Dentists Take Advantage of Children on Medicaid

They’re raking in hundreds of millions of dollars across multiple states.
Over the past couple of years, the Office of the Inspector General (OIG), which is part of the Department of Health and Human Services, has been looking into a colossal scandal across the country. Thousands of dentists have been implicated in a series of reports by the OIG. The charge? Highly questionable Medicaid reimbursement bills for excessive and even needless services given to low-income children, often to their great harm.
The latest report from OIG looks at California. It identified 335 providers with questionable billing practices who collected $117.5 million from Medicaid for pediatric dental services in 2012 alone. Half of these dentists worked for dental chains, suggesting an organized scam. They are, in fact, gaming Medicaid.
The OIS analysis found that some general dentists were providing an absurd—and frankly impossible—number of services per day compared to the average in California. Twenty-four services per day is average in the state; two dentists averaged more than 500 services per day; one dentist provided 1,658 services in a single day!
It gets worse. OIS uncovered evidence suggesting that over 100 general dentists were either billing for procedures they didn’t do or were performing unnecessary dental procedures:

  • One hundred and eight general dentists provided stainless steel crowns to a suspiciously high proportion of Medicaid covered children (18% of children on Medicaid compared to a 5% average).
  • Ninety-eight dentists provided pulpotomies to a high percentage of Medicaid children (18% compared to an average of 5%). A pulpotomy, often referred to as a “baby root canal,” involves the removal of a part of the tooth.
  • Eleven general dentists extracted teeth from a very high percentage of their young Medicaid patients (44% of children on Medicaid against an average of 12%).

In one case, a dentist performed nineteen root canals—in addition to twenty-one other services!—on a single five-year-old child. Most children around this age have only twenty teeth.
The report “raises concerns about the quality of care and whether children treated by these dentists were harmed by these procedures.” Indeed! It is unconscionable to think that dentists around the country are performing excessive, needless procedures on children. To make matters even worse, there’s good evidence to suggest that root canals—despite the assurance of safety from conventional dentists—spread harmful bacteria throughout the body and can contribute to other diseases. Imagine the impact these procedures could have on a young immune system!
These are only the dentists who got caught. How many others are doing this? What about pediatricians treating children on Medicaid? One can only imagine the depths of this type of malfeasance.
Besides these Medicaid cases, there are also problems with Medicare, the program for seniors. Over the years, Medicare fraud has also cost taxpayers hundreds of millions of dollars: in 2012, for example, federal authorities arrested 107 healthcare providers in several cities and charged them with overbilling Medicare to the tune of $452 million. Just as dental chains were especially implicated in OIS investigation, Medicare fraud seems to be less a problem of individual practitioners and more of organized theft schemes involving dozens of doctors, nurses, and healthcare and medical supply companies.
As demand for care outstrips the supply of doctors willing to treat Medicare and Medicaid patients, patients are losing access to providers—and of course it’s the neediest patients who are affected. This well-documented problem will only worsen if such fraud continues unchallenged.


    1. Given the amount of sugar in formula and juices plus the amount of sugar esp. HFCS in “cheap” food – crackers, cookies and processed foods and without doing the brushing and flossing – or actually eating a raw apple or carrot along with a cookie to help nutritionally – that stuff will rot your teeth out – esp. the baby teeth. So, I wouldn’t be surprised if some “entrepreneurial individual” will come up with just that – dentures for babies !!! . Crazy world – A lot like the movie Idiocracy.

      1. Not to mention if that apple or carrot isn’t organic it is doused in toxic chemicals from the “farms”. I feel bad for kids today, sure we all had some toxic exposure but the kids these days are exposed from the womb to the grave with toxic pesticides/herbicides/insecticides(in the food, water, sprayed in the air near their schools and neighborhoods; We are talking drift-prone toxins like Dicamba and the Vietnam-era 2,4-d), chemical additives in the food, fake sweeteners and other toxins that cause serious health problems and impair the bodies ability to nurture and defend itself. If the majority of Soya is GMO and herbicide-laced, that means that soy bottle milk you feed your kid has toxic chemicals in it and if you think your breastmilk will be any better, think again because these chemicals have already permeated your body and flow within your very blood, against your will and the “government” you pay taxes to/contribute to is intentionally fighting against your right to know these things.
        And everyone wonders why people are so unhealthy, why the kids have autism, etc.

        1. “Better living through chemistry” I remember that mantra – Rachel Carson pointed out much of the toxicity of putting chemicals – mostly leftovers at that time from the 2 world wars in her book Silent Spring. It should be required reading, but we dumb down with flouride in the water, prescribed chemical drugs for children, pesticides, antibiotics, vaccines, and of course putting plenty of matter into the air – (taking it from the smokestack scrubbers and putting it on jets to spew out causing larger cloud covers, and blocking out the sun. Nice job guys.

          1. Yeah, Geo-engineering is a crime against humanity. They literally spray toxic particles over civilian populous and the only reason they are doing it is a failing attempt at a “quick fix” for the problems they are causing this planets ecosystem and environment. Yet when you mention it to others they just mention chemtrails and that old term, conspiracy theorist.
            Even if you show them the “government” documents that talk about geo-engineering and how to do it, for some reason people refuse to believe what is going on behind closed doors. It is too easy for them to just believe that the US is the greatest and the safest and that the corporations and govt really do protect us and care (hah, what a joke).
            Somehow, this will all come to an end. It is up to We the People to choose whether that is Human Extinction or People Power putting it to an end.
            Because that is the road we are on.

          2. Yes, Rachael Carson was ahead of the curve, and it should be required reading… It will never happen in the South or Southwest though! Here in AZ, over 400 dentists were found to be criminals/and or non licensed! Good grief!

  1. Generally, Medicaid children are from lower income families where the dietary an oral hygiene habits can lead to a much higher prevalence of tooth decay, the need for root canal therapy, pulpotomies, stainless steel crowns and missing teeth. All of which would lead to a greater number of services than children not on Medicaid. Not the whole answer but has to be taken into consiteration when looking for fraud.

    1. I read about a program in Scotland where instead of putting flouride in the water and expensive “corrective” measures for the poor, they went into the schools and showed the kids how to take care of their own teeth, by brushing, flossing and eating more veggies and fruits. Imagine – teaching kids how to take care of their own teeth. But there is not a lot of money in that for dentists, is there.

      1. They did this for my elementary grade classes when I was a kid in school.
        The US doesn’t do “teaching” anymore. It would rather have you indoctrinated to believe the industry propaganda.

        1. And gov.”moonbeam” Jerry Brown just signed mandatory vaccinations for school kids. Exemptions I am told are difficult to get.
          I wonder how much the AMA, and PHrma paid him and California to do this. Dr. Pan who helped to write this bill SB277 has definitely been “bought”. He couldn’t even answer a simple question without consulting with his handlers – two lobbyists . And you can guess what they represented.

        2. Funny that in Europe that Mercury fillings are banned and the FDA was about to ban them here, until a bunch of sissy dentists started whining about it, because they dont make as much money as a real doctor makes and they supposedly cant afford fillings that are actually safe. Reminds me of the Inferior Court allowing factories to pump out toxins because the industry cant afford to make them safe. Money comes before health in this country, money comes before EVERYTHING. Thats what happens in a plutocracy where the politicians get paid off, SuperPACS are legal and the people in charge and the drug industry think it’s okay to test drugs on children in third world countries after intentionally infecting them (Guatemala.) The only solution is to sue them- and take away what really matters to them- their money. Sue them until they’re all bankrupt!

          1. Yeah the ADA is the whiny dentist organization that all of the dentists follow here and refuses to correct their statements that mercury fillings are safe (which they are not).
            They’ve been doing this for decades now and they refuse to change their ways, the alternative is shaming them until they do or bankrupting them with loss of customers.
            Search up DAMS holistic dentists/safe mercury removal and you will find what you need to know about this!

          2. I like the idea of law suits, it seems to be the only way to get some real reform around here!

      2. About putting fluoride in water – you really need to do your homework. The line about how fluoride can “help reduce tooth decay” is a BLATANT LIE. There is no, – repeat *NO* mechanism in the human body, where fluoride from water is re-deposited onto teeth. Fluoride is an industrial by-product of bauxite mining
        for aluminum. It was sold to large municipal water suppliers in the early 1900’s.
        Yes, there MIGHT be SOME benefit from TOPICAL application of fluoride, but
        that’s a big MAYBE….. Yes, you have been conned, scammed, and LIED TO about Fluoride…. Just sayin’….

        1. Hey Brad, I think you and I are on the same page. I am painfully aware of the damage that fluoride does – I have an adult daughter with fluorodosis and I see it when I work with young teens backstage in local school theatre productions. It makes no sense to put it in the drinking water – no way to control the dose that anyone gets. I get updates on fluoride from the online site Fluoride Alert I spoke with the head of the local water treatment facility – when I asked about fluoride in the drinking water – he got a little bent out of shape and then later called me to apologize. I also have spoken with the representative in my district to ask about the issue of fluoridation could be discussed. I still need to get my act together with printing out studies and the recent ruling by I believe the EPA reducing the amount of fluoride in the drinking water BECAUSE it causes fluorodosis. Gee, had I known what the discoloration on our daughter’s teeth was back when it first showed up, I would have had serious words with the *&&^% dentist who pushed for fluoride treatments. Fluoride in the water is just the tip of the iceberg of how industries “recycle” the toxic waste they produce. And to save money, some communities import fluoride from China – their gov’t doesn’t give a crap about the populace either.

          1. It is fluorosis. Too much fluoride in your body.
            Dental fluorosis, also called mottling of tooth enamel, is a developmental disturbance of dental enamel caused by the consumption of excess fluoride during tooth development.
            The risk of fluoride overexposure occurs at any age but it is higher at
            younger ages. In its mild forms (which are its most common), fluorosis
            often appears as unnoticeable, tiny white streaks or specks in the enamel of the tooth.
            In its most severe form, tooth appearance is marred by discoloration or
            brown markings. The enamel may be pitted, rough and hard to clean.[1] The spots and stains left by fluorosis are permanent and may darken over time.
            this is from Wikipedia – but it is permanent and now you can buy all kinds of teeth whiteners – trying to get rid of the “stains”.

          2. Stay natural baby! Coconut oil and bentonite clay + your favorite essential oils and some sea salt = awesome toothpaste that isn’t toxic!
            Now you just need to get RO water systems to filter the fluoride and you’re set!

  2. Medicaid fraud has gone on since the very beginning and it certainly isn’t going to stop, especially when Medicaid continuously denies payments AND is now paying less for services rendered. So, doctors and dentists seem to believe they have no choice (in order to cover their operating expenses) to double and even triple book appointments. This leaves extremely little time to see patients so, what happens is that they break up the services over several visits in order to make the services worthwhile. I no longer deal with young children on Medicaid. I now work with elderly patients and to make matters worse, they do the same thing to the aging population who may have dietary needs, medications to take, etc. One time, I sat in an office 4 hours before the doctor saw my family member! Now that we are subjected to Obamacare, it is ten times worse! Let’s be real . . . . . our healthcare system is beyond broken. It has now shattered to pieces and I believe it will take decades before they can straighten it all out.

  3. I remember going to one of these chains and they recommended that I get ALL my fillings changed as they were getting “old”; I never went back. That was twenty years ago and my fillings are still OK.

    1. If they are mercury fillings, you want to get them removed.
      Check out “Holistic Dentists” and “Safe Mercury Filling Removal”.
      There is an organization that can provide a list of local holistic dentists who can do safe mercury removal, in your state.

      1. This dentist intention wasn’t to remove the fillings because they were mercury. He would have replaced with same if I (one) wanted. Indeed, if one wants to remove mercury fillings they should be removed safely by using a correct procedure.

  4. we are blessed with ethical, caring and attentive dental care for our medicaid child!

      1. no he is well treated and we apparently should be even more grateful than I realized! he is also a spectrum child and all consideration is given to that as well.

    1. Your case is a rare exception. Secondly, parents of children on Medicaid are usually neglectful parents who don’t have a clue, and couldn’t care less about their child’s dental health. Between bad diets, poor dental hygiene, and an misunderstanding of what a child needs, are all contributing factors that lead to poor overall health for the child. There is no “magic bullet” to good dental health, as there is no “magic bullet” to good health. It takes diligent work to live in good health. Medicaid helps, but, so does ALL the other factors that go into being healthy.

  5. Seniors need to scrutinize the reports from Medicare about services provided, to make sure they are accurate, and also to participate in deciding what treatments to have. It’s ok to tell the doctor no if you believe a treatment is not in your best interest. I once refused to let a cardiologist perform another heart cath on my husband–there was no good reason and it might have harmed him in his weak condition. We must take responsibility in order that neither we nor the government are defrauded.

  6. Probably the dentists didn’t actually do all those root canals on one child– or perhaps any root canals at all. They were obviously billing for all manner of things they hadn’t done.

  7. Some fraudulent billing concentrates on Medicaid because state administrators really don’t care about the recipients. Recipients never see a statement and don’t know. I have seen amalgam fillings removed due to fraudulent fears of metallic (not organic) mercury and after further damage to the tooth replaced by composite fillings that do not wear as well.
    Frauds against Medicare or TMA (military retirement) are being investigated (usually together) and more efficiently than private insurance. They recover money and often refer cases to the Department of Justice for incarceration. I seen cases with such evidence that the perpetrators were eager to plead.
    One set of cases involve compounding pharmacies who charge from 10 to 1000 times the price of equivalent mass-produced pharmaceuticals and split the profit with the prescribing physicians. There will be ex-millionaires in 8 by 10 cells.
    At least those compounded pharmaceuticals provide some benefit. Government health programs are being billed for totally ineffective naturopathic, chiropractic and especially homeopathic therapies. The FDA has been asked to handle the last but the first two await regulation by the states.

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