NEWS 8 INVESTIGATES
DALLAS -- In the eighteen months since News 8 began reporting on the Medicaid dental program, we’ve discovered hundreds of millions of dollars paid out by Texas that other states don’t pay for at all. We’ve discovered children being lured from their neighborhoods into dental chairs, just for the Medicaid dental fees they’d bring. And we’ve outlined how gift cards have been used to entice parents to bring their kids to certain dentists.
The State of Texas is now cracking down on those practices through enforcement and new systems for reimbursing dentists. But that’s only increased the competition for new, young Medicaid patients and the income they can bring to a dental office. In their worst forms, might be described as tempt and torture.
The Switch Bonus
In the parking lots of Dallas DART stations, crude flyers are being tucked under commuters’ windshield wipers.
“Get paid to take ur [sic] kids to the dentist. The dentist is giving $20.00-$35.00 per kid,” the flyer reads.
It urges people to call a number and talk to a woman named Phyllis Gonzales. News 8 did. She told us that if we switched our children from our old Medicaid dentist to her Medicaid dentist, we would be paid $35 per kid.
This is against the law, according to the Texas Department of Health and Human Services.
Ms. Gonzales told us in a text that the place to go was 1-Stop Dental in Hurst. News 8 went to 1-Stop Dental in Hurst to claim our $35 bonus.
“We don’t do that,” the office manager told us.
He would not tell us his name, but state records and Facebook accounts show he is Ali Mostafaie. He is the owner of 1-Stop Dental in Hurst, Gold Star Dental in Fort Worth, and First Impression Dental in Arlington. Mostafaie is married to Dr. Victoria Tran, a dentist, who works at those locations. Mr. Mostafaie vociferously denied that he or Dr. Tran were making any payments to parents to switch their children to his office.
Three weeks after our visit to 1-Stop Dental, we called Ms. Gonzales back and asked her if she was working for Mr. Mostafaie. “Not anymore,” she said.
She said her income from dentists’ offices had helped her family through hard times.
Tempt and Torture
Up in McKinney, Dr. Jon McClure has no affiliation with any dentist’s office except his own. He has just opened his own practice after a painful journey through the dark reaches of Medicaid dental practice.
After graduating from Baylor Dental School a few years ago, he went to work for a chain of dental clinics with several offices around the state. What he’d learned in dental school was one thing, he discovered. The real world could be something entirely different.
“There’s huge dollars being stolen from the taxpayers,” he said.
McClure was tutored by a company trainer, he said, on how his new employer delivered care.
“I was specifically told every tooth gets something [a treatment],” McClure said.
He learned a new vocabulary. It included words like “production,” “roundhousing,” “head holders,” and “happy checks.”
His office listed each dentist’s “production” on a chart in the office break room. Production is a synonym for how much each dentist was collecting for treating kids every month.
“The low ball was $90,000 a month, the high one was $160,000 a month, which was just astronomical to what my fellow graduates in dental school were collecting,” McClure said.
The patient volume, according to an assistant at one chain specializing in Medicaid, was huge.
“We saw 40-to-50 patients a day,” she said. “Sometimes more.” She worked at two of the highest-grossing Medicaid dental chains in Texas.
Young patients were regularly strapped onto papoose boards, which are similar to stiff strait jackets, that prohibit a child from moving arms or legs. Then, with the child slightly anesthetized, but still conscious, treatment commenced.
A dental assistant known as a “head holder” would hold the child’s head still while the dentist drilled - sometimes nearly every tooth in the child’s head - which were then capped with stainless steel crowns. In the worst clinics, this practice is known as “roundhousing.”
“'Roundhouse' means when you get a mouthful of stainless steel crowns on a five-, four-, seven- or eight-year-old child,” a dental assistant said.
“If you have somebody who’s strapped down and screaming and somebody holding their head,” Dr. McClure said, “how do you do good work that way?”
The children could be traumatized from dentistry for the rest of their lives, dentists say.
Another dental assistant describes the immediate effect of roundhousing on children.
“They will throw up. They will urinate on themselves. They’re sweating,” she said.
Then the children were cleaned up for presentation to their parents, who would be kept in another room.
“We take a hair dryer, we dry their hair," she said. "Give’em a balloon, and they would be presented to the parent.”
In the last six years, Medicaid dental spending in Texas went from $300 million to more than $1.43 billion.
An expansion of benefits began in 2007 with the best of intentions: to improve dental care among poor children. The State of Texas had been a defendant in a lawsuit that accused the state of shorting Medicaid patients. But with expansion, abuses cropped up.
Children up to three years old would now be entitled to as many as four visits per year to a dentist for education, counseling, and preventive treatment. The dentist is supposed to spend several minutes with the parent and child. But some practitioners discovered it is a quick way to get paid up to $157 a visit by Medicaid.
In some offices, the counseling sessions are now known as “Happy Checks.”
“So the dentist would put the mirror in [the child’s mouth], torque it, pry the kid’s mouth open, put fluoride on, and that would take less than a minute,” McClure said.
McClure found all of this deeply distressing. He refused to use papoose boards, got out of corporate dentistry, and returned to dental school for an advanced degree. He now has a new practice in McKinney.
“I even put my own name on the door,” McClure said, "because I don’t want to be associated with anything corporate.”