.D.S., Chair of the Board of Dental Examiners opposes the bill, no big surprise there, but other dentists of Hawaii fully support it.
Dr. Miyazawa argues that passing this law would not give the board any power to enforce it, and I’m saying to myself, "why the hell not?"
Dr. Miyazawa also says “HRS 448-17(a)(12) provides for sanctioning "any other improper, unprofessional, or dishonorable conduct in the practice of dentistry.”
Provisions like this or something close is on the books in most all states, and it hasn’t done one thing to stop these Medicaid dental mills, slowed them down one bit, or even caused them to pause for a split second despite the hundreds and hundreds of complaints and reports.
Hawaii’s HB 2301 would amend HRS 448-A to include as follows:
(a) No person or entity without a license issued pursuant to this chapter shall direct or interfere with a licensed dentist's judgment and competent practice of dentistry.
(b) No dentist licensed pursuant to this chapter who engages in the practice of dentistry in any form, shall permit a person or entity, other than a dentist licensed pursuant to this chapter, to direct, participate in, or interfere with the licensee's practice of dentistry.
Section B above certainly would limit that quota and bonus system that the dental mills have established in other states now wouldn’t it?
HB 2301 would also add 448-B to read as follows:
No person licensed pursuant to this chapter shall engage in the practice of dentistry in a commercial or mercantile establishment, or advertise, either in person or through any commercial or mercantile establishment, that the person is a licensed practitioner and is practicing or will practice dentistry in a commercial or mercantile establishment.
This section shall not prohibit the rendering of professional services to the officers and employees of any person, firm, or corporation by a dentist, whether or not the compensation for the service is paid by the officers and employees, or by the employer, or jointly by all or any of them. For the purposes of this section, the term "commercial or mercantile establishment" means a business enterprise engaged in the selling of commodities or services unrelated to the practice of dentistry or other healing arts.
I think this is a great beginning to an end of the dental mills and I would suggest everyone who reads this and its language to get with their state law makers and get something like this or close to it passed in their respective states.
One thing that is not addressed in this bill is the use of papoose boards. I understand people think the Dental Board would regulate this since the ADA and the AAPD have "guidelines" however leaving things like this to "Boards" of dentists' own peers simply isn't working.
I’ve already started that quest in my state and I can’t urge my many loyal readers enough to do it in your own.
update 3-2010:
I've written to Rep. Caldwell, who at present is running for Mayor of Honolulu to see what happened to his bill.
I did find this:
HB 2301 HD1, Relating To Dentistry
Majority Leader Kirk Caldwell's bill to prohibit "interference in the practice of dentistry by an unlicensed person or entity" and prohibit "the practice of dentistry in a commercial or mercantile establishment" was characterized on the Floor by Rep. Gene Ward as "the anti-Wal Mart, anti-Big Box bill" who went on to say that it was a premature, misplaced constraint of trade. The bill passed, with Rep. Ward as the only no vote.
When kids wouldn't behave, he choked them, slapped them and banged their heads against chairs. He'd often haul them out of their seats by their necks or yank them forward by hooking his fingers under their upper front teeth.
No, this isn't another column about some thug with a three-page rap sheet. This is about Dr. David Moore, pediatric dentist extraordinaire, and what went on in his Billingsley Road office.
In one case described in a report by the North Carolina State Board of Dental Examiners, Moore pulled a girl "off of the dental chair by her head and neck and slammed her against the window in the operatory." In another, he choked a boy and left marks on the child's neck and face. A third child also emerged from his office with marks on his cheeks and arms after Moore strapped him to a chair and used a mouth prop that caused unnecessary bleeding.
That's just a small sample of how the low-income children who visited Moore's Small World Clinic, which specialized in Medicaid patients, were treated. The rest of the story doesn't get much better. According to the dental examiners' report, Moore left children unattended while they were under intravenous sedation and failed to note his reasons for sedating them in their records. Though he didn't have a general-anesthesia permit, he administered general anesthesia to other children and left them unattended as well.
Why knock your patients out? My guess is that it's a heck of a lot easier to perform hours of unnecessary work when they're out cold.
That's where the Medicaid fraud comes in. Moore repeatedly billed the government for work he didn't do and failed to justify work that he did, an investigation by the dental examiners revealed.
A rational person would assume that Moore's dental career was kaput, but rational people apparently don't sit on the dental examiners board. As punishment, the board revoked Moore's license for six months starting Jan. 13. When he gets it back in July, they plan to get really tough with him by putting him on probation.
Here's how that harebrained scheme is supposed to work. According to an agreement Moore signed with the board, if he doesn't beat up kids, illegally gas them, work on them alone or bar their parents from the examining room, he gets to keep his license. The board plans to enforce this by training his staff -- who will be hired and paid by him -- to keep an eye on him. Moore will be required to establish a fund for each staff member that covers their salary for up to six weeks -- not six weeks, but up to six weeks. They'll get the money if they fink him out, but only if the board later finds he broke the law. How they'll pay the rent until they find a new job isn't covered in the agreement.
What happened at Small World Clinic is just the latest example of the dental examiners board's laissez-faire attitude toward fraud and patient abuse by Charlotte dentists. Two and a half years ago another investigation by WCNC-TV's Stuart Watson found that two other pediatric Medicaid Dental Centers in Charlotte were barring parents from the examining room, strapping down children as young as 4 for hours, and drilling and capping eight to 16 teeth at a time, procedures that the board found were often unjustified or unnecessary.
After more than two years of inaction, the board finally wrote letters of censure to six of the doctors. The two owners of the clinics, Drs. Letitia Ballance and Michael Derose, were put on that infamous probation. If they bill Medicaid for more than six crowns in a single day, neglect to get parents' permission before the procedure or commit fraud again, they could lose their dental licenses for six whole months. Wow. That's tough.
Part of the problem here is that like doctors, dentists police themselves in North Carolina, with results that can be frightening. The six dentists who serve two-year terms on the dental examiners board are elected by the other dentists licensed in this state. (A hygienist and regular citizen also serve on the board, but they don't get to vote or sit in on disciplinary hearings.)
This creates a sticky situation. Laying the smackdown upon your fellow dental practitioners isn't the way to maintain your popularity or your seat on the board. Make too many enemies and it could come back to haunt you when you leave. And since the board is the final word, why stick your neck out when you could stick up for a colleague who handles poor kids no one wants to work on anyway? It's not like there's a lot of money in that Medicaid stuff, and dentists have to make a living somehow.
Right?
There are hundreds of stories on the Internet about this happening, however none compares to the torture of the innocent children like those involving Medicaid Dental Centers, Small Smiles, Smile High, Smile Starters and other FORBA managed dental clinics.
To All Dentist and Dental Corporations Exploiting and Abusing Our Children and Stealing Our Tax Dollars For Your Personal Gain and Lavish Life Styles: Big Brother Is Watching As Is This Blogger.
Improper Medicaid payments for dental services have been identified periodically by State Medicaid Fraud Control Units (MFCU). In 2004, a MFCU investigation determined that dentists were reimbursed $4.5 million for unnecessary dental services. In 2000, another MFCU identified a widespread fraud scheme by dentists who recruited children to receive Medicaid-reimbursable services, many of which were unnecessary or were not provided.
Thirty-one percent of Medicaid pediatric dental services in the five States resulted in improper payments. In the five States we reviewed, improper payments for pediatric dental services provided during calendar year 2003 totaled an estimated $155 million, of which the Federal share was approximately $96 million.
Medicaid Program, abusing children and elders, and intentionally inflicting bodily injury.
The dentists unnecessarily performed root canals, drilled into patients’ healthy teeth, and completed as many as 20 medically unnecessary filling procedures on the same patient, defrauding the Medicaid program of $4.5 million.
In 2000, Florida’s MFCU investigated a widespread Medicaid fraud scheme by dentists who recruited children to receive Medicaid-reimbursable services. Many of the services were found to be unnecessary or not provided.
In fiscal year 2006, the Centers for Medicare & Medicaid Services (CMS) implemented a program designed to estimate and monitor State and national improper payment rates in the Medicaid program.
In this report, they analyzed Medicaid pediatric dental services provided during calendar year 2003 in five States (Idaho, Indiana, Massachusetts, North Carolina, and Texas).
