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.

Dental Insurance and Obama Care: Who’s Right?

Dental Insurance and Obama CareThe National Journal is reporting that the National Association of Dental Plans is spending more than $1 million on a campaign to change a provision in the health care law that they feel will require some people to buy duplicate dental insurance coverage.

Let me repeat…The dental benefits trade organization is spending $1,000,0000 to hire a lobbying firm to convince the Obama administration to fix the provision by the end of 2011.

Is this a good thing? Click here for a 92-page white paper “Road Map” with Delta Dental as a co-sponsor.

The NADP is concerned that, starting in 2014, the almost 44 million people who receive pediatric dental coverage through small business employers will also have to buy coverage through the new health insurance exchanges. It is asking regulators to clarify that their existing coverage meets the law’s requirements.

“Truthfully, this is the No. 1 issue for our industry,” said NADP executive director Evelyn Ireland. “It is the most crucial thing for us to get done.”

NADP wants to ensure that people will be allowed to keep their existing dental insurance coverage under the new health care, a promise President Obama repeatedly made during the heath insurance reform debate.

For a multitude of reasons I have never been a big fan of Delta Dental. However, after reviewing the 92-page white paper I think there may be some merit to this $1,000,000 argument.

Before, I make up my mind, I would like some pro or con feedback from our readers.

Please post your comments below.

Dentists: Does 99 Dollars an Hour Make You a Wealthy Dentist?

Dentists: Does 99 Dollars an Hour Make You a Wealthy Dentist?Dentists make $99.00 an hour, which is more than orthopaedic surgeons but less than nurse anesthetists, according to a study by Suneel B. Bhat, MD, an orthopaedic surgery resident and his colleagues at the Thomas Jefferson University Hospital.

Presented this month at the American Academy of Orthopaedic Surgeons (AAOS) 2012 Annual Meeting, Dr. Bhat’s study found that becoming an orthopaedic surgeon was a “poor financial investment” compared with studying law, dentistry, or anesthesia nursing, according to Medscape Today News.

“Our study, the first direct comparison of the financial return of orthopaedic surgery to other professions, highlights the point that there is a relatively lower financial value incentive for qualified individuals to enter orthopaedics compared to several other professions, which could potentially have far-reaching implications on career choice and subsequent access to care for patients,” the authors concluded.

The Medscape report revealed that the researchers found that dentists earned a cumulative career total of $6,866,796.

That was less than the $10,756,190 made by orthopaedic surgeons, the $8,381,250 made by lawyers, and the $7,338,412 made by nurse anesthetists, but more than the $3,867,504 made by nurse practitioners.

Also published in the report is the amount of debt factored into the study for orthopaedic surgery students, which has increased by $34,000 for public schools and $40,000 in private schools over the past five years.

Since 1984, the medical school tuition has raised in public institutions by 165% and in private institutions 312%. They assumed that educational loans would be deferred until the annual liability was less than 25% of earnings, and that interest on the loans was 8.25%, according to Medscape.

When hourly income was calculated, orthopaedic surgeons made $88.00 per hour, compared to $93.00 for nurse anesthetists, $130.00 for lawyers, $49.00 nurse practitioners, and $99.00 for dentists.

The lingering recession has taken a bite out of dentists’ incomes over the past 4 years with many laying off employees and postponing retirement. The average dentist salary according to the U.S. Government Bureau of Labor Statistics is $74.00 an hour, with some new dentists earning $26.00 per hour at the lower salary range, while dentists at the upper range earn $80.00 per hour.

Another recent study compared the earning of high school graduates who skipped college and grad school expenses and went directly into the trades. The study compared a plumber with no advance educational cost and debt to a physician. The plumber came out ahead on life time earnings.

The real kicker was that the physicians not only got nailed for the extra school costs and debt expense, but were taxed by the government at a higher rate on their delayed earnings.

With the cost of higher education continuing to rise and the amount of student loan debt graduates carry after graduation, do you think dentists leaving dental school today still have the opportunity to become a wealthy dentist?

For more on this study see: Dentists’ Hourly Income Better Than Orthopaedic Surgeons’

CareCredit Accused of Predatory Lending Practices

Care CreditCareCredit is a credit card designed to help people pay for medical costs they otherwise wouldn’t be able to afford. About 50,000 US dental providers offer the card.

But a recent NPR report indicates that complaints about CareCredit have increased.

More patients are claiming they didn’t realize they were signing up for payments they would never be able to afford.

“People are being convinced to take on more credit than they can afford,” claims Elizabeth Landsberg, an attorney with the Western Center on Law and Poverty. “We have people who are living on a fixed income of $1,000 a month who are being signed up for $6,000 in credit. There’s no way they can make those payments.”

Though the American Dental Association endorses CareCredit, many people do not realize that the ADA is paid for its endorsement. “The blurring of medical provider and financial services provider is problematic,” said Mark Rukavina from The Access Project, a health care advocacy group.

Read the NPR report

A Health Care Reform Conundrum

Our discussion of mercury led to such, ahem, heated discussions on our blog that I took the unprecedented step of closing the comments down to finally force a truce. After that, I thought it was time to move on to something more light-hearted… like health care reform.

I’ve been so busy it’s been hard enough just keeping up with my own blog. But someone forwarded me an email that really caught my eye. It’s so dead-on I wish I could take credit for having written it myself.

Here you go:

So let me get this straight…

This health care plan will be written by a committee whose head says he doesn’t understand it, passed by a Congress that hasn’t read it and whose members will be exempt from it, signed by a president who smokes, funded by a treasury chief who did not pay his taxes, overseen by a surgeon general who is obese, and financed by a country that is dead broke…

What could possibly go wrong?

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