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Senate Report Alleges Fraud and Abuse by Private-Equity Backed Dental Practices

Posted on Wednesday, October 9, 2013

Washington, D.C., July 26, 2013–The US Senate Committee on Finance this week issued a discouraging report on ways in which some large dental practices are putting profits before patients.  The report is particularly disturbing in that most of the alleged fraud and abuse of patients involved children.  Such conduct is inexcusable, and should be prosecuted vigorously.  However, equally disturbing is the broad brush that implicates a whole class of practice models rather than focusing on the actual offenders.

The Senate report identifies companies in which dentist employees have been pressured or required to perform unnecessary procedures in order to maximize profits.  This is a clear violation of the ethical principles of the profession, as set forth in the ADA Code of Professional Conduct.   The Code states that “professionals have a duty to act for the benefit of others,” and that “contract obligations do not excuse dentists from their ethical duty to put the patient's welfare first.”  The ADA strongly believes that any pressure applied to dentists in conflict with this code should be reported and pursued aggressively.  Regardless of how they are employed, dentists must protect and promote the best interests of the patient above all else.  That is the purpose of the ADA Code, by which all member dentists agree to abide.  We believe that all dentists, whether they are ADA members or not, should follow this code.  States have legal and regulatory power to hold all dentists providing care within their jurisdictions to the same legal standards, regardless of who owns those dentists’ practices.  State dental boards should exercise that authority.

Included in the Senate report is a stated concern about the ability of the dental profession to provide access to care to millions of low-income families and other vulnerable populations.   

But the causes of what amounts to a dental health crisis affecting these underserved Americans are complex and require a comprehensive set of solutions.  The ADA, state dental societies and individual dentists have for decades wrestled with this situation as advocates before state and federal governments, in addition to their traditional roles as caregivers.  There has been significant progress made, especially in bringing more children into dental offices for much-needed care.  But much more is needed, especially with regard to young adults, who have the lowest rate of dental visits of any age group.

Healthy teeth and gums are not a luxury—they’re essential.  Dental health is a crucial part of people’s overall health.  Prevention is a critical change factor.  The majority of dental disease in children and adults can be prevented, if they receive oral health education and regular dental care.   Without a seismic shift away from solutions based solely on intervention and toward prevention, the nation will continue to fight an uphill and ultimately losing battle against dental disease. 

It is with this in mind that the ADA and all of the state dental societies this year launched Action for Dental Health: Dentists Making a Difference, a major initiative aimed at bridging this dental divide by targeting specific, proven and community-based solutions toward specific problems.  Action for Dental encompasses numerous initiatives that fall into three categories:  Providing care now to those with the most immediate needs, strengthening and expanding the public/private safety net, and bringing dental health education and disease prevention into communities.

Through Action for Dental Health, we’re helping states replicate programs that move patients out of hospital ERs and into the dental chair.  We’re helping dentists provide care to the 1.3 million nursing home residents who cannot travel to a dental office.  We’re advocating for increased water fluoridation, getting more private practice dentists to contract with safety net clinics, training Community Dental Health Coordinators, and enlisting other health professionals to make oral health a greater priority.  We are providing a wealth of information to the public through the ADA’s new patient website,  And we are continuing and increasing our advocacy at the state and national levels for Medicaid programs that work, not only for children, but also for the almost entirely ignored population of low-income adults. 

The nation should be greatly concerned with the findings of the Senate report, which we hope will spur more progress.  Only a multi-faceted, targeted approach to the numerous barriers that impede dental health will work.  Action for Dental Health represents our commitment to leading the way toward the day when all Americans who seek it get the care they need to enjoy good oral health they deserve. 

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