This is just what we need, a whole new generation of fearful children arriving for a dental appointment. Kool Smiles settled lawsuits filed by whistleblowers to the tune of almost $24 million in January. The dental services provider did not admit to any wrongdoing during its settlement with federal prosecutors, and the Justice Department’s focus was on fraudulent Medicaid billing for unnecessary or inappropriate dental services on primarily poor children. Earlier that week, TV stations in Arizona were reporting on two children who had recently died for reasons related to dental appointments at a Kool Smile office.
The litigation’s main stage was reserved for fraud, though. The Hartford Courant said the whistleblowers complained to the government about how the “chain paid substantial bonuses to dentists who met production goals that rewarded expensive, unneeded, and often painful treatments for children who still had their baby teeth.” As a result of this news coverage, the “torture chamber” comment above was made after other details surfaced such as swaddling (which is not a new technique for pediatric dental care) and using a hair dryer to dry children’s clothes after they urinated out of fear. Nevertheless, most of us likely agree that children should not have to undergo unnecessary root canals, crowns, and extractions.
Kool Smiles pushed back against the federal investigation, saying the cases represented the care provided in “less than 1% of the procedures billed.” The company also said the whistleblowers engaged in “professional disagreements” about the “appropriate level and cost of the care.”
Frontline, the PBS news documentary program, concluded its own investigation of Kool Smiles in 2013 by asserting that the chain places more crowns on children than any other provider (a statistic disputed by Kool Smiles). The documentary includes a cool (pun intended) quote from a former office manager who said, “It became more about numbers—not so much as what we were doing to help the community, but more about numbers. It became where we had a goal that we had to meet each day. So they would tell us if we had to make $15,000, that’s what we had to make, regardless of how we got there.”
Somewhere, Doc Bubba at his small solo practice smiles in an I-told-you-so manner.
However, we can’t lose sight of the kids in this type of discussion. Several articles address pediatric care in this issue. My favorite quote is from Sarah Lawrence’s article on page 50. “Younger kids may have a toy or stuffed animal they brought with them from home. Introduce yourself to their favorite toy and let them know that you might even be able to count the number of teeth that their teddy bear has! This helps children relax, and then they will usually get excited at the possibility of looking at their special stuffed animal instead of focusing on their fears.” We should spend more time getting acquainted with Sport, for example, which is the name of the stuffed animal on this month’s cover. There’s nothing torturous about that.