DALLAS - Last year, Texas taxpayers spent $184 million so kids on Medicaid could get free braces. Taxpayers did not just pay orthodondists for doing work many in the middle class consider a luxury. Under Medicaid, the public spent $13 million on orthodontic transportation.
Children got picked up, taken to orthodontists' offices, had their braces installed or worked on and were taken home again. Medicaid pays for up to 26 trips per patient.
Many experts say that's evidence of a well-intentioned program gone wrong.
In his office in Dallas, Dr. Deji Fashemo looks at a three-dimensional photo of a child who badly needs orthodontic help. It is a mouth so crammed with teeth it's painful to look at. So in need of structural repair, the patient can hardly open to brush his teeth.
Then Dr. Fashemo pages to another 3-D view of a child with cleft palate, where a tooth, called an ectopic tooth, cannot grow in.
These are the poignant and relatively rare examples of the children the Texas Medicaid Orthodontics program is designed to help.
But with the high amounts Texas taxpayers are expending under Medicaid Orthdontics - as much as the rest of the nation combined - and the ballooning volume of children being treated - 120,000 last year - there are questions over whether all that treatament is needed.
Take Athens in East Texas. Population: 12,000.
Last year, at the Orthodontics Centers of America (OCA) in Athens, Texas taxpayers shelled out $1,679,000 for braces for Medicaid children. At about $2,500 per case, a standard per-mouth benchmark for Medicaid orhtodontics, that amounts to hundreds of cases.
The procedures were all approved by the state.
Like the work done on Medicaid patient Jessica Anaya, who News 8 interviewed across the street from the OCA clinic, just after she had her braces put on. She said most of her friends have braces. But do they have bad teeth?
"No," she said, "not really."
Taxpayers didn't just pay for braces at OCA in Athens. Records obtained under the Texas Public Information Act show taxpayers shelled out $142,529 for 1,797 trips to OCA office last year.
Back in Dallas, looking at the three-dimensional photos, there's little doubt that Dr. Fashemo's patients are in dire need of help. But he knows dollars are scarce.
"If any part of the system is abused by people who don't necessarily qualify," Fashemo said, "resources are finite. So that is taking away from somebody who would be able to get care."
Fashemo and other dedicated specialists in Dallas treat patients many orthodontists either can't or won't care for.
"I do have kids who drive eight hours from Amarillo," he said.
It turns out Amarillo is the home of Goodwin Orthdontics. Last year, Goodwin collected more than $2.6 million from Medicaid for children's braces. Medicaid spent another $171,000 to bring those children to his office.
In June, federal agents raided Goodwin.
According to a search warrant, Michael Goodwin typicaly spent "half of each month" at another dental clinic he owns in Indiana. The search warrant alleges unlicensed assistants did much of the work while he was away. The core of the search warrant is an allegation that says Goodwin performed 23,521 fraudulent Medicaid claims over three years. Federal agents raided the office in an effort to seize his checking accounts.
At this writing, the office is closed and Goodwin was unavailable for comment.
It isn't just rural Texas, however, where taxpayers are footing the bill to transport childre for free braces. The Smile Again clinic in Richardson collected $2.7 million for braces under Medicaid last year.
Despite the fact that the clinic is in the middle of an urban area, Texas taxpayers spent $25,000 last year to take patients there. Dr. Stephen Chu, who owns the facility, did not respond to a phone call.
One of the largest Medicaid Orthodontic billers in the state is National Orthodontix in Corpus Christi. National's clinics collected $9,691,000 for Medicaid braces last year. National has offices from Corpus Christi to El Paso.
But just in Corpus, taxpayers spent $56,900 last year to transport children for free braces.
Many young patients News 8 has interviewed indicate braces are a sign of teenage status. Outside the OCA clinic in Athens, Medicaid patient Noah Davidson says his new braces don't hurt yet.
"I'm sure they will tomorrow," Davidson said. "My friends say they will."
With $197 million spent on pickup, delivery and treatment under Medicaid Orthodontics last year, Texas taxpayers can feel the pain of braces right now.