Byron Harris, the dogged investigative reporter for Dallas, Texas television station WFAA, has come up with two more installments in his continuing investigation of the state’s Medicaid agency and the money it spends on braces for kids who, under the state’s rules, might not qualify for them. Throughout the summer Harris told stories of how dental chains profited mightily from the state’s largess at a time when other parts of the health system were starving. Last year the state spent more than $184 million—nearly double the amount it spent in 2008—on braces for 120,000 kids, some of whom may not have met the state’s criteria for orthodonic work.
Two weeks ago Harris produced another story, this one focusing on the All Smiles dental clinics, and the founder’s “two sumptuously outfitted Gulfstream corporate jets with sticker prices in the tens of millions of dollars.” Harris reported:
FAA records show that the All Smiles Air Force has flown to destinations such as Hilton Head and Telluride in recent weeks, evidence of some of the money All Smiles has collected from Texas taxpayers for putting braces on kids’ teeth under Medicaid.
Harris combed state records and found that the Texas Medicaid orthodontic program paid All Smiles, one of the four largest billers for braces in Texas, more than $10 million last year. That was nearly five times more than the state of Florida paid out for kids’ braces under its Medicaid program. Using the Texas Public Information Act, Harris found that All Smiles clinics put braces on more than 1,000 children under the age of twelve last year. Since kids younger than that often don’t have their permanent teeth yet, Texas requires special approval for each child. Was the decision to put braces on those kids’ teeth driven by corporate policy or dental necessity?
What make Harris’s work so compelling is that he is drilling deep into a system that allows these sorts of practices to continue and flourish. He ended his piece by noting that the Texas Dental Board, the Texas attorney general, and U.S. attorneys could all prosecute corporations for practicing dentistry, but so far nobody has. Harris says he is continuing to probe further, hinting at what might be coming in the next months. “The whole system is contracted out to a private corporation and the state says we can’t talk to the company that does it, “ he said.
The seventh installment explored the money the state spends on transportation to get kids to the dental clinics. Not only did taxpayers pay for dental work, they also paid to collect children from miles around and deliver them to the clinics. A clinic in Amarillo collected $2.6 million for braces; Medicaid paid another $171,000 to get the kids to the door. In Corpus Christi, National Orthodontix got almost $10 million from Medicaid, which spent another $57,000 for transportation just to bring the kids to its Corpus Christi office. The expenditures add up. The piece makes the point that if kids who don’t qualify get care and use finite resources, then others who do need braces go without.
Harris’s investigation is notable not only for what it reveals about the state’s spending and who gets the money, but for the example it sets in this age of journalistic parsimony and journalism shaped by special interest spin. It shows investigative reporting can still be done by local TV stations. Government and corporate wrongdoing continue unabated, and the need to root out what’s going on and at whose expense is more important than ever in these times of budget cuts. Said Harris: “If what’s happened here is an example of how easy it is to missbill against the government, then the problems with Medicare and Medicaid are much bigger than anybody has imagined.”
Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for CJR's Covering the Health Care Fight. She also blogs for Health News Review and the Center for Health Journalism. Follow her on Twitter @Trudy_Lieberman.