NEWS 8 INVESTIGATES
Thousands of kids get free dental care under Medicaid in Texas. Texas taxpayers foot the bill, including putting crowns on the teeth of toddlers who don't yet have their permanent teeth.
A News 8 investigation finds that some dentists want that Medicaid business so badly, they hire recruiters to bring in patients.
At a Texas Health and Human Services Office on Masters Road near Dallas, a man quietly stands in the parking lot, waiting for mothers who've just received food stamps to emerge from the waiting room.
He is a recruiter. He's handing out cards for Happy Teeth Dental, just two doors down in the same complex.
At another HHS office across town, two women also wait for new food stamp recipients. They're handing out cards for Lancaster Dental a few miles away.
And at another HHS office just up the road, Bear Creek Family Dentistry has a small kiosk set up to recruit new patients.
Medicaid parents are regularly solicited by dentists offering free stuff — such as iPods, zoo tickets, and electric toothbrushes — if they take their kids to certain dentists.
It is a little-seen side of Medicaid dentistry, a $1.5 billion business in Texas, where, statistics show, welfare and unregulated free enterprise come together like nowhere else in the United States.
Demera Brown recounts what happened to her outside the HHS office on Masters Road. "They asked me to set up an appointment, and they would give you a discount on your dental work and they would give you a $10 gift card," she said.
In this case, it was a gift card to Walmart.
So last spring, Ms. Brown took her 19-month-old son Prentis into the Happy Teeth Dental office.
She said Prentis' teeth were fine at first. Texas Medicaid encourages parents to take their children to the dentist beginning at six months of age, up to four times a year, until they are 35 months old.
Those visits can cost taxpayers about $600 annually per child. The idea behind the frequent visits is that early exams and education will prevent problems later on.
Prentis' oral health was fair on that first visit, records show. The visit cost Medicaid $144.97.
On his next visit three months later, the Happy Teeth dentist said Prentis' oral health was poor. A lot of work was needed.
Records show the dentist told Ms. Brown he was going to do four pulpotomies and install four steel crowns on his teeth. A pulpotomy is, in essence, a baby version of a root canal.
Ms. Brown told News 8 she didn't know what a "pulpotomy" was.
The doctor strapped Prentis into something called a papoose board, often used for young patients, gave him nitrous oxide, did four pulpotomies and put four steel crowns on his four upper front teeth.
The cost to Texas taxpayers, records show, was $1,282.45.
News 8 showed Prentis' X-rays to Dr. Carolyn Wilson of Baylor College of Dentistry. She said the X-rays indicated Prentis did have cavities on the teeth, but said they appeared to be small.
"Without looking at the patient, I can't give you a definitive answer," about the treatment, she said. "But by looking at these X-rays, I would never jump to the four 'pulp' and four crown plan."
Prentis' dental journey, however, would get worse.
Five weeks after the crowns were put on his teeth, he developed a fever.
"His mouth was really, really big," his mother said. Photos from her cell phone show his upper gums were swollen. Two of Prentis' teeth under the new crowns were abscessed.
Another dentist had to pull them — at taxpayer expense.
Prentis' grandmother, Cassaundra Brown, went back to Happy Teeth to complain to the dentist. "He asked if there was anything he could do," she recalled. "There was nothing he could do... Prentis didn't have any teeth left."
"Texas is the epicenter of a disaster of Mediciad dental," said Houston attorney Jim Moriarty, who is suing one chain of dental clinics for mistreating children under Medicaid.
"There's no leadership whatsoever restricting what these people can do." he said.
Records obtained by News 8 under the Texas Public Information Act show that in 2010, the most recent year for which statistics are available, Texas spent $145,349,000 on pulpotomies and crowns, the kind of work done on Prentis. By comparison, the State of California — which has twice as many children as Texas — spent less than one half as much — $54,285,000 — according to the figures available from that state.
Bear Creek Family Dentistry, with five North Texas locations and its booth at the food stamp office, was paid $7,831,000 for steel crowns and pulpotomies in 2010.
By comparison, the entire State of Florida spent $5,346,000.
"Why isn't anyone policing this?" Moriarty asked. "Why isn't the governor policing this? Why isn't the attorney general policing this?"
At Happy Teeth Dental, we asked to speak to Dr. Alex Molayem, who is listed as the dentist there.
He never responded.
A man in the office who identified himself as the dentist's brother and Happy Teeth district manager, said the clinic does not employ salesmen.
The Texas Dental Practice act says it is "illegal to pay ... directly or indirectly ... for securing or soliciting a patient for a dental clinic."
Bear Creek Family Dentistry did not return phone calls.
It is not against federal law to give away small gifts under Medicaid. The theory is, it is so beneficial to get a child to go to the dentist, it's all right to give them a gift.
Demera Brown and her son Prentis may not agree.