- ‘Dollars and dentists:’ Investigating the dental care crisis in the U.S.
- http://www.pbs.org/wgbh/pages/frontline/dollars-and-dentists/
- http://www.publicintegrity.org/health/dollars-and-dentists
Provide names of other journalists involved.
Lead Reporters: David Heath, The Center for Public Integrity and Jill Rosenbaum, PBS Frontline
For PBS Frontline:
Lead Producer: Jill Rosenbaum
Supervising Producer: Carl Byker
Correspondent: Miles O’Brien
Editor: Phil Bennett
Deputy Executive Producer: Raney Aronson-Rath
Executive Producer: David Fanning For The Center for Public Integrity
Editor: Ellen Weiss
Executive Director: Bill Buzenberg
List date(s) this work was published or aired.
Published June 26 & 27, 2012. Aired June 26, 2012.
Provide a brief synopsis of the story or stories, including any significant findings.
We began by exploring the under-reported story of tens of millions of Americans who lack access to dental care. Forty percent of Americans say someone in their family has put off going to a dentist because they cannot afford it. Unlike health care, there are no safety nets for dental care, even though the pain can be excruciating and even fatal. Stepping into that void are fast-growing corporate dental chains owned by private equity firms, which promise lower-income people affordable dental care. But Dollars and Dentists documented how these chains prey on people with few other options. We found widespread complaints of overcharging and unnecessary treatments. We investigated Kool Smiles, the largest Medicaid chain serving roughly two million children in 15 states and the District of Columbia. We dug up proof that the chain uses revenue targets that encourage dentists to over treat children. Even the tiniest of lesions between teeth are treated with prefabricated stainless-steel crowns instead of simple fillings, since Medicaid often pays twice as much for crowns. We found cases where other dentists said no treatment at all was even needed. Though the company denied it had production targets, we were able to obtain confidential records showing the targets and depositions of company executives proving that the Kool Smiles fires dentists for not meeting those targets. We also did an in-depth investigation of Aspen Dental Management, the largest corporate chain serving low-income adults. Our reporting found that its business model relies on finding patients who haven’t been to the dentist in years and diagnosing thousands of dollars in treatment. Because so few can afford the care, Aspen signs patients up on the first day for special credit cards with low teaser rates. Because they are charged in full up front for the treatment, patients find it very difficult to change their minds after signing up for credit. If payments are missed, the interest on the cards skyrockets to rates as high as 29 percent. Like Kool Smiles, Aspen Dental has productivity targets and both patients and former employees complain of overcharging and overtreatment. For example, former dentists said Aspen Dental recommends full extractions and dentures when partials would do.
Explain types of documents, data or Internet resources used. Were FOI or public records act requests required? How did this affect the work?
The fact that Kool Smiles serves mostly Medicaid patients made it possible to obtain data from two states, Virginia and Texas. We compared the ratio of stainless-steel crowns to all restorations for all dentists and found Kool Smiles bills for crowns far more often than other Medicaid dentists treating similar patients. Many other states either wouldn’t give us data or delayed its release. We also obtained thousands of pages of documents through FOIA requests from three states that had done their own investigations of Kool Smiles. These states had determined that Kool Smiles routinely performed unnecessary services and at least two states had found many cases of substandard treatment. The private Medicaid administrator in Georgia had kicked Kool Smiles out of its network. There was also critical information available from lawsuits, including depositions that we were able to obtain from lawyers. Our investigation of Aspen Dental was far more challenging because of the difficulty in obtaining documentation. But sources provided us with internal scorecards used to measure dentist and office performance as well as the contracts dentists must sign. We also purchased a key document from Moodys, a business information service, which provided insight into the company’s financial performance and its business strategy. Finally, we were able to obtain court records for patients who complained of overtreatment. We began our research by requesting complaints made to all state attorneys general in which Kool Smiles or Aspen Dental did business.
Explain types of human sources used.
Perhaps the biggest challenge we faced was to locate and talk to as many former employees, dentists and patients as we could. Because the chains require employees to sign confidentiality and non-disclosure agreements, it was extremely difficult to find folks willing to talk on the record, or on camera. Many spoke to us on background and in most cases we were able to get documentation for what they told us. But, it took a lot of time, and a lot of reporting. One of our sources received a letter from Aspen Dental threatening legal action right before publication. It was a challenge to find patients willing to talk on the record. We required each patient to get a copy of their dental records, which we then sent to our own dental experts. Aspen Dental in particular took extraordinary steps to delay the release of its records, in violation of state dental laws. In one case, the patient had to file a complaint with the state dental board before the records were released. It was also difficult to find dentists willing to criticize other dentists on the record. In addition, we reached out to state dental boards, dental directors of state Medicaid programs, professors at dental schools and heads of nonprofit dental treatment programs.
Results:
The day after our stories broke, Sen. Charles Grassley, R-Iowa, announced that his investigators had found evidence of abuses by corporate dental chains treating children on Medicaid. He continues to investigate. The Texas state legislature asked a Kool Smiles executive to testify about the problems we had uncovered. A Republican senator listened to the executive defend the chain and then read her our story, telling her that they continue to have concerns. The legislature is still considering options. Authorities in Texas say privately that they are conducting both a criminal and civil investigations of Kool Smiles for Medicaid fraud. A similar investigation is under way in Massachusetts and Virginia. This fall, a class action lawsuit was filed in federal court in Aspen Dental’s home state of New York by 11 patients alleging that Aspen Dental owns and controls its 358 dental clinics in violation of laws in 22 states which allow only dentists to own a dental practice. The suit heavily cites our series.
Follow-up (if any). Have you run a correction or clarification on the report or has anyone come forward to challenge its accuracy? If so, please explain.
We have done follow-up stories on reaction to our stories. There have been no corrections or clarifications. Prior to publication, Kool Smiles compiled a lengthy response that we incorporated in the story and posted on our Web site in its entirety. Kool Smiles later hired an economic consultant, who essentially replicated the analysis that Kool Smiles had already done.
Advice to other journalists planning a similar story or project.
We would tell other reporters that there is a lot of fertile ground here. There is a lot of local reporting to be done, as well as reporting on dental access, inadequate regulation, the role of corporations in providing dental care, and the growing shortage of dentists in this country. There is also a great deal of need.