Small Smiles excluded from Medicare, Medicaid programs

Church Street Health Management (CSHM), which operates 70 Small Smiles dental clinics in 22 states and the District of Columbia, has been excluded from participation in the Medicaid and Medicare programs for a minimum of five years by the U.S. Department of Health and Human Services (HHS).

The action follows a recommendation by a U.S. Senate committee that the Small Smiles chain should be excluded from the Medicaid program for encouraging dentists to perform unnecessary treatments to boost profits.

The March 7 exclusion letter sent from the HHS' Office of Inspector General (OIG) and signed by Robert DeConti, the assistant inspector general for legal affairs, cited CSHM for failing to cure several breaches of the Corporate Integrity Agreement (CIA) between CSHM and the OIG. The letter was addressed to CSHM's chief compliance officer.

The violations in the exclusion letter include the following:

• Failure to file quality of care reportable events at the Oklahoma Smiles in Tulsa, OK, and the Small Smiles Dental Centers in Mattapan, MA
• Failure to maintain disclosure logs at Oklahoma Smiles that were supposed to include a patient's quality of care reportable event; also failure include the chief dental officer's October 22, 2013, disclosure to the chief compliance officer about the incident
• Failure to implement policies to inform patients, parents, and guardians when a substantiated incident of patient harm occurs
• Failure to have the chief dental officer, regional dentist, or chief compliance officer participate in compliance review visits at CSHM facilities
• Failure to perform annual general training in the third reporting period
• Failure to comply with compliance officer certification: On March, 14, 2013, CSHM submitted a false certification by the chief compliance officer with its third annual report to the OIG, the exclusion letter stated.

CSHM's exclusion from federal healthcare programs is effective April 7 unless the company appeals.

In July, 2013, in investigative report by a U.S. Senate committee concluded that the Small Smiles dental chain should be excluded from the Medicaid program for encouraging dentists to perform unnecessary treatments to boost profits.

The report followed a two-year Senate investigation by Sens. Charles Grassley (R-IA) and Max Baucus (D-MT) of dental chains owned by private-equity firms.

The 1,500-page report also recommended that corporate-owned chains that use similar deceptive business models should be ousted from the federal program as well.

Investigators looked at five dental chains that allegedly used deceptive business models that gave managers rather than dentists control over the clinics. In addition to CSHM, the investigation included NCDR, which owns 130 Kool Smiles clinics in 15 states and the District of Columbia; ReachOut Healthcare America (ReachOut), which operates mobile clinics that treat children at schools in several states; Heartland Dental Care, which operates more than 300 clinics in 18 states; and Aspen Dental Management, which operates more than 300 Aspen Dental clinics in 22 states.

The Senate report focused on CSHM and ReachOut because both companies treat Medicaid children almost exclusively.

Small Smiles changed hands in 2012 while in bankruptcy and claimed at the time that it is "mending its ways."

The Senate report recommended that HHS and the OIG exclude Small Smiles from Medicaid and "any other corporate entity that employs a fundamentally deceptive business model resulting in a sustained pattern of substandard care."