NEWS 8 INVESTIGATES
They might be called bounty hunters.
They're dressed as dental professionals, but they are recruiters whose job is to find Medicaid-eligible children for dentists to work on.
In 2010, Medicaid paid $1.6 billion for dental work on children, more than $500 per child.
The recruiter's job is to entice parents to take their children to the office of a certain dentist. They often give free gifts to parents to seal the bargain.
Some dentists, in turn, compensate the recruiters by giving them a bonus for each child they bring in to the office.
All of it is ultimately funded by taxpayers' money.
On a recent Friday afternoon on John West Road in East Dallas, Juanita Bonner was walking along a sidewalk after picking up her children from the school bus. With her kids by her side, she was stopped by a van from Access Dental.
"Today he offered me a free pizza dinner," Bonner said. It was not a rare occurrence. It happens every day, she said. "Not just Access... it's everybody."
The freebies dispensed in the battle for patients are diverse: Pizza dinners, manicures, pedicures, and the most prized of all: Walmart gift cards.
"Can you imagine getting a $20 gift card just to bring your kid to the dentist?" asked grandmother Linda Passow.
Her daughter, Misty Kinney, has three children. Mother and daughter were fueling their car at a Mesquite shopping center when they said they were approached by a man who appeared to be wearing dental scrubs.
Kinney recalled what he told her: "'Each child we get in [to the office]" we give out a $20 gift card.'"
Kinney got an appointment card from the recruiter and set up a time for Misty's son to visit the AmeriSmiles clinic . Then, mother and daughter called News 8. More on that later.
A couple of miles away, at the Galaxy Dental office on Garland Road in Dallas, News 8 observed a more discrete operation on several mornings. A group of women dressed as community service workers went into the Galaxy office, then emerged to fan out into neighborhoods to talk to Medicaid moms.
Galaxy is part of a chain of dozens of dental clinics in Texas.
The women, it turns out, are part of an army of 400 people called Texas Community Outreach Associates who are paid salaries to funnel patients to Galaxy and its affiliates.
One-to-one solicitation of patients is illegal, according to the Texas Department of Health and Human Services. "Federal law prohibits you from soliciting a patient," said HHS spokeswoman Stephanie Goodman. "You can't offer them special incentives. You can't do a direct solicitation."
The website of Texas Community Outreach Associates looks like a social service agency at first glance. The workers, it says, belong to "chapters." They wear maroon shirts that sport a logo of interlocked hands on the back.
But state corporation records show TCOA is a private business with the same address as Dental Professionals of Texas, DPTX. DPTX is the parent company of Galaxy Dental and 22 other dental brands in the state.
DPTX clinics take in an estimated $100 million a year, much of it from Medicaid.
After a News 8 investigation in March, DPTX reorganized its recruiting, and formed Texas Community Outreach Associates. Kevin Byington heads up the new company. He portrays himself as a reformed recruiter.
Byington said he used to work for a dental chain that paid recruiters $40 for each Medicaid patient, $20 for each privately insured patient, and $10 for each cash patient.
"The competition is steep, I can tell you," Byngton said, adding that he was repelled by the idea of bounties.
He said TCOA workers are salaried and do not receive bounties. He said they work from "information tables" set up outside supermarkets and community centers. The tables are there to "educate" consumers on social services available to them.
Byington admits he gets paid by private clients, who he would not reveal. A Galaxy dental brochure was prominently displayed on one information table we saw.
An information sheet from TCOA outlined how recruiters worked for Dental Professionals of Texas before March, and how the relationship was supposed to work afterward. Even under the new system, workers turn the names of potential patients over to the dental clinics each morning.
"We provide the leads and referrals, and the office takes it from there," Byington said.
But a recruiter who worked for the company until the end of April told News 8, the business of "marketing" for the dental chain had not changed.
"They wanted 100 patients every month from each marketer," the former recruiter said, adding that she used giveaways such as manicures, pedicures, and toys to lure mothers and their children into the office.
Dental offices were often packed with patients, she said, and marketers would buy them breakfast and lunch to keep them from leaving the office while they were waiting to see the dentist.
Dentists would often see seven patients an hour, she said.
The woman asked us not to reveal her identity, saying that while she did not know recruiting patients was illegal, it was clear to her that something about the recruiting system was not right.
"They [the parents] were just here to get the gift certificates and the promotion they [the dentists] were offering," she said.
Many of the parents had recently taken their children to another dentist. Now they were being told their children need new treatment and fillings, and they balked at that.
"If the dentist is paying someone to solicit clients on their behalf, that is not legal," HHS spokesman Stephanie Goodman said.
Back at AmeriSmiles, Misty Kinney and her mom invited us along as they took Misty's son in for his appointment. We found "Adon," whose name was on the AmeriSmiles appointment card they'd received. He was wearing dental scrubs and said he'd just been recruiting patients.
But he was not the same person who offered Kinney the $20 gift card. Adon, who wouldn't reveal his last name, said he was not paying other recruiters or offering gift cards. He seemed mystified about how his name appeared on AmeriSmilies sales material.
What was happening was no mystery to Kinney and her mother.
"That's coming out of our tax money that we're supposed to be using for our community," Passow said.
They left the office.