Thursday, December 17, 2015 by Julie Wilson
An Atlanta-based dentistry chain accused of performing painful and unnecessary work on children before billing it to Medicaid has settled a lawsuit with the parents of 618 Texas children. Details of the settlement remain unknown due to the fact that the plaintiff’s attorney, George Mauzé of San Antonio, was asked not to speak on the case while negotiations are still underway.
Embroiled in the drawn out legal battle is Kool Smiles, the largest Medicaid dentistry provider in the country, servicing approximately 2 million underprivileged children through 129 offices in 15 states and the District of Columbia.
The dispute began several years ago when plaintiffs accused Kool Smiles of performing inappropriate and unnecessary work on their children including the placement of oversized stainless steel crowns to treat cavities (rather than fillings), and strapping children to papoose boards and extracting their teeth or doing root canals without sedation, reports Courthouse News.(1)
Kool Smiles has been accused of malpractice in four states including Connecticut, Massachusetts, Georgia and Texas.
An investigation of Kool Smiles in Conn. uncovered unsatisfactory dental work, some of which could be considered abuse. After reviewing X-rays of child patients, the state’s Medicaid director became concerned “when she saw a disproportionate spike in kids getting stainless-steel crowns to treat cavities coming from a number of dental offices,” according to PBS’s FRONTLINE.(2)
“The state pays at least $230 for these shiny crowns, compared to as little as $100 for a filling. But their use is controversial to treat small cavities.”
“The X-rays didn’t show a need for these kinds of services,” said Donna Balaski, head of Connecticut’s Medicaid dental program. “What we tended to see was that there was a small cavity and they wanted to put a crown on it.”
Another incident involved a Kool Smiles dentist applying a painful crown to a three-year-old, causing her gum’s to bleed. After seeing a new dentist, the parents learned that the child’s tooth only had a stain and not a cavity.
Similar instances of malpractice also occurred in Texas. In 2013, 15 parents sued three Kool Smiles affiliates and four dentists. That same year, 19 more lawsuits were filed against the Medicaid provider.
In an attempt to “streamline the litigation, the state’s Multidistrict Litigation Panel, administered by the Texas Supreme Court, transferred the cases to state Judge Noe Gonzalez in Hidalgo County in March this year for pretrial proceedings.”
“In November 2015, additional suits were filed on behalf of 490 minor children against Kool Smiles and numerous defendant dentists. In all, suits have been filed on behalf of approximately 618 minor children,” according to court documents from Brazos County, where the Jan. 2013 cases were filed.
The parents of 11 children, whose ages range from two- to eight-years-old, allege in the Nov. 2015 complaint that dentists working at a Kool Smiles location in Bryan, Texas, subjected children to “painful and unnecessary treatments that [they] billed to Medicaid,” Courthouse News reports.
The alleged malpractice by Kool Smiles highlights an increasing trend of providers taking advantage of the Medicaid system, overbilling for unnecessary services. It also illustrates the failure of government assistance programs. While designed to give kids care they otherwise couldn’t afford, in this case, Medicaid services often provide much lower-quality care than patients who visit regular dentists.
“Parents and kids don’t like the look of the shiny crowns, and dentists acknowledge they’re used less often on children from families that can afford dental care [emphasis added],” FRONTLINE reported. “Yet crowns are common on Medicaid patients. Guidelines from the American Association of Pediatric Dentists say that crowns are appropriate for children with large or extensive cavities, especially if they aren’t likely to take care of their teeth.
“Crowns are more profitable than fillings for dentists, because they can charge more for them,” and they only cost the dentist $8 each.
Kool Smiles does far more crowns than average on children age 8 and under on Medicaid, according to an analysis of 2010 Medicaid data in two states done by CPI and FRONTLINE. In Texas, a child under the age of 9 at Kool Smiles has nearly a 50-50 chance of getting a crown as a restoration to treat problems like cavities, our analysis found. That compares to a one in three chance on average at other providers. And in Virginia, a child 8 or under on Medicaid going to Kool Smiles is twice as likely on average to get crowns than at other dental offices.