Parents Overbilled For Pediatric Dental Care

Below is snippet from a blog of another parent complaining about being ripped off by a pediatric dentist. The dentist is out of Colorado Springs, CO of all places. If you've been keeping up with my blog you know there are many references to children's dentistry and the great state of Colorado.

If the dentist had not been so greedy hitting the parents up for more money they probably would have gotten away with over billing the insurance company.

I encourage EVERYONE to really look over the statements your insurance company sends you showing the amount they paid your dentist. Don't hesitate to call your dentist and ask about items you don't recognize or clearly understand.

If you find charges you feel are fraudulent file a complaint with the following:
The BBB
Your State's Dental Board
The ADA
The Federal Trade Commission
Your Insurance Company
Your State's Attorney General


Also the ADA has procedure codes (standardized codes used to bill insurance companies for each procedure). Don't hesitate to call other dentists and ask what they charge for the particular code of interest. You can also do this to "shop around".

We reviewed the bills, they charged us for 5 cavities and told us they going to do one. They charged significantly over what the insurance considers reasonable and expect us to pay the difference.

We are still trying to figure out why they charged $300 for sedation when our regular dentist charges $45. Why we have a bill for 5 cavities when one was fixed. Until we figure this out DO NOT GO TO COLORADO SPRINGS CHILDREN'S DENTISTRY.

We have paid almost $1000 for one infected tooth. I believe they are taking advantage of us by overcharging and billing for work that wasn't done.

Steer clear of Derek Kirkham DDS, and the rest of Colorado Springs Pediatric Dentistry. This practice is out to rob you blind.

Check out the full complaint here.

Georgia DCH Statement Regarding Kool Smiles Investigation

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

The Smile Behind Small Smiles

Meet, Atif A. Abdulmalik, of Bahrain. He is the CEO of Arcapita Bank, formerly Islamic Investment Bank until it changed it's name in early 2005. This is the company behind FORBA, LLC, or at least one of them.

FORBA, LLC is Small Smiles.

I don't know a lot about Venture Capitalist, Holding Companies nor how they all operate change hands, move about or hide.

Here is what I have found out here on the net:

There was The Carlyle Group, American Capital Strategies, and Arcapita Bank who got together and created Small Smiles Holding Company to purchase Sanus Holding who had just acquired FORBA in the fall of 2006.

In a press release found in a Nashville newspaper it states that Sanus Holding acquired FORBA, LLC and moved it's office to Nashville.

Then there is a report in January 2007 "Arcapita Bank, an Islamic Investment Firm and it's affiliated acquired Sanus Holding.

I don't know how all this worked but what I can figure out is that all of the medicaid and other state insurance programs who are billed for work done (necessary and UNnecessary) from Kool Smiles and evidently Small Smiles is headed to Bahrain, off the coast of Saudi Arabia.

Looks like our tax dollars are padding the pockets of another Islamic country via abusive dental care.

Abusive treatment of our kids and their teeth, over billing our medicaid system and no telling what else I've not discovered yet is just a kick in my teeth!

Don't take your Kids to these Dental Chains for heavens sake!

Wake Pediatric Dentistry-Johnson City, NC

If you live in Johnson City, NC and have children who have an upcoming appointment at Wake Pediatric Dentistry, you might save your child a life of torment if you take a few minutes and check out this discussion.

Shocking and Sickening!
There are a few compliments on the dental practice, some from it's own employees, however the complaints are very very upsetting. Don't miss the first page of this discussion, nor the last one even if you don't read one word in between.

Here are a couple of reviews of Wake Pediatric Dentistry from 2006, they weren't so good either.

Like I've been trying to point out with the blog, it's not just Small Smiles, Kool Smiles and other dental care chain traumatizing our children for a buck.

There are recounts after recounts of different dentist in this area using these barbaric type of behavioral management techniques.

Here are just a few dentists names listed as Bad Apples in this particular discussion group:
Dr. Horowitz
Dr. Parrish
Dr.Swarr office in Raleigh

Papoose Boards- Not In The UK

According to what I've been able to find out on the net, the General Dental Council in the UK prohibits the use of papoose boards several years ago for normal and pediatric dentistry.

Here is a discussion forum about it.

Children Dental Clinic, Does Not Mean Pediatric Dentist

Over the course of the last few days I looked into, read, reread, watched reports from news organizations across the Internet on some of these Dental Clinics designated for treating children and some even taking children on medicaid or state insured children only.

Some have sweet websites with smiling children splashed on each page and show the kid friendly decor and the happy smiling faces of the dentists and staff.

Small Smiles, Kool Smiles, Smile High, and Ocean Dental are the main clinics I've looked at in recent days.

Something I thought was a bit misleading to parents and the children treated is even though they are geared toward children, designed specifically for children does not mean they employ Pediatric Dentists or owned by Pediatric Dentists. Most I've looked at are only trained in General Dentistry.

Now I'm not saying by any means they don't have a clue about dentistry. Nor am I saying they took correspondence course to get their licenses. Many may well have attended wonderful dental colleges. I'm just saying because the clinic/office is decorated in cartoon characters doesn't mean they are Pediatric Dentists.

For example there are job ads online for Ocean Dental looking for dentists, assistants, office and administrative personnel. However, the critiria for the dentist do not ask or require them to be actual Pediatric Dentists, with the 2 extra years of training for treating children dental issues.

In their ads they never say they are Pediatric Dentists-(Pedodontist) they say something like "General Dentistry For Kids and Young Adults" so they are not breaking any laws to my knowledge.

It's just the whole set up makes you think you are getting a pediatric dentist to treat your children, so buyer beware.

It's not hard to find out if they are licensed in Pediatric Dentistry. All I had to do was check out the company sites, see the names of the dentists at different clinics or who owns the clinics and check to see if they hold a Pediatric License or a member of the AAPD. Pretty simple really. Many of them will list the dentist's name, where he/she went to school, what association he/she's a member of..etc.

I'm getting a bit off subject here though messing with this kind of information.

My complaint is "STOP STRAPPING DOWN CHILDREN FOR DENTAL CARE"

What's Going On At Ocean Dental Corporation?

I don't know exactly what is going on over at Ocean Dental Corporation, in Stillwater, OK but something has them checking out this blog pretty often in comparison to other visitors.

I have to give this some serious thought since guess what... they specialize in child dental care just like Small Smiles and Kool Smiles (check out the comments section) who have been busted for abusing and traumatizing children, using restraints and doing unnecessary dental procedures, as reported by WJLA TV in the DC area, 9News in Denver and 11Alive TV, Atlanta, Georgia respectfully.

They too are proud to announce they accept medicaid patients, which sends up red flags all over the place based on Small Smiles and Kool Smiles in my opinion. But so far, this blogger hasn't found any information on them, complaints or compliments.

Below is a list of Ocean Dental locations across the US.

Click on the address for a printable map.
City	Address	Zip	Phone
Stillwater, OK	510 S. Duck	74074	405.377.7300
Oklahoma City, OK	1610 W. I-240 Service Rd.	73159	405.605.4900
Downtown Oklahoma City, OK	47 NE 23rd St.	73159	405.525.1222
Norman, OK	500 West Main Suite 200	73069	405-321-2349
Moore, OK	2305 S. I-35	73160	405.799.0800
Warr Acres, OK	3919 N.W. MacArthur	73122	405.787.7827
Enid, OK	913 W. Maple	73701	580.242.0300
Lawton, OK	5314 N.W. Cache Rd.	73505	580.595.9492
Shawnee, OK	4409 N. Kickapoo	74804	405.273.7077
Tulsa, OK	6801 E. Admiral Place	74115	918.836.8366
Muskogee, OK	930 A West Shawnee	74401	918.682.6060
East Cleveland, OH	8101 Euclid Ave.	44103	216.229.2500
West Cleveland, OH	3545 Ridge Road	44102	216.961.6860
Columbus, OH	3646 E. Main St.	43213	614.231.4800
Little Rock, AR	3024 S. University	72204	501.565.0606
Hot Springs, AR	221 Airport Rd., Space G	71913	501.321.4963
Fort Smith, AR	1326 S. Waldron Road	72903	479.484.0008
Jonesboro, AR	1810 E. Highland Drive, Suite B	72401	870-934-0339
Fayetteville, AR	745 E. Joyce, Suite 224	72703	TBA
Des Moines, IA	1345 E. University Avenue, #302	50316	515.264.9022
Louisville, KY	3977 7th St. Road	40216	502.447.5699
Corpus Christi, TX	1620 South Padre Island Drive, Suite 250	78416	361-853-3334
El Paso, TX	1166 N Yarbrough Drive	79925	TBA

update: Since posting this comment, there seems to be an email circulating through the company with a link to this comment, and people from Ocean Dental are this blogs best customers recently.

Still don't know what's going on over there, but something on this blog has them stirred up.

update:
Looks like Ocean Dental has contracted with Tulsa School District to bring a mobile dental truck to the schools for dental treatment of children on Medicaid:

Here is the minutes from the meeting in Sept. 2007:

Enter into a contract with Ocean Dental to provide dental services for
Medicaid-eligible students through the operation of the Ocean Dental mobile
clinic during the school year 2007-2008.
There will be no cost to the District.


FURTHER RECOMMEND the attorney for the School District prepare the
appropriate contract and the proper officers of the Board of Education be
authorized to execute the contract on behalf of the District. Contact person-
Taylor Young.


RATIONALE: These services will be available to TPS schools that enroll
30 or more students. Routine and preventive services will be performed
within the scope of the clinic. These services are available to interested
schools meeting the criteria for participation.
The mobile clinic is totally self-contained requiring no District services.
Parent/guardians must give authorization to Ocean Dental to provide these
services. Students will not be placed under anesthesia which results in them
being unconscious. Services which require complex procedures will be
performed at Ocean Dental facilities.
The mobile clinic will be staffed with a dentist, an assistant and a staff
member who escorts children to the clinic on school property. A mutually
agreed upon schedule will be developed to prevent disruption of the
educational process.

Mothers Comments RE:Smiles High Clinic, Kool Smiles

"OnTipToe" from Colorado reported the following story:
January 2008

If you are relying on medicaid coverage and seeking dental care for your child, who is insured, watch out for this! One company, called "Small Smiles" and in our city they were called "Smile High" has been known to have this type of BAD practice!
(blogger note: Smile High's Lead Dentist was Dr. Tu Tran, the founder of Kool Smiles in Georgia.)

I took my twin daughters there for their first visit to the dentist when they were 18 months old. Main reason for going there was it's close proximity to my home. We are in a poor part of central Denver.
Strangely, and for the sake of my girls, I was involved in CNA clinicals at a local hospital at this time. The very day, I spent several hours in a class at the hospital discussing the federal laws governing restraint of patients in hospitals and LTC facilities. So, I was educated on this and it's ethical and moral issues.
When I got to the dentist, the first thing I had to do was read and sign a consent form for treatment which listed the 10 ways that the dentist might restrain my child for treatment. This threw me, given the class I'd just had. I was very surprised, this being my first experience taking kids to dentist, that this was a regular part of their practice. When the clinician came out to call one of my daughters back, I got up and started gathering everyone up. She said, "You can't go back." I was aghast! What do you mean? Don't you see this is just a baby? I will go with her, as well as her twin! Well, none of the dentists will treat the child with the parent present, I was told. I couldn't believe it!
So, I asked for the records that I filled out and signed, as well as that restrain form. I left. Not before hearing a young dentist tell me that ALL pediatric dentists were trained in this practice of restraint and disallowing parents into exams. He warned me that I would not another dentist in this city who would allow me to accompany my child into the exam. I told him that my child would just not have dental care then!
Next day, I took that form into class for my instructor to see. She told me that EVERY form listed there was patently illegal practice with ANY patient in the US, by FEDERAL law. So, my advice: if you or your child is subjected to this practice when going to the dentist, call them on it. Tell them you'll report them to the Dental licensing board for illegally using restraint.
Thankfully, we have found a great pediatric practice here in Denver which has wonderful doctors and staff. They always allow me to be present for exams and NEVER use restraint or scare tactics for treatment. They are clean, bright and have a great attitude. And all my children, the twins are 9 now, son 6 and daughter 3, enjoy their visits to the dentist without fear. It's called Primary Dental and they are located in Wheatridge, CO.
I have heard some horrible news reports about children subjected to numerous root canals on their baby teeth in one visit. These are primarily done on children who have medicaid coverage. And it's been found that these dental practices are using any way they can to overbill medicaid. Some ex employees interviewed told of promotions and expectations of employees to add services to pad the bills to the government. Adult practices won't even do more than two at a time! Another report about a 6 yr old boy who was so severely restrained that the dentist broke his leg! So, please, you owe it to your children to find another practice, if this is happening to them. LISTEN to them about their fears if they are distressed about visiting the dentist!
Good luck and take care.
_____________________________________________________________

Jen in Fairmount, GA says this about Kool Smiles
August 2007

I don't know the reason, but I am so happy to know no one else who has Wellcare will be fooled into going to Kool Smiles again! I wish they had pulled them a month ago so we would not have taken my grandson. I hope they do go out of business!!! I don't know what kind of dentists they are (we weren't allowed to know) but they did provide one of the most traumatic events of my daughter, grandson, and my lives. We had no plans to ever go back, anyway, but I wish it had not been an option in the first place!

______________________________________________
Frm Kool Smiles Employee, Virginia Beach, VA
August 2007

I believe your news station may want to look into this matter on a deeper level. I resigned my employment with Kool Smiles due to the type of care the children were receiving and the way in which the corporate leaders were managing/reporting the billing of such dental care to Peachtree/Medicaid.
Several months ago Medicaid entered many of the Kool Smiles offices, unannounced, and seized dental records - including x-rays. It is clear now what the audit revealed. The children's dental needs are the most important issue here and by Peachtree/Medicaid pulling their contract the results of the care the children were truly receiving had to have been clear in the records/x-rays.

_____________________________________________
Whib101, Roswell, GA.
August 2007

You folks do not have a clue.. I am very familer with the corp ops of Kool Smiles. They operate a medicaid mill. Those poor kids have multiple dental procedures performed at one visit. How may adults out ther get a extraction, root canal and crown work done at one sitting. For Dr Strange to say these 71,000 kids would be without a dental home is a joke. There is no continuity of care in this operation the kids do not even see the same dentist on follow-up visits. The dentists practicing at these locations are not even board certified pediatric dentists.
Its no wonder they only serve govt funded patients... private insured patients would not tolerate the substandard practices this operation conducts
Thank God those two managed care providers through clinical audits recognized what these profit maximizers were doing !
______________________________________________________
Sharon, Gainsville, GA
August 2007

I personally took my children to a Kool Smiles office where they were given a total of 6 crowns that their current dentist has now said were completely unnecessary. Also, I filed a lawsuit against Kool Smiles for damage and injuries that my the 3 year old daughter received during her treatment. In my opinion, no responsible parent should ever settle for the lack of care received at Kool Smiles. Many private offices accept Wellcare and provide much more personalized, quality service.
________________________________________________________

This blogger could just go on and on with these type of complaints, opinions and thoughts. This is just an example of the type of complaints out there about Kool Smiles, Smiles High, Small Smiles and the like.

Wrapped In A Rainbow

Telling a child he/she will be wrapped in a rainbow sounds wonderful doesn't it, but here is the real truth.

It's still a straightjacket, papoose board, pediwrap, no matter the pretty colors.

At Specializedcare.com here is the info on the "Rainbow Wrap". Note at the bottom it tell the dentist/user to check with their state laws on using one of these.

On the website this is the "fine print", I made it the Large Print.

The Rainbow® Stabilizing System is the most flexible and comfortable system available to prevent sudden and unsafe movements. The mesh wrap is breathable to reduce patient overheating and the soft padded board provides greater patient comfort.

The NEW Rainbow Wrap is made of "sport-mesh," which is strong, but less rigid, making it more comfortable for your patient.

The Rainbow Wrap is now 'coat-length,' meaning that it stops above the knee. A wide, 6-8" velcro strap is provided to stabilize the legs and knees and to prevent kicking. With this strong strap, the legs can be stabilized first, so the patient will be better controlled as the Wrap is secured.

The Rainbow Wrap can be used as a one-piece or a two-piece wrap. Velcro strips lock the top and bottom halves of the wrap together, for those who prefer a one-piece system. Just remove the Velcro strips to have the flexibility of two-section Wrap.

The Rainbow Stabilizing System now comes with a Laundry Panel. When this panel is placed over the 'hook' Velcro on your Rainbow Wrap prior to laundering, it will help prevent lint and other materials from sticking to the Velcro, thus extending the life of your Wrap.

Head stabilizers are sold separately.

Important: Consult the appropriate authority in your state for regulations on the use of stabilizing devices.

Interview with the Journalist Who Broke This Story in Washington DC Area

Interview with Reporter, Roberta Baskin from WJLA-TV, in Washington DC who brought the use of Papoose Boards to the attention of the public.

Thanks to Poynter's Online
An Investigation

WJLA-TV investigative reporter Roberta Baskin aired a story Monday night about the nation's largest chain of for-profit dental clinics. With 66 clinics nationwide, Small Smiles makes a good living off Medicaid. (Watch the story. Warning: It is hard to watch.)

WJLA said it found x-ray technicians who were not licensed to perform the work they were doing, and the station said young children were sometimes children-strapped to "papoose boards" that kept the kids immobile during uncomfortable procedures that their parents were not allowed to witness.
The station said the clinics also quoted former clinic workers who said they were pressured to push baby root canals as treatment because such treatments are lucrative.

I interviewed Baskin via e-mail to learn more about the investigation:

Roberta Baskin

Q. How did you find this story?

A. It began with picking up the phone and listening to a random caller. She was a dental assistant who said she'd been fired for complaining about how her clinic treated Medicaid kids. She went on to describe a bonus system, with daily financial goals, which she believed provided an incentive to do unnecessary procedures for more Medicaid money. At first she complained to the Maryland inspector general's office overseeing Medicaid. But they referred her to the Better Business Bureau. That riled her enough to call WJLA.

Q. What surprised you the most?

A. It surprised me most that the small policy clinics have a policy to separate children from their parents and say it's a privacy regulation under the Health Insurance Portability and Accountability Act (HIPAA). It surprised me even more that they let our cameras in the back, when they wouldn't allow parents in. It also surprised us how much access we got and how much video we were allowed to shoot of questionable practices. The dental staff is so used to doing what they're doing that they didn't seem to think there was anything unusual about their treatment of Medicaid families. It's just the way those Small Smiles clinics we videotaped do business.

Q. How did you get access to patients?

A. We brought patient consent forms in English and Spanish and asked for permission. Some families said yes, others declined.

Q. How were you able to prove the story to be true, given that you are dealing with HIPAA, Medicaid and medical board oversight?

A. It's a complex system. In addition, there are managed care agencies between the clinics and the state, each with their own rules of engagement. We interviewed more than 100 people: dentists, associations, dental boards, inspectors general, Medicaid, dental assistants, on and on. There are other former employees of Small Smiles we interviewed who were afraid to go on camera, but their stories laid out the same issues.

Q. Just the topic of dentistry, little kids getting root canals and being tied up in "papoose boards" all sounds disturbing. Did you have any concerns that people wouldn't watch it?

A. Yes. It's not a pretty subject. A newsroom employee outside editing was in tears just listening to the children cry. Another production staffer was sobbing after seeing it. We had an extraordinary response in e-mails and calls from viewers. Most were angry at the practices, some were upset by what they saw. And yes, a few were angry at me. We needed to show what we saw so people would see what they otherwise couldn't. We also made an effort not to show shots in the mouth or too many faces. The photojournalist purposefully shot Miguel's feet because that told a lot of the story.

Q. What did you learn when investigating this story that other journalists should know?

A. The most important stories are always the hardest. This one was a challenge on many levels. But tenacity and patience eventually pay off. Also, you don't have to shoot on hidden camera. Going through the front door is always best. A child had died in Maryland from a brain infection caused by untreated tooth decay. It highlighted the fact that four out of five dentists refuse to take Medicaid kids. Small Smiles has a business model that exclusively handles those kids. We just asked to see how they do it.