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Kool Smiles to pay $23.9 million to settle claims of ‘unnecessary procedures' on patients

Kool Smiles.jpg

A nationwide dentist chain with El Paso locations recently agreed to settle a multimillion-dollar lawsuit brought by the U. S. Department of Justice.

The DOJ claims the company, known locally as Kool Smiles, “knowingly submitted false claims to Medicaid for unnecessary procedures.”

Some El Paso parents tell KFOX14 Investigates this happened to them.

“I was about to do it,” said Vanessa Zamora. She took her four children, children who all have Medicaid, to Kool Smiles for years. But when the dentist said her youngest daughter needed two crowns, something didn’t seem right.

“She’s the one who always brushes her teeth and is always on top of it,” said Zamora.

Her husband suggested they take her daughter for a second opinion. That dentist told her crowns were not necessary.

“She had a small cavity, just needed a small filling, no crowns whatsoever,” said Zamora.

Zamora thought about the two crowns she'd allowed dentists at Kool Smiles to put on her older children’s teeth.

“I was upset, I was upset. I thought what about the other two crowns, what if they weren't needed? I allowed them to put it on without questioning it because I’m not the professional,” said Zamora.

At Rawlings Dental Clinic, operated by the El Paso County Health Department, Dr. Kelley Brooks wants to see her patients leave with a healthy smile.

“I want a patient to be better when they leave me than when they come,” said Brooks.

Because there is a promise dentists make to protect their patients.

“We take an oath of ethics,” said Brooks.

In the recent settlement, Kool Smiles, which operates six El Paso locations, agreed to pay nearly $24 million to the federal government and 17 states for allegedly submitting false claims to state Medicaid programs.

The DOJ claims that “between January 2009 and December 2011 Kool Smiles knowingly submitted false claims for unnecessary baby root canals, tooth extractions and stainless steel crowns.”

The government also alleges Kool Smiles billed Medicaid for baby root canals that were never performed.

The DOJ alleges the clinics “routinely pressured and incentivized dentists to meet production goals by disciplining 'unproductive' dentists and awarded 'productive' dentists with substantial cash bonuses based on the revenue generated by the procedures they performed.”

After this story first aired, dozens of parents shared their experiences on social media, with stories similar to Zamora’s story.

“I used to take my daughter there. Had a cleaning, they said no cavities, went back six months later for another cleaning, said they had to put a cap on her front tooth it was too decayed. I said nope and took her to EP Dentistry. They showed me on X-ray there was no cavity,” said Nicole Ramos.

“I took my kids once years ago and they wanted to do all kinds of unnecessary stuff to their baby teeth. When we took them back to their regular dentist, even they said they should've never suggested those things,” said Adam RC.

“I changed my kids to a new dentist office after their second visit ... All they wanted to do was put unnecessary crowns, that for sure the other dentist confirmed they didn't need,” said Jaky Juan Espinoza.

Zamora said she had a gut feeling about the procedures.

“You know better, you know better, but it's what they're telling you to do, so why are you going to question it?” said Zamora.

“Always seek out a dentist you are comfortable with,” said Brooks.

When you take your child for a check-up, here are some things to keep in mind.

If a treatment plan seems to be too much, Brooks says to get a second opinion.

“If you know you're doing your part and helping your child brush and haven't seen any discoloration in their teeth, go get a second opinion,” said Brooks.

Zamora is glad she did.

“There was no way their teeth are that bad -- we are on top of them,” said Zamora.

KFOX14 Investigates reached out to the Texas Board of Dental Examiners to find out whether any dentists associated with Kool Smiles are facing a review of their license in the wake of the DOJ settlement.

"The Texas State Board of Dental Examiners is not lawfully permitted to discuss investigations. Allegations concerning dentists performing 'unnecessary' procedures would be investigated in any case submitted to this office,” said Kelly Parker, the executive director.

KFOX14 Investigates also checked the licenses of all dentists listed as working for Kool Smiles in El Paso; all have valid licenses and do not have any current disciplinary action.

KFOX4 Investigates reached out to Kool Smiles to find out whether any dentists were terminated as a result of the DOJ probe and asked for a response based on concerns of unnecessary procedures.

In a statement, their attorneys said:

“The settlement agreement with the government does not relate to any claims regarding the quality of the dental care provided to patients. Importantly, the settlement does not include any admission or determination of wrongdoing by the companies, their employees or any Kool Smiles dentists.

“The companies have complete confidence in Kool Smiles dentists and the quality and level of care they provide.”

For parents like Zamora, it's not enough.

“It really scares me because now I'm going to second-guess everything,” said Zamora.

Dr. Brooks also said the way Medicaid is structured now, patients are assigned a home dental office. But the choice is still yours. You can call Medicaid and ask to have it changed to the dentist you prefer to see.

Brooks said to keep in mind, as a parent you have to give written consent on your child’s treatment plan.

So make sure you understand the procedures and are comfortable with the plan before signing.

Full statement from Kool Smiles:

Statement Regarding Kool Smiles and Benevis Voluntary Settlement with U.S. Department of Justice:

Benevis, and its affiliate Kool Smiles, have voluntarily entered into a settlement with the U.S. Department of Justice (DOJ) and various State Attorneys’ General to end the government’s seven-year long False Claims Act (FCA) investigation relating to services provided from 2009 to 2011.

The settlement agreement with the government does not relate to any claims regarding the quality of the dental care provided to patients. Importantly, the settlement does not include any admission or determination of wrongdoing by the companies, their employees or any Kool Smiles dentists. In fact, the companies strongly disagree with the government’s allegations.

The investigation largely focused on professional disagreements between qualified dentists in determining the appropriate level and cost of the care. For perspective, the government disagreed with the care provided in less than one percent of the procedures billed during the reviewed period.

The government’s own data, as well as independent, third-party research and analysis conducted by experts, disprove the allegations. A recent study by respected healthcare economists Dobson DaVanzo & Associates found Kool Smiles dentists provided fewer total dental services per Medicaid patient than non-Kool Smiles providers. It also found this resulted in the government paying significantly less per Medicaid patient for dental services provided by Kool Smiles dentists than it pays for Medicaid patients treated by non-Kool Smiles dentists.

The companies are disappointed that reasonable disagreement between dentists can become a FCA case. However, given the seven years and significant expense already incurred, as well as the anticipated additional time and expense associated with lengthy litigation, the companies believe putting this matter behind them was the best option for their dentists, team members and the patients they serve.

The companies have complete confidence in Kool Smiles dentists and the quality and level of care they provide, and are proud to support the ongoing work of Kool Smiles dentists as leading providers of dental care for underserved communities nationwide.

Since 2002, Kool Smiles has been serving underserved communities, and today Kool Smiles provides needed dental care through more than two million patient visits per year, many of whom would not otherwise have access to dental care. In addition, Kool Smiles dentists have provided more than $128 million in uncompensated dental care to treat patients and families who did not have access to Medicaid dental benefits or other dental insurance, and could not afford to pay. The companies will continue to work toward expanding access to quality dental care for all families.

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