Previously I have written an article titled Fraud and Abuse in Medicaid Clinics where a discussion was made that currently dentists have large amounts of debt when they graduate from school. This leads to them having to face potentially hard and difficult choices to pay their bills as they essentially become indentured servants.
Recently Senators Charles Grassley (R-IA) and Max Baucus (D-MT) published a 1517 page report in June 2013, titled “JOINT STAFF REPORT ON THE CORPORATE PRACTICE OF DENTISTRY IN THE MEDICAID PROGRAM.” This report is a very large PDF file (143 MB) and is available for download over at http://www.finance.senate.gov/library/prints/. Don’t be intimidated by the size of the report though as it really is a bit over 30 pages with the rest of the 1400+ pages serving as an appendix. Hence, it is very readable.
The report talks about dental management companies that in some cases own dental clinics and have complete control over operation which includes clinical care provided by dentists. Some states have specific requirements which only allow a licensed dentist to own a clinic. However, the report discusses how some dental management companies have deceptive ownership structures which may hide from state authorities that the owner of the clinic is in name only. The report discusses how many of these clinics focus on low income children on Medicaid and provide unnecessary treatment hence putting profits ahead of patient care. This wastes tax payer funds.
The report examines five different corporate dental chains but focuses more on two of them. The report makes three recommendations:
- That any corporate entity that employs a fundamentally deceptive business model resulting in a sustained pattern of substandard care should not be receiving Medicaid funds.
- That states should enforce existing laws against the practice of corporate dentistry
- That states should consider licensure of mid-level providers to provide dental care to low income children on Medicaid and allow them to be reimbursed for their services
The third point is a point of controversy and contention in the dental community. The report discusses how dentists don’t participate much in Medicaid due to low reimbursements and that low reimbursements may in turn lead to abuses of low income children. The report says
“…dental therapists are able to perform basic dental procedures that are in great demand, such as filling cavities and extracting childrens’ primary teeth. These training programs are shorter than dentistry school, and the therapists receive pay that is roughly half of what a dentist would receive. The ADA has opposed these positions out of fear that mid-level providers will provide substandard care.”
This is a very lengthy report and much information is contained in it. If you are looking for a summary and some additional information without downloading the full report, there are few articles on the web that do just that. See
1) Donna Domino. Senate report wants dental chains booted from Medicaid. July 24, 2013. http://www.drbicuspid.com/index.aspx?sec=sup&sub=pmt&pag=dis&ItemID=313851
2) Eddie Burkhalter. Alabama dental clinics operating illegally, Senate report says. July 25, 2013. http://annistonstar.com/view/full_story/23212853/article-Alabama-dental-clinics-operating-illegally–Senate-report-says?instance=top_center_featured