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Small Smiles Lawsuit

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Small Smiles Scam

October 7,2010

"Medicaid Welcome!"

For lower-income families, spotting that sign in a dental clinic's window is a godsend. Dentists who accept Medicaid are rare, and finding a dentist to handle even the most basic services like teeth cleaning and cavity filling can seem like an impossible task for the 58 million Medicaid-reliant families in the United States. It's no wonder they often jump at the chance to bring their kids to Small Smiles, one of the few children's dental clinics nationwide that caters exclusively to Medicaid patients.  

Unfortunately, the clinics' motives were far from altruistic.

When you're a parent on Medicaid, you don't have the luxury of getting a second opinion. It may have been several years since you were able to take your child in for a dentist's visit, and you may have no idea what to expect or what is considered "standard practice" for a child's dental exam.

Even so, most parents who went to Small Smiles thought it was odd when they were told they wouldn't be allowed to accompany their children - many of whom were aged two or even younger - into the treatment room.

When their children emerged from the room crying and hysterical, the warning bells went off.

Most of the children weren't old enough to effectively communicate what had happened to them in the Small Smiles clinic, but follow-up visits to other dentists told the story for them. Children as young as two years old had suffered multiple root canals without anesthesia. They had bruises around their mouths from rough treatment. Children were being strapped down to the dentist's chair, screaming, while multiple unnecessary procedures were performed.

There were less violent cases, though they were hardly less abusive. Many parents were told their children would need half a dozen or more fillings - an odd claim, considering that many of these children were young enough to only have a half-dozen teeth. Other parents were told their children would need root canals on their baby teeth, and insisted that delaying treatment could result in infections that would spread to the brain and threaten the child's life.

Many parents acquiesced to the procedures. Few were wise enough to get a second opinion. Those who did invariably found that their children didn't need any of the extensive treatments the Small Smiles doctors had recommended. The parents might have been told the child needed seven fillings; the second opinion would show nothing worse than a minute discoloration on a single tooth.

These are beyond discrepancies in medical opinion. These are flat-out lies - lies designed to enrich the corporate owners of Small Smiles.

The Small Smiles dentists are presumably not malicious or sadistic people. It is doubtful that they get satisfaction from putting children through unnecessary and often painful procedures. Given the monetary possibilities written into the current Medicaid system, however, dentists needn't be motivated by desire to follow such unethical practices. Greed is motivation enough. 

Medicaid reimburses the Small Smiles clinics for every procedure they perform -whether or not that procedure is medically necessary or advisable. The more procedures the dentists can do in a day, the more money they'll recoup for that quarter from the federal government. A child who comes in needing a teeth cleaning and nothing else is a financial loss, but a child who receives multiple fillings, however unnecessary, makes a tidy profit for the time spent doing the procedure.

Especially if you can do even more procedures in a fraction of the time.

Which is how children who had no dental problems at all started walking out of Small Smiles' clinics with multiple fillings, root canals on their baby teeth, caps and crowns, and a deathly fear of going to the dentist ever again. Former employees of Small Smiles explain that there were "production goals" for every day at the office, which is to say that the dentists and assistants were supposed to see a certain number of patients per day. Staff would receive bonus checks for exceeding their "production goals". As an example, one clinic has a stated goal for their staff of 100 patients per day with a staff of only two dentists and two dental assistants.

That means each patient needs to get in and out of the dental chair in an average of ten minutes. 

Given the numbers, it is difficult to imagine that any consideration was given to performing the surgeries administered in those ten minutes properly and carefully.

Stories like these tug at the heartstrings, and many parents who are not reliant on Medicaid for their children's dental coverage are right now thanking their lucky stars that their child will never have to undergo such torment. No child should have to pay the price for such abusive and unethical conduct.

Unfortunately, those same parents are unwittingly the ones paying the literal price of the Small Smiles scam.

Medicaid is a government program, and when Small Smiles gets a check to pay for the unnecessary procedures they've performed on innocent children, it comes directly out of your tax dollars.

When a child is wrapped in a straitjacket-like device to ensure they can't move while multiple invasive procedures are unnecessarily performed in spite of their screams, you paid for it.

When a child gets every one of their barely grown-in baby teeth capped with metal without any medical reason, you paid for that too.

You paid for it when they got "baby" root canals without anesthetic. You paid for it when their parents were shown out of the room so the abuses could continue unchecked. You paid for it when they put out the friendly signs that said "Medicaid Welcome!"

And you'll continue to pay for it until we can put a stop to these abuses of the Medicaid system.

However, unless serious changes are made in the health care system, the cost of unethical dentists will continue to come out of your pocket. Companies will simply pay their fines, settle what lawsuits they can, and move on. We've seen recent evidence of this: Small Smiles' parent company, FORBA Holdings LLC, agreed to pay the United States government and participating states $24 million to resolve allegations that the company billed Medicaid for unnecessary procedures. They admitted no fault.

It's not enough. The company won't go bankrupt, and the practices won't stop. Children will continue to be hurt. And you will continue to pay for it - unless we take action now. Here are a few ways you can help:

Write your congressperson

Contact your state medical board to see if complaints have been filed against your dentist

You're not alone. Share your story.

Contact Information

4119 Montrose, Suite 250
Houston, Texas 77006
f. 713.528.1390
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