Each state protects its citizens through a board of dentistry that holds every dentist accountable for dental care provided in the office(s) they own. Although it’s rare, accountability becomes important when a patient accuses a dentist of a transgression. Today, corporately owned and/or managed dental offices, falling outside the protective clutches of state dental boards, are making patient protection effectiveness more difficult to understand.
In 2012, Bloomberg News reported alleged abuse and overtreatment of children by dentists employed by Private Equity owned dental clinics. In the report, was a story about how a 4 year old boy treated at school suffered baby teeth root canals and crowns that, according to his mother, were not needed and performed without permission. According to the article’s author, Sydney Freedberg, “Management companies are at the center of allegations of…unnecessary procedures, low quality treatment, and the unlicensed practice of dentistry.” http://www.bloomberg.com/news/2012-05-17/dental-abuse-seen-driven-by-private-equity-investments.html. Dental Management Service Organizations, known as DMSOs, are corporations often funded, owned and/or managed by Private Equity companies. State dental boards have no jurisdiction over their activities and do not regulate them.
Regulatory Protection Caught between Teeth & Profits?
Also reported by Bloomberg, U.S. Senators Grassley and Baucus have questioned whether one Private Equity owned dental chain under federal investigation has focused “more on achieving self-imposed quotas via assembly line service than proper patient care,” http://www.bloomberg.com/news/2012-05-31/republicans-target-dental-bill-that-private-equity-hates.html. Dentists are obligated by law to provide dental care that restores and/or maintains health, and not recommend or provide services beyond patient needs and desires. Accusations are, dentists in corporate dental offices might be providing treatment that patients don’t actually need, placing the profit needs of corporations over of the clinical needs of patients, as in the sad story of the 4 year old boy. Unlike a private practice dentist, a separate corporate entity such as a DMSO operates outside the jurisdiction of state dental board accountability.
State dental boards require that dental offices be owned by dentists licensed in their state. Some Private Equity owned dental companies, DMSOs, have been sued for using “straw” owners. The accusations are, licensed dentists listed as dental practice owners and managers are not independent, but actually subject to the management and policies of DMSO corporations. Reported by Syracuse.com, one corporate dentist is listed as the owner of corporate dental offices in Central New York, New Hampshire, Massachusetts, Rhode Island, Michigan, Illinois and Iowa. The same dental group was named in a federal lawsuit of placing “…profits ahead of patient care…” http://www.syracuse.com/news/index.ssf/2012/10/lawsuit_aspen_dental_uses_dent.html.
Corporate management denied the claims, stating, the accusations are “entirely without merit.” Commenting on a separate lawsuit against the same company, Massachusetts Attorney General, Martha Coakley stated, “We allege this dental company took advantage of its patients by deceptively marketing its services and unfairly charging in advance for dental treatments.” The company settled the Massachusetts class action lawsuit in 2014, for nearly $1,000,000, without admitting fault. http://www.mass.gov/ago/news-and-updates/press-releases/2014/2014-12-22-aspen-dental-aod.html.
Legislation leaves Patients Unprotected
Politics might be getting in the way when it comes to DMSOs. In April, 2012, the Texas State Board of Dentistry testified before the Public Health Committee of the Texas House of Representatives: “… The role of these clinics has been questioned due to the opaque relationships between…dental management services organizations (DMSO) and the practicing dentists. DSOs are not legally defined in the law, leaving their practice and authoritative roles in dental offices vague and unregulated… It may also enable DSOs to potentially and/or unintentionally manipulate the system without any disciplinary actions… However, there is great concern whether DSOs may also be interfering and influencing the practice of dentistry to meet organizational financial quotas.”
State dental boards have met stiff political resistance to regulating corporate owned dental chains. According to an online Bloomberg report, combined efforts by the DMSO lobby, US Federal Trade Commission, business groups, and Washington DC politicians killed North Carolina dental board efforts to regulate DMSOs. After losing their appeals, North Carolina’s board continued in its efforts by pleading its case before the U.S. Supreme Court. A decision is expected in June, 2015, http://www.bloomberg.com/news/2012-05-31/republicans-target-dental-bill-that-private-equity-hates.html. The DMSO lobby has claimed that it lowers the cost of dental care and that regulating their activities would be a restraint of trade. Unfortunately, they have not shared factual information substantiating their claims of lowering costs. DMSO and private dental offices fall under the same dental benefits guidelines.
While not every DMSO is the same and not every patient visiting a DMSO will be mistreated, there is still reason for concern. According to an article by Dr. Michael Davis, one third of disciplinary actions involve dentists from DMSO dental chains, even though only about 5% of dentists, nationally, are employed by them. http://www.drbicuspid.com/index.aspx?sec=wom&pag=dis&ItemID=317095&wf=2104. Considering the higher rate of corporate dentists being disciplined, continued resistance to dental board authority cautions, “Buyer beware,” if deciding to choose a dentist without a personal referral.
Regardless of whether the choice is a DMSO dental office, or a private practice dental office, when looking for a dentist, don’t rely on insurance company lists. They provide no disclosures about practice settings and histories, and offer no factual guidance on the actual level of service and quality you should expect. Instead, concerned patients should seek an ethical dentist with clear accountability and a known willingness to provide a level of care not subject to outside influences. Every dental patient deserves to know they and their families are protected, and the dentists that support them in that belief.