Orthodontic Braces: Taxpayers Spent $424 Million for Children in Texas

Orthodontic Braces: Taxpayers Spent $424 Million for Children in TexasIn June of this year, The Wealthy Dentist published a story about Taxpayers footing the bill for orthodontic braces in Texas.

In Texas, Medicaid pays dentists for orthodontics per procedure, instead of a lump sum for the “finished mouth” of straight teeth.

This has made Medicaid orthodontia a lucrative dental business in Texas.

WFAA-TV of Texas has been investigating this story for the last six months and has uncovered hundreds of millions of dollars of questionable Medicaid spending on dental braces for children in Texas. Their news reports prompted federal investigators to now audit the Texas Health and Human Services Commission, which controls the Medicaid funds.

According to the WFAA website –

In a letter to the state, the Inspector General says it will examine the “authorization process for orthodontic treatment” under Texas Medicaid. “The objective of our audit,” the letter continues, “is to review the State’s controls to ensure that only medically necessary orthodontic cases are paid.” The time period covered by the audit is September 1, 2008 through May 28, 2011.

The new station’s investigation revealed that during that period, Texas taxpayers spent $424 million on orthodontic braces for children under Medicaid. Taxpayers spent $100 million in 2008, $140 million in 2009, and $184 million in 2010, state records show.

Texas dentist, Dr. Christine Ellis, who teaches at UT Southwestern Medical Center, has twice traveled to Washington in an attempt to convince lawmakers to scale back Texas Medicaid orthodontics payments and divert funds for more pressing dental needs.

Her attempts fell on deaf ears. According to the WFAA-TV article, Ellis said, “There’s no response. No one is putting the brakes on this thing.”

Billy Millwee of the Texas Health and Human Services Commission is now telling WFAA-TV that if taxpayers money has been lost, the Attorney General might take action to get it back. He went on to say that Texas will have a new managed care Medicaid dental program beginning next spring.

For more on this story see: Feds Investigate Texas Dental Medicaid Program and Taxpayers Footing the Bill for Braces in Texas.

Invisalign Cost (Survey Video)

Dental safety and BPAInvisalign lets adults get straight teeth without traditional braces.

Unfortunately, the costs keep Invisalign from many patients who might otherwise consider adult ortho.

In a dentist survey we conducted, we found the average cost of Invisalign treatment from a general dentist was about $4,800.

Specialists were a little more expensive at around $5,400.

Treatment from an orthodontist averaged about $6,900.

Jim Du Molin and Julie Frey discuss what dentists think about Invisalign braces:

“Costs are too high for this to be a mainstream treatment for people willing to have adult orthodontics,” said a Michigan Dentist.

“The lab fees are excessive, and Invisalign could use some competition,” said a New York Dentist.

While there’s a lot more interest in adult braces than there used to be, it’s still not quite mainstream.

And with lab costs like that, it’s hard to imagine it truly going mainstream.

What are your thoughts about Invisalign braces?

General Dental Patients Are the Most Profitable For Dentists

General Dental Patients Are the Most Profitable For DentistsFor most dental practices, a certain percentage of dental patients drive the majority of profits.

But you might be surprised to learn that the more extensive dental treatment patients may not necessarily be the best profit-drivers.

It’s important for dentists to know what type of dental patients are the most profitable to their dental practice. In studying what makes this group profitable, dentists can apply what they discover to other dental patients.

The Wealthy Dentist conducted a survey asking dentists which type of dental patients they find are the most profitable for their dental practice.

34% of dentists responded, “General dental patients are always the core (profits)!”

Here’s a breakdown of the rest of the dentist’s responses —

24% Dental implant patients
18% Cosmetic dentistry patients
11% Sedation dentistry patients
09% Braces patients
02% Dentures patients
02% Other

Here are some comments from our dentists:

“Our most profitable patients are those that pay in full before treatment begins.” (Texas dentist)

“Dental implant patients seem to always pay on time.” (Ohio prosthodontist)

“Patients who pay in full and refer other patients.” (General dentist)

“Sedation patients are the most profitable.” (California dentist)

“Cosmetic patients who want to replace amalgam with a more esthetic composite.” (Arizona dentist)

General dental patients have long been the most profitable type of dental patient for dentists, is this true of your dental practice?

Dental Braces: Are General Dentists Capable of Straightening Teeth? (video)

Dental Braces: Why Many General Dentists Prefer to Do Braces (video)Straight teeth are hugely desirable in our culture, but who is the right doctor to straighten a dental patient’s teeth with braces?

An orthodontist or a general dentist?

One general dentist, who refers out all orthodontia cases said, “I believe that only a good orthodontist can get really good, long-lasting results.”

Another general dentist, who refers out very few cases said, “I do all my own orthodontics and I believe the average general dentist is fully capable.  It’s just that at dental school it is instilled in us to refer and not touch it!”

The Wealthy Dentist conducted a survey that asked dentists what percentage of orthodontic patients they refer out.

To hear the results of the survey and how dentists responded, Click on Play —

What are your thoughts on general dentists placing braces?

Dental Braces: Once Again Texas Makes News with Braces

Dental Braces: Once Again Texas Makes News with Braces What is it with Medicaid dental care and braces in Texas?

The Texas Health and Human Services Commission, which administers Medicaid in Texas for dental braces, has filed a request to be reimbursed for $7.5 million in alleged fraudulent claims it paid to Amarillo orthodontist Dr. Michael Goodwin.

Federal authorities also moved to seize the commercial and personal bank accounts of Dr. Goodwin and his wife as part of a probe linked to a Medicaid fraud scheme, according to the Amarillo Globe-News.

In 2008, Dr. Goodwin became an individual Medicaid provider, which allowed him to bill Medicaid only for services personally provided by the orthodontist.

Soon after the change, the Amarillo orthodontist was reported as scheduling up to 400 Medicaid patients a day and allegedly billing the government for orthodontic treatment he did not perform. The Globe-News further reports that patients and former employees likened the Amarillo Medicaid fraud scheme to “herding cattle.”

In 2009 the Texas Attorney General’s Office’s Medicaid Fraud Control Unit was alerted to the fact that Goodwin was likely billing Medicaid for work done by dental assistants, who worked on dental patients that state law prohibits them from doing “at Goodwin’s direction and without his direct supervision while Goodwin was out of town, away from the office or even while present in the office,” according to an affidavit for the case.

The affidavit further states that Dr.Goodwin scheduled patients in 10-minute increments, “causing pressure for assistants to practice dentistry quickly” and eventually billed Medicaid for their work.

It goes on to outline the fact that Dr. Goodwin would fly from Texas to dental offices in Indiana almost every month, while billing Medicaid for orthodontic patient services in Amarillo on dates when flight records showed he was clearly in Indiana.

The majority of Goodwin’s patients were Medicaid recipients with some reporting that figure could be as high as 95% of his dental practice.

Unfortunately, this is not a new dental braces trend in Texas …

Last June, The Wealthy Dentist reported that in 2010, Texas spent $184 million on Medicaid orthodontics — more than the rest of the United States combined. Dentist Richard Malouf’s All Smiles Dental Centers of Texas collected $5.4 million from Medicaid orthodontics. Since that time, All Smiles’ Medicaid orthodontics billings nearly doubled to $10.2 million.

In September we further reported that WFAA-TV had uncovered that Texas taxpayers had spent $424 million on orthodontics for children under Medicaid. Taxpayers spent $100 million in 2008 and $140 million in 2009 — above the $184 million spent in 2010.

On March 1, 2012 Texas implemented a new managed care Medicaid dental program, only time will tell if this will stem the bleeding of taxpayer money on braces in Texas.

For more on this story see: Feds Link Orthodontist to Medicaid Fraud Scheme

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