Complaints to attorneys general yield sources for dental investigation Date: 04/30/13
By Mary Otto
Dollars and Dentists, a joint investigation by David Heath of the Center for Public Integrity and Jill Rosenbaum of PBS Frontline captured a first-place Award for Excellence in Health Care Journalism.
The report, which aired last summer, explored the dearth of care for millions of poor children and adults and raised serious questions about the business practices of dental chains that serve Medicaid children and the elderly.
I caught up with Heath at Health Journalism 2013 in Boston and he was good enough to share some reflections on the making of the project.
Q: What should other reporters keep in mind when looking at their own states in regard to the issues you raised in Dollars and Dentists?
A: It’s really an interesting story because it’s really two major problems compressed into one. There is an alarming lack of dental care for people who need it. We were shocked to find that about half the kids in this country in any given year are on Medicaid and in a lot of the states the reimbursement rates are not good enough, so they don’t get care. So that’s a huge problem.
And then on the other side of it, you’ve got states that actually have decent reimbursement rates and they seem to attract these dental clinics that are turning it into a factory process where they are just getting kids in and out and giving care that is best for the bottom line. So there are two sides to this story. It depends on which state you are in. If you are in a state with a low reimbursement rate, kids are going untreated. And if you are in a state with a good reimbursement rate, you may have kids that are getting bad treatment.
Q: How did this project get its start?
A: The attorney general in New York had announced he was looking at the problem with these health care credit cards and the high interest rates. It really started off that we were looking at other aspects of the financial crisis. The more we dug into it, the more we realized there was a bigger story in these dental clinics that, like I said, operate like mills, so we shifted the focus.
Q: And then you found people to talk with you about their experiences in these places. How did that work?
A: It was easy to go on consumer websites and read the voluminous amounts of complaints that were there, although it was very difficult to get in touch with any of the people. So what we did; we got our interns to write to every attorney general in a state that had a significant number of corporate dental chains and we asked for all the consumer complaints. In some cases we got nothing because the state either didn’t release them, or the state wasn’t known for being consumer friendly, or the attorney general wasn’t the right agency. In other cases, we got a lot. Ohio had a ton. It was hit or miss.
Q: And you sought out the people with complaints. Some were about care received in clinics treating Medicaid children. But others were from seniors who spoke about having bad experiences with these health care credit cards.
A: That turned out to be two separate stories too. The chains that billed to Medicaid have their own business model that is really unique. And then you have these other chains that service adults and those are very different. They work with the credit cards. So you had the adults and the children, and two different business models. It was very different reporting we did for the two of them.
Q: What has been the response to the coverage of these kind of problems?
A: There had been this issue with Small Smiles. It wasn’t a new issue. I don’t think many people realized the problems with Small Smiles are not limited to one chain and that was sort of a systemic problem.
In Texas, one of the Republican leaders in the Senate is sponsoring a bill to regulate corporate dental chains.
There have been lawsuits filed. There are investigations going on in various states. I see an awakening on this issue of interest and action.