Investigation Claims Some Dental Chains Providing Unneeded Work To Milk Medicaid Cash Cow

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People covered by Medicaid often complain that they are not getting the treatments that people with private health insurance receive. But a recent report claims that some high-volume dental chains are pushing their dentists to deliberately perform unnecessary procedures on Medicaid patients in order to make more money.

In a new interview with ProPublica, David Heath of the Center for Public Integrity talks about the findings of the Center’s recent investigation into these mega chains.

“We looked at two of the larger chains, and found evidence that these companies were putting pressure on their dentists to produce at certain revenue targets,” explains Heath, whose investigation was the subject of a recent Frontline (scroll down to watch the entire episode), “thus encouraging them to do procedures that may have been unnecessary.”

According to Heath, one chain that focuses on children tries to make up for the low dollar amounts of Medicaid reimbursements by “doing things like taking x-rays that were not needed, or putting stainless steel crowns instead of fillings on their teeth. They could make twice as much money from Medicaid on these crowns versus just putting a filling on a tooth.”

At the other chain, which has around 350 offices in 22 states and focuses on adult patients who have gone years without sitting in the dentist’s chair, Heath found people who received dentures they didn’t need, and had teeth pulled out that could have stayed.

He claims that one 87-year-old went in just to get two teeth pulled, but “Instead they looked at her mouth and they came up with a treatment plan that was going to cost $8,000. They convinced her though hard-sell tactics to borrow that money through a credit card, and something like $2,000 of that was just to clean her teeth.”

Heath says that these huge firms recruit recent dental school grads who see this as a quick way to get out from under hundreds of thousands of dollars in student loan debt.

What drives these huge chains, the investigation found, is the fact that they are owned by private equity firms, which have adopted their management style to a health care business.

Explains Heath:

“You have people who are not dentists coming up with a business plan that’s based on metrics. They try to get new patients in who haven’t been to the dentist in a while, and they’ve already calculated how much revenue the average new patient should generate.

If you happen to go in and you don’t really have anything wrong with your mouth and you’re a new patient you’re not fitting the model. That creates pressure for the dentists to find things that are ‘wrong.’”

Since the Frontline episode aired in the summer, a Senate investigation has begun. Likewise, some states, including Texas, have begun their own studies of possible Medicaid abuses. However, as the wheels of government often turn so slowly as to be imperceptible, Heath admits it could be quite some time before the impact of his investigation is found.

Now you can plug in your headphones and ride out the rest of the workday watching the Frontline episode: