NEWS 8 INVESTIGATES
From the air, it looks like there's a shark in swimming pool of the 13,000-square-foot mansion in Frisco. Turns out the shark is only painted on the bottom, complementing the water slide, next to the tennis court, which gives the place the look of a resort.
It all belongs to owner of Smiley Dental Clinics, which last year collected at least $1.9 million in medicaid orthodontics (MO) fees, according to state records.
While the shark in the dentist's pool may be an illusion, it's not imaginary that Texas dentists have been swimming in a sea of Medicaid money over the last three years.
Orthodontics — braces on teeth — may be a luxury for the children of middle-class families, but since 2008, the state has shelled out more than $400 million to put braces on poor kids.
State records show that 34 Texas clinics collected more than $1 million each in payments last year.
No permanent teeth? No problem
In general, children don't have all their permanent teeth until they're 12 years old. That's why the Texas Medicaid Provider Manual limits orthodontic services to the treatment of children 12 and older.
"The rules are clear," explained Dr. Kenneth Bolin of Baylor College of Dentistry in Dallas. "Children under 12 do not get full orthodontic treatment."
But the state has been regularly breaking its own rules.
Last year, nearly 19,000 children under 12 got braces, according to state records. That's 24 percent of all the kids who received Medicaid braces.
State rules do allow special exceptions for children under 12, but each special case must be personally reviewed by the state dental director. Baylor's Dr. Bolin says it's unlikely that the state dental director reviewed nearly 19,000 cases last year.
News 8 was unable to ask Smiley Dental about its practices in treating patients under 12 because it did not return our phone calls.
"Clearly, these are thousands and thousands of children who are getting braces not because of a health-related reason, " said State Sen. Jane Nelson (R-Flower Mound).
After she saw News 8's investigative report, Sen. Nelson added two riders on the Health and Human Services Commission budget.
One rider calls for the state to evaluate placing Medicaid dental services under managed care. Instead of paying on a fee-for-service basis, as it does now, the state would manage the total delivery of dental services. This evaluation is to be completed by March, 2013.
"We need to see if there are certain companies or individuals that are not being totally honest about what they're doing," Nelson said.
To that end, she also sponsored a rider for stricter enforcement of regulations. The language calls for the Inspector General of Health and Human Services to strengthen its ability to "detect, investigate, and prosecute abuse by dentists and orthodontists under Medicaid."
Nelson has also asked the Texas Dental Board, by letter, to beef up enforcement.
Both of Nelson's riders passed the State Legislature and were signed into law Friday by Gov. Rick Perry.