Drilling for Dollars, In Your Kid's Mouth


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:

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.