Congressional committee has continuing concerns about DMSOs

A congressional oversight committee expressed impatience that little has been done to rein in scofflaw dental management service companies (DMSOs), according to a February letter to the Office of Inspector General (OIG).

The February 13 letter from Reps. Michael C. Burgess, MD (R-TX), and Diane DeGette (D-CO) urged the OIG to use its authority to exclude "individuals and entities that have engaged in fraud or abuse related to federal healthcare programs from participation in Medicare, Medicaid, and other federal healthcare programs." Dr. Burgess and DeGette are members of the House Committee on Energy and Commerce's Subcommittee on Oversight and Investigations.

The letter noted that Small Smiles was one of five corporate dental chains that had been investigated by the U.S. Department of Justice for deceptive practices. It referred to a U.S. Senate committee's July 2013 report recommending that the Small Smiles dental chain should be excluded from the Medicaid program for encouraging dentists to perform unnecessary treatments to boost profits.

"Despite a change in ownership and repeated professed improvements, CSHM and Small Smiles clinics continue to operate under contracts that we believe circumvent state laws," Dr. Burgess and DeGette wrote in the letter. "It is unacceptable that the same problems first uncovered in 2008 continue to exist today, especially in light of oversight by an independent monitor and the U.S. Department of Health and Human Services (HHS) Office of Inspector General."

CSHM officials declined to comment.

A few weeks after the letter was sent, on March 7, the OIG excluded CSHM, which owns the Small Smiles chain, from federal healthcare programs such as Medicaid for multiple breaches to a compliance agreement.

The letter noted that Small Smiles' former owner, Forba Holdings, agreed to a $24 million settlement over allegations of Medicaid fraud brought by the U.S. Department of Justice. The settlement included a Corporate Integrity Agreement (CIA) that the company would adhere to quality and compliance standards, and undergo extensive audits by an independent monitor.

The committee members pointed out that throughout the course of the CIA, Forba repeatedly breached the agreement, including performing unnecessary treatments on children, improper administration of anesthesia, providing care without proper consent, and overcharging Medicaid. They noted in their letter that, although CSHM now owns the chain, "similar to Forba's management structure, CSHM retains all rights of ownership, employs all staff, recruits all staff, makes all personnel decisions, and receives all income from Small Smiles clinics."

Dr. Burgess and DeGette exhorted the OIG to take action against scofflaw DMSOs as recommended in last year's Senate report.

"Based on the report by the Senate Committees and the prior findings of HHS OIG, we concur with our Senate colleagues and recommend that HHS OIG should consider excluding any corporate entity that employs deceptive business practices that result in substandard care from the Medicaid program," they wrote.

While federal laws don't require that dentists own and operate dental practices, they noted in their letter that 22 states and the District of Columbia have laws that forbid anyone other than dentists from owning dental practices.

"States have expressed concerns, rightfully so, that patient care should always be determined by the patient and their healthcare provider," Dr. Burgess and DeGette wrote.

The committee members seemed to chide the OIG for not taking action sooner. "We would appreciate your immediate attention to this matter," they wrote. "Every day that HHS does not exercise the tools at their disposal, the chance increases that more Medicaid patients will suffer."