U.S. Senate report critical of dental clinic chains

Small Smiles chain should be booted from Medicaid program, report recommends

0 | Medicaid-CHIP, Oral Health

— A two-year investigation by the U.S. Senate concludes that corporate-owned dental chains have provided substandard care to poor children covered by Medicaid, while overbilling the joint federal-state program.

The bipartisan report goes so far as to recommend that the company that operates the Small Smiles dental chain should be booted from Medicaid.

Small Smiles clinics focus almost exclusively on children covered by Medicaid. It is the largest dental chain in the country with 63 clinics in 19 states and Washington, D.C., — including Wichita, Topeka, and Kansas City — according to the chain's website.

The Senate report says the company has incentives for dentists to do more work on children’s teeth than some kids really need as a way to boost revenue.

“Fortunes should not be made on Wall Street by sacrificing proper care for the underprivileged,” says the 1,500-page report put out by U.S. Sens. Charles Grassley (R-Iowa) and Max Baucus (D-Montana).

In a written statement, Small Smiles characterized the report as outdated: “We do not believe that this report adequately reflects the current operations.”

In January 2010, the U.S. Department of Justice charged Small Smiles owner — Forba Holdings LLC — with Medicaid fraud, saying the chain was liable for:

"...causing the submission of claims for reimbursement for a wide range of dental services provided to low-income children that were either medically unnecessary or performed in a manner that failed to meet professionally-recognized standards of care. These services included performing pulpotomies (baby root canals), placing crowns, administering anesthesia (including nitrous oxide), performing extractions, and providing fillings."

Forba settled in June, 2011 and later that year changed its name to Church Street Health Management, which is based in Nashville.

"In this case, Forba put greed and profits before the well-being of children," U.S. Attorney Timothy J. Heaphy said then. "It endangered the health and safety of innocent children and defrauded the taxpayer of millions of dollars. Today’s settlement addresses these egregious acts and sends a clear message that Medicaid fraud will be expeditiously addressed."

In Church Street's response to the report, it said that it is a "new company with no prior affiliation" to Forba.

'No complaints' in Kansas

Lane Hemsley, who heads the Kansas Dental Board, said that he has not heard such complaints around here.

“I don’t recall that I’ve received any complaints, and certainly there’s no open public records regarding any complaints about the franchising operations since these laws went into place in 2011,” Hemsley said.

Audio clip

KPR story: U.S. Senate report critical of dental clinic chains

Listen to Audio Clip

Hemsley says Kansas law requires franchised clinics to be owned by a dentist licensed in Kansas. The role of the management companies is limited to the non-medical aspects of the clinics.

But the Senate report says that the contracts the company requires of franchisees render the “owner dentist” an owner in name only, and almost all profits go to the chain's corporate owners. The report also said dentists are required to treat a high volume of patients, which limits the quality of care they can provide.

An investigation by Frontline last year found similar complaints about unnecessary and substandard care at Kool Smiles, another corporate dental chain owned by private-equity investors. Senate officials said they tried to include Kool Smiles in their investigation, but the company did not cooperate.




Small Smiles on KWCH TV, part 1 of 3




Small Smiles on KWCH TV, part 2 of 3




Small Smiles on KWCH TV, part 3 of 3




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