Corporate Scandals

Drilling for Dollars, In Your Kid's Mouth

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Over at Bloomberg.com, a disturbing story describes health care management services companies doing unnecessary dental work on unwilling patients. "Some of them have been riding a boom in Medicaid outlays on dentistry, which rose 63 percent to $7.4 billion between 2007 and 2010, outstripping the 4.9 percent growth in other dental spending," Bloomberg reports. While taxpayers provide the funds, school systems provide lots of patients, sometimes without their families' consent. For example:

Whoops, wrong mouth.

In August 2010, [dentist Ralph] Green's lawyer appeared before the Arizona dental board to answer a complaint that ReachOut did unnecessary drilling on a Phoenix student's teeth—even after the student's mother, Valerie Davila, told the company she was seeing a family dentist and didn't need any work.

The 6-year-old, Sabrina Martinez, suffered "unnecessary pain," Davila said. "Imagine if it was your child."

There were two children with the same name at the school, and the work was done on the wrong Sabrina Martinez, Green's lawyer, Jeff Tonner, told the dental board.

Then there's this allegation:

In San Diego, Tina Richardson's third grader, Alexander Henry, came home in March with four baby teeth missing after a school session with a ReachOut-affiliated dentist that was so painful he "waved his arms frantically," "pushed everyone off him" and "bled so badly that they had to send him to the nurse's office," according to her complaint with the state dental board. Among other things, Richardson said the consent process wasn't valid.

Richardson said Alexander had seen a dentist nine days earlier who didn't recommend any teeth pulling. Although she signed a consent form in September covering many procedures including extractions, she said she didn't sign another one that came in November seeking permission to take out three teeth. No one from ReachOut called to discuss the proposed procedures, she said.

The reporter approaches the story from a number of angles, some more compelling than others. There's less than I'd like about what was going on in the schools that allowed such abuses to occur, more than I'd like about legislation aimed at the companies' business model rather than their access to public money and to the schools' captive clientele. (A North Carolina bill backed by the incumbent dental industry, for example, "would subject agreements between dentists and the companies to state approval.") The article meanders a lot as well, as big Bloomberg exposés often do. But caveats aside, it's a disquieting tour through the perverse incentives created by public spending, the disregard some school systems apparently have for informed consent, and the sleazy operations eager to take advantage of the situation.

Elsewhere in Reason: Peter Suderman on Medicare fraud.

NEXT: Walter Olson on Nicholas Kristof's Bogus Anti-Beer Crusade

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  1. While taxpayers provide the funds, school systems provide lots of patients, sometimes without their families’ consent.

    Just what is it about “The Children Belong To Us, The State” that you understand?

      1. I think the first one was more accurate.

  2. I don’t know much about dentistry, but what kind of asshole would just perform dental work on a minor without their parents consent? But I guess OM is right, these kids belong to the State.

    1. I don’t know much about dentistry assholery, but what kind of asshole asshole would just perform dental work on a minor without their parents consent?

      A stupid, greedy one. Also, this is a clear illustration of what happens when the government, not the patient, is the actual customer.

      1. assholery…dentist

  3. That’s just fucked. Not only is it totally despicable to do unnecessary dental work on children, but there are plenty of people out there who need some dental work but can’t afford it. If this money is going to be thrown around, at least give it to people who would benefit from it.

    1. I’m guessing the Principal and her family getting a nice discount for this.

    2. “If this money is going to be thrown around, at least give it to people who would benefit from it.”

      Zeb, my friend, you have a complete lack of understanding about how government works.

      1. No, just lack of willingness to accept this crap.

  4. Lol this is hardly a new phenomon and Dentists don’t only use this trick on Medicare patients.

    When I was a kid the dentist my parents took us to routinely inflated the number of cavities we had, averaging ~10 per visit that needed filling. We only discovered the problem when my brother was a teen and went to see a different dentist on his own. At his last visit with the family dentist more than a year prior he was told he had 14 cavities that needed filling, the new dentist found 1.

    Basically the old guy was just making up a number based on what he wanted to bill that week and unfortunately for me (I’m immune to Novacaine) he actually went through the drilling process on each one.

    1. 14? I would be finding that SOB as an adult and doing some work on him.

  5. I would beat the living shit out of someone if they performed dental work on my kid without my consent or knowledge. The people responsible at the school need to be taken out to a field and re-educated.

    1. I changed my mind. I would perform unlicensed dental extractions on them instead.

      1. I just assumed that’s what you meant by “re-educated.”

    2. And as satisfying and just as that would be, convictions and jail terms would ultimately be more satisfying. You’d keep your hands clean and avoid becoming a monster. The perps would learn firsthand what it’s like to be on the receiving end of the state’s hospitality. And they’d never work in education again.

      1. Except they’ll never get convictions, let alone jail terms, so…

    3. That sounds nice and all, but I bet your kids would be harmed more by you being in prison than by the unapproved dental work which already happened anyway and can’t be undone.
      But I don’t see how what they are doing is not criminal.

  6. There were two children with the same name at the school, and the work was done on the wrong Sabrina Martinez, Green’s lawyer, Jeff Tonner, told the dental board.

    That right there is worth sending someone to jail over. Anyone actually looking in the mouth would know that the drillings did not need to happen. So actually performing the work was willfully fraudulent and negligent.

    1. Several someones. The dentist, the principal, possibly others. Don’t forget assault (no consent). And conspiracy to defraud. Etc.

      I’d personally go easy on the poor dental assistant though, especially if she turned state’s evidence.

      1. But who’s going to prosecute the school officials? I’m going to bet nobody does. I’m willing to bet kickbacks are involved.

      2. It would have to be the feds doing the prosecution, given the demonstrated unwillingness of local prosecutors to go after local government officials in all but the most egregious cases.

  7. This happened to my wife–during the halcyon days of communism here in the Czech Republic. The dentist came to her school and filled in all her molars, saying he was just shortening the inevitable or something.

    As an adult she had to get all those shitty fillings replaced–fun times.

    1. My dentist in San Diego made a fortune on fixing the teeth of all the newly minted Qualcomm millionaires that came from Eastern Bloc countries.

    2. Re: PS,

      This happened to my wife–during the halcyon days of communism here in the Czech Republic.

      What are you implying, PS? Huh? HUH???

      1. Well, unlike California, it was communism with a human face. Or at least it was until the Russkies rolled in the tanks.

    3. but she got them for FREE FREEEEEEEE!!!

      /lolz

      1. I always wondered why the dentist did all the extra work.

        I suppose it was the work ethic instilled by the great work of the State.

  8. But I’ve had a judge (an AZ one, no less) tell me personally that doctors are professionals and so we can trust them because of that.

    1. Well, surely you can. Politicians and judges are professionals too, and you trust them, don’t you?

      1. So are police, and we all know that there is no one more honest and trustworthy than the average law enforcement professional.

  9. I don’t know how things are in AZ, but if you treat a patient without proper consent you’re liable for assault. Why isn’t this guy in jail? Oh, wait – agent of the state.

  10. “There’s less than I’d like about what was going on in the schools that allowed such abuses to occur, more than I’d like about legislation aimed at the companies’ business model rather than their access to public money and to the schools’ captive clientele.”

    Typical. Government and business team up to fuck people over. Solution: government must save us from business.

  11. True, slightly related story.

    We just relocated to the Peoples Republic of Massachusetts for work. My wife was in need of her annual physical to get her Birth Control renewed.

    So she schedules an appointment and things are going as planned until the Dr informs her that state law requires an annual rectal exam to “check for Colon Cancer”

    So she was required by law to submit to a stranger sticking fingers up her ass in order to get the prescription she needed.

    Just think of all the good times we got coming with Obama Care.

    1. the Dr informs her that state law requires an annual rectal exam to “check for Colon Cancer”

      I have very, very serious doubts that is true.

      At most, I bet the state requires that doctors ask if the patient wants to get checked for colon cancer.

      A state law that blocks further care unless the patient agrees to a colon cancer check strikes me as ext to impossible. At this point.

      1. Not to mention, I don’t believe that an anal-digital exam is a colon cancer check. Groovus could no doubt confirm this.

        I think you may have a doctor on your hands there who is abusing his (her?) position for jollies, and needs reporting to the licensing agency.

        1. I’m not groovus, but I was under the impression that the anal-digital exam was for prostates. Colonoscopy is for checking out colons, since it’s like, further in there than fingers can reach and all.

          for the benefit of anyone who was previously unaware: chicks don’t have prostates (well, according to wikipedia they “do”, but they’re not located in the same place. homologous structures.)

    2. I agree with RC, a finger in the ass is not a check for colon cancer no more than a finger up your pecker is a check for bladder cancer. You probably need to talk to someone about your wife’s doctor.

      1. Well we’ve only been here about 2 months, so it’s not like there was any pre existing relationship with the Doc.

        That said…

        http://mamedicallaw.com/2011/1…..creenings/

        “Plaintiff’s counsel claimed that the defendant was negligent in failing to offer or perform annual colon cancer screening in the form of a digital rectal exam, fecal occult blood cards, lower gastrointestinal series and sigmoidoscopy or colonoscopy from 2002 to 2006.

        The defendant acknowledged that the standard of care required colon cancer screening, and that if he had been the patient’s primary care doctor, he should have conducted the screening test. However, he claimed that the patient was only seeing him for blood pressure checks, and did not want a “full PCP.” He was a private-pay patient and had declined any further medical services.

        The case settled prior to trial for $1.5 million.”

        It may not be explicitly required by law but rather effectively required on the basis of that suit and the doctors malpractice insurer.

  12. “”Imagine if it was your child.”

    Uh….I am imagining a dentist and a principal with no teeth.

  13. It looks like these parents did consent to having their kids “cared for” without them being there…at least once.

    FTA: “Richardson said Alexander had seen a dentist nine days earlier who didn’t recommend any teeth pulling. Although she signed a consent form in September covering many procedures including extractions, she said she didn’t sign another one that came in November seeking permission to take out three teeth.”

    Just curious, but what kind of idiot signs a consent form for that lets a school program pull her kid’s teeth without her consent on the spot, and without her being present for the procedure?

    Fuck anybody that would consent for anything invasive being done to their child unless they were present. I know I wouldn’t.

    1. That’s a good question. It’s amazing what power parents are completely willing to hand over to schools.

  14. You want to go after the dentist, where it hurts?

    File a complaint with the licensing board.

    The school officials? Well, performing medical procedures without informed consent is assault. That makes the officials co-conspirators or accessories. File a criminal complaint against them.

  15. Who the fuck pulls baby teeth? I suppose there could potentially be some medical necessity in certain cases….but don’t 99% of baby teeth take care of themselves when the new teeth come in?

    But hey, your kid doesn’t really need those teeth for however long it takes the new ones to come in, do they?

  16. Boing Boing is covering this as the evils of corporate healthcare, completely failing to notice that the practice would not exist if payment was by the customer.

  17. I love how everything to prevent adults from doing anything is “for the children”, and when there are actual children involved, it’s “pull out their teeth for profit”.

    And I’m a bit disappointed with the author for not working in a Tooth Fairy ref on the title. 😉

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