A joint investigation with

DentalWorks Chain Misdiagnosed for Money, Dentists Say

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Watch Dollars and Dentists, a joint investigation by FRONTLINE and the Center for Public Integrity.

DentalWorks, a national dental-care chain, is facing two lawsuits in North Carolina claiming that it unlawfully practiced dentistry and deceptive practices.

A lawsuit filed by the state dental board alleges that the company lied about its operations. A second lawsuit, filed by dentists who worked for the chain, alleges that it pushed staff to inappropriately diagnose patients in order to bill them for more costly procedures.

DentalWorks is one of several dental-care companies facing scrutiny of its practices recently.

In last June’s Dollars and Dentists, FRONTLINE and the Center for Public Integrity reported that Kool Smiles, which serves children covered by Medicaid, has been accused in several states of providing unnecessary treatment for children in order to bill more money. Kool Smiles has denied the allegations in an extensive response.

Last July, Sen. Charles Grassley (R-Iowa) said his office was probing Kool Smiles, Small Smiles and ReachOut HealthCare America, which all serve poor children on Medicaid.

And Aspen Dental, one of the nation’s largest corporate dental chains, was accused in a class-action lawsuit in October of deceiving patients and illegally owning dental practices. Aspen Dental, which denies the allegations, filed a motion to dismiss the case. Attorneys representing former patients in January filed an amended complaint (pdf) in January that added 13 more pages of allegations, which Aspen Dental has since filed to dismiss.

The Latest Lawsuits

DentalWorks is the trade name of DentalOne Partners, Inc., a national dental company operating in 14 states. The suit filed by the North Carolina State Board of Dental Examiners accuses (pdf) DentalOne Partners of influencing clinical policies, including pushing for inappropriate diagnoses in order to bill for unnecessary treatment.

The suit also claims that the company told the board that it only provided management services to its practices, and that it maintained two sets of financial records to conceal the fact that it owns and operates them as a chain, and collects the profits. North Carolina law prohibits corporations from owning a dental practices or practicing dentistry.

In a related lawsuit, 14 dentists allege (pdf) that the company exercised “excessive control” over the practices’ finances, and in some cases, interfered with the dentists’ own decisions regarding patient care.

In their filing, the dentists say that in the 1990s, DentalWorks had built a reputation of providing high-quality care.

That began to change in 2003, according to the lawsuit, when the company allowed its dentists to buy into limited-liability corporations that managed dental practices. The idea was that the companies would manage the business so that dentists could focus on patients.

What the dentists say they didn’t realize was that those companies were “nothing more than a ‘shell’ — a legal entity which, through time, has no purpose other than to be an instantaneous pass through of funds and an insulating layer to protect DentalOne Partners from liability,” the suit alleges.

That’s when the company began to put profits over patients, the dentists claim.

For example, they say that in 2008, DentalWorks promoted the use of Arestin, a drug that manages periodontal, or gum disease, and provided continuing education classes that stressed that gum disease was vastly underdiagnosed. The classes were run by employees who weren’t licensed dentists.

Some dental hygienists were given “financial incentives” based on regular performance reviews that monitored how often they diagnosed gum disease and prescribed Arestin, the suit said. In some cases, dental hygienists in company training were urged to “force the probe, if necessary, to achieve the 5mm reading accepted as the standard” for treatment that would allow them to prescribe Arestin and perform the more costly cleaning.

In “numerous practices,” the suit says, dental hygienists openly disagreed with doctors about whether treatment for gum disease was needed, and sometimes changed treatment plans accordingly.

The company also made similar pushes for veneers and ceramic crowns, which appeared to be financially based, “but under the guise of treatment,” the suit claims.

Some of the dentists say they lost patients for aggressively pushing such treatment. Three were disciplined by the dental board for their actions regarding gum disease.

But the moves also resulted in “a significant rise in profitability” for the company, the lawsuit says.

Starting in 2011, DentalOne Partners also began lobbying the North Carolina legislature to remove regulatory oversight of its practices by the dental board, using funds from from the dentists’ practices, the lawsuit said. The board still has the authority to regulate dental practices in the state.

A call to DentalOne Partners on Tuesday was directed to Mark Soll, a company attorney. He didn’t immediately respond to a voicemail or email seeking a comment. “We are confident that, after the facts are known, the company will be shown to have operated in accordance with North Carolina law and its various agreements,” he recently told the Fayetteville Observer in North Carolina.

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