Texas Medicaid dental program pays millions for crowns, fillings

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by BYRON HARRIS

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WFAA

Posted on June 20, 2012 at 10:09 PM

Updated Wednesday, Jun 20 at 10:21 PM

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NEWS 8 INVESTIGATES

One year after News 8 began looking into the $1.5 billion Texas Medicaid dental program, its executives have either announced their departure, already left, or have been reassigned.

Texas Health and Human Services Commissioner Tom Suehs has announced his retirement.

Medicaid Commissioner Billy Milwee, who was promoted earlier this year, has announced his retirement.

The dental director, Dr. Jerry Felkner, quit last fall.

And the chief of Dental Public Health, Dr. Linda Altenhoff, has been assigned new duties.

These changes came after News 8 revealed that more than $500 million was paid out for Medicaid children, primarily for cosmetic braces.

Meanwhile, Medicaid data obtained by News 8 under the Texas Public Information Act indicate a potentially larger problem with steel crowns and composite fillings.

Last year, the state paid more than $100 million for 690,145 steel crowns on children's' teeth, all of them for kids less than nine years old.

While much of that treatment was surely needed, critics say the Medicaid dental system is being grossly abused by a few dentists.

David Alvarez was five years old when he went into a corporate dental office in San Antonio, accompanied by his father and grandmother. 

His parents expected that David might need four crowns. He emerged from the office with 20.

"He looked like he got beat up," mom Teresa Alvarez said. "His lips were swollen. He couldn't close his mouth. He looked like a robot."

Dallas Freeman was only three when he went to the same San Antonio dentist. He came out with 15 caps on his teeth. Dental records show the dentist spent less than 23 minutes working on Dallas' mouth.

Taxpayers paid $3,800 for the procedures.

"He was crying," said his mother, La Toya Freeman. "They strapped him down so he could barely move."

Children are often restrained on "papoose boards" while undergoing dental procedures. Both David and Dallas required oral surgery under sedation after their initial treatments.

San Antonio Attorney Tom Crosley is suing several corporate dental chains in Texas. "We have been shocked at the amount of Medicaid fraud or over-treatment going on with kids in our communities," he says. "The kid goes into the appointment and has no complaints, no symptoms, no teeth hurting. But the kid walks out 30 minutes later with a mouthful of metal."

Records obtained by News 8 show Clinica Hispana, a storefront clinic at 8410 Fondren in Houston, was the state leader in steel crowns. Every child who got steel crowns there last year received at least nine of them, records show.

Records do not show a dentist at the establishment. Taxpayers spent $337,000 on the procedures.

At Rodeo Dental in Fort Worth, children who got crowns averaged at least eight, at a cost to Medicaid of $1,004,000. All told, the state paid Rodeo more than $1.7 million for steel crowns at three locations last year, records show.

News 8 asked the state for the top 200 Medicaid billers for a number of procedures. Then we took the statistics to Dr.Kenneth Bolin at the Baylor College of Dentistry in Dallas. Bolin noticed that while Rodeo Dental was putting an average of eight crowns on each child, a clinic in Lubbock was putting on only two.

"There's no logical reason there should be that much of a discrepancy," Bolin said. "That definitely deserves a record audit."

In March, News 8 reported that some dental chains have actively recruited patients. One of them was Bear Creek Dental, which has seven clinics in North Texas.

After our stories, State Sen. Jane Nelson wrote HHS Commissioner Tom Suehs that she was "deeply concerned about illegal solicitation of patients." Medicaid paid Bear Creek more than $3.5 million for steel crowns last year.

Dental chain All Smiles, which declared bankruptcy earlier this year, was still able to collect $1.6 million for steel crowns in 2011, records show.

Some chains also bill the state large amounts for filling children's' teeth with composite resins. The leader: Dental Professionals of Texas (DPTX), a chain operating under 23 different names at 40 locations.  

News 8 reported that DPTX helped form a company called Texas Community Outreach Associates to recruit patients.

Kevin Byington, who headed Texas Community Outreach, said he had 400 "community workers" in three states. He admitted DPTX was his "client."

"They [dentists] have a lot of expenses from dental school to pay and they need to be busy," Byington told News 8.

Since our story, Byington's operation has closed.

State records show his client, DPTX, was the state's largest biller for resin fillings under Medicaid last year, collecting $15,870,000. At one DPTX clinic in Fort Worth, Archstone, collections averaged more than $1,000 per patient, records show.

"That would also be a red flag for me," Baylor's Dr. Bolin said.

Three months ago, the state changed the way it manages its Medicaid dental program. It will be months before the results show up.

The Office of Inspector General also has several investigations under way after News 8's stories. Those results, if any, have not yet been made public.

E-mail bharris@wfaa.com

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