DALLAS - Many parents know it can cost as much as $5,000 to put braces on a child's teeth. Despite the high cost, it's a financial sacrifice some families make for a child's appearance.
Rarely are braces a health issue. But, while some families struggle to pay for braces, under Medicaid in Texas, tens of thousands of children get braces for free.
Last year, Texas spent $184 million on braces under Medicaid. And while Texas spent as much as the rest of the nation combined, some states, like Michigan and Kansas, spent zero.
Some dental organizations in Texas charge the government millions for braces under Medicaid, seeing hundreds of patients a week. Who's doing all that work? The fact is that many parents don't know, and the state doesn't check.
Under Medicaid, every tweak of a child's braces can mean more money for an orthodontist. And in Texas, nobody does more tweaking than Navarro Orthodontics, which does business under nine different corporate entities in the state.
Run by Dallas residents Carlos Navarro, his brother Marco Navarro and their partners, Navarro Orthodontix - as the umbrella company is known - collects as much money from taxpayers as anyone in the entire United States for Medicaid orthodontics.
Last year, the Navarro operations took in $22 million in a dozen clinics in Texas, according to the Texas Department of Health and Human Services. That's $2.5 million more than the entire state of California.
Navarro Orthodontix is a part owner in a corporate jet, allowing commutes among the cities where the company has clinics, which range from Allen, north of Dallas, to Rio Grande City in the Rio Grande Valley.
A visit to the Rio Grande City clinic in June showed an operation designed for high volume. Banks of chairs lined the waiting room. An information chart for patients revealed one of the cores of the business - Medicaid. The chart tells parents their kids are entitled to 26 visits for orthodontic treatment over three years.
Under Medicaid, taxpayers foot the entire bill.
Not on display in June were the names of the professionals doing the work. State regulations require the name of the dentist to be posted in the office. The receptionist told News 8 the dentist on duty was a Dr. Springer, but she had to check with her supervisor to see if was permissible to release his name.
Parents are not allowed to accompany their children into treatment, said Priscilla Ortiz, who was taking her daughter to the clinic under Medicaid.
"The first time I brought her to get them done, they took her in whatever, and then they called me in letting me know what they were going to do and that was it," Ortiz said. "Every time I come in, we're not allowed to go in."
She said she was happy with the dental work performed on her daughter, but that she did not receive paperwork indicating what the work was, and she said she did not get a bill.
"When we get here, they charge all that at once," Ortiz said.
Records obtained by News 8 indicate Navarro Orthodontix sponsors low-wage dental workers from Mexico.
We obtained a visa for Rosa Ferri Rodriguez. It's a TN visa, granted under NAFTA for people with special technical skills. She was sponsored by Navarro Orthodontix as a "medical technologist."
She's now licensed with the state as a dental assistant, and works at Navarro Orthodontix, according to state records.
Jose Nunez's visa, obtained by News 8, listed him as dentist at Navarro Orthodontix.
He is not licensed to be a dentist in Texas, according to state records. He is licensed as a dental assistant. His pay stubs show he was paid as a dental assistant at Navarro at fraction of what a dentist makes.
The question is who is doing what inside Navarro's offices?
Navarro Orthodontics bills the government at a rate set by Medicaid. The lower wages Navarro's owners can pay, the higher the profits.
Marco Navarro appears to have done well by Medicaid.
He has been licensed to practice dentistry in Texas for five years. During that time, he has acquired a $2.25 million home on the TPC Golf Course at Las Colinas and several other properties in North Texas. Although his dental business is funded by U.S. taxpayers under Medicaid, Navarro himself is not a U.S. citizen, according to his public relations firm.
In answers to written questions, Navarro Orthodontix said the nationalities and names of its employees are private. It says it fully complies with all paperwork requirements of Medicaid.
Navarro also said the names of dentists and hygienists are posted inside every office waiting room. Recent visits to Navarro clinics in Dallas show this now is true, as opposed to what News 8 discovered in June.
The Texas Board of Dental Examiners regulates dentists in Texas. The board said the only way it could take action against unlicensed dentistry is if it received a complaint.
Since parents are not allowed in treatment rooms at many clinics to see who is treating their children, that would be difficult.
"It makes no sense to me," said State Senator Jane Nelson, (R-Flower Mound) of the Dental Board's policies. "And they will receive a complaint from the legislature that they're not doing their job to make sure they're watching over taxpayer dollars."