The Center for Public Integrity’s David Heath, who has done extensive reporting on the practices at Small Smiles dental clinics, was quick to get out the news on July 23:
The headline was “Senate report recommends ouster of large dental chain from Medicaid program.”
“One of the nation’s largest dental chains for children should be thrown out of the Medicaid program for encouraging dentists to perform unnecessary treatments to boost profits, a new U.S. Senate report concludes,” Heath wrote.
“A two-year Senate investigation of dental chains owned by private-equity firms found that Small Smiles’ business model deceptively gave managers rather than dentists control over the clinics. The report said that management set daily production goals and awarded dentists bonuses based on the amount of work they do, resulting in overbilling and poor quality of care,” added Heath, who collaborated with Jill Rosenbaum of PBS on a 2012 investigation, “Dollars and Dentists,” that took a hard look at Small Smiles and other dental chains.
The 1,500-page report, released by Sens. Charles Grassley (R-Iowa) and Max Baucus (D-Montana), offered its own grim assessment of clinics it concluded were controlled by corporate investors rather than dentists.
“Fortunes should not be made on Wall Street by sacrificing proper care for the underprivileged,” noted the report.
Baucus, chairman of the Committee on Finance, and Grassley, ranking member of the Committee on the Judiciary called upon the U.S. Department of Health and Human Services to ban dental clinics from participating in the Medicaid program if the dental clinics skirt state laws designed to ensure that only licensed dentists own dental practices as part of an effort to prevent substandard care.
“Any company that subjected children to painful unnecessary dental procedures at taxpayer expense has no place in the Medicaid program,” Baucus said.
While many of the clinics technically meet state-level rules requiring their owners to be licensed dentists, the report concluded, the clinics have placed control of their operations in the hands of corporate investors and the result is a system that “places profits above patient care.” Twenty-two states and the District of Columbia ban corporate dentistry, according to the report.
For their part, Small Smiles officials responded by describing the report as outdated.
“We do not believe that this report adequately reflects the current operations,” Heath reports they said in a written statement.
Last year, the company changed hands while in Chapter 11 bankruptcy. The new owner, Nashville, Tenn.-based CSHM, told Heath it has no affiliation with the previous owner and has a new management team that is trying to fix the problems at Small Smiles.
But with Small Smiles clinics in Dothan and Montgomery, Ala., and other corporate clinics located elsewhere in the state, the story was also picked up by Eddie Burkhalter of The Anniston Star.
“Several Alabama dental clinics are operating in violation of state law, and are putting profits before patient care, according to a report released this week by the U.S. Senate Finance Committee,” Burkhalter wrote in his own thorough report.
“Those clinics are performing unnecessary procedures to pay the corporate investors that own the clinics, the report states. The report recommends that state and federal agencies end that practice by enforcing existing laws.”
In Pittsburgh, where ABC affiliate WTAE began reporting on questionable practices at Small Smiles in 2010, reporter Paul Van Osdol offered another local angle on the evolving story.
Van Osdol spoke with families outside a local Small Smiles clinic about the Senate’s findings.
“If you have the U.S. Senate saying this company should not get more money from Medicaid, what does that tell you?” Van Osdol asked the father of one young patient.
“That’s telling me something’s wrong, something’s not right, time we do a little investigation of our own,” the father replied.
