Every profession inclusive of law enforcement, medicine, education, and law has an unfortunate number of violators to the public trust. Dentistry is no exception.
When dentist violators step over the line, often repeatedly and with self-serving intent, they become subject to national media attention. The spotlight exposes abusers and their schemes. These betrayers merit public shaming. Unfortunately, the entire profession also takes a public image hit.
The public may assume there’s a “professional code of silence” or “old boys’ club” that serves to shield and protect bad actors. In reality, ethical dentists with concern for the public health and safety frequently work effectively and quietly with authorities. Honorable dentists realize denial and coverups of deviant doctors eventually harm and degrade the entire profession. Yet we live in a society that too often calls these heroic whistleblowers “rats” or worse.
Three cases recently gained substantial recent attention in the national media, which elected to focus on the lawless actions of rogue dentists and damages to the public welfare. Little to no light was placed on ethical dentists who courageously stepped up. They risked personal and professional attack and potential legal retribution. Despite valid concerns of negative consequences, though, they took the high road.
For the most part, these ethical doctors aren’t seeking public praise, awards, or even a simple thank you. They do the right thing, for that reason alone. It’s the right thing. While we will respect their personal privacy, we also will laud their behaviors, contrary to how they say they’ve done nothing special. These are very special doctors.
Texas Dental Medicaid Scandal
The settlement by Xerox subsidiary Conduent for $235.9 million with the State of Texas gained national attention. Conduent allegedly failed to provide proper oversight as Texas’ retained agent for dental Medicaid expenditures.
Allegedly, according to Texas Attorney General Ken Paxton, this Medicaid managed care organization (MCO) “rubber stamped orthodontic prior authorization requests without assuring the required review of each request by qualified clinical personnel, which violated its responsibilities.” At one point, the Medicaid dollar expenditures for orthodontics in Texas exceeded Medicaid orthodontic costs of the other 49 states combined.
There is plenty of blame to go around. This included Xerox, which operated the Medicaid MCO. Also at fault was the State of Texas, which ignored repeated credible whistleblower alarm calls of suspected fraud and malfeasance. Not to be left off the hook were alleged dishonest dentists and their allegedly crooked employer dental service organizations (DSOs). All received significant media attention.
Many hundreds of disadvantaged Medicaid children were subsequently abandoned while in the midst of full orthodontic treatment. Their dentists often refused further patient service, as the freeflowing money spigot on Texas Medicaid orthodontic treatment had been limited. These Medicaid treatment doctors simply abandoned their patients. Many dentists left the state. DSOs that were focused on Medicaid either closed or declined to complete orthodontic care. A crisis was created, as this vulnerable population had nowhere to turn.
Many dozens of heroic members of the Texas Association of Orthodontists came forward with no recognition or media attention. Minimally, many hundreds of cases were stabilized so brackets, bands, and wires could be removed for homecare access. Moreover, hundreds of these cases were taken to full ideal orthodontic completion. Further, these often highly challenging cases were professionally serviced with no financial remuneration.
The skill and knowledge of these board eligible and board certified orthodontists should not be minimized. They often assumed cases in mid-treatment, cases that were initiated by general dentists who received orthodontic training at motel classes or on-the-job training. These specialists adroitly handled and resolved numerous iatrogenic orthodontic cases.
In assuming completion of these Medicaid children’s orthodontic treatments, again at no financial gain, doctors risked being called into legal depositions, with associated loss of time and income from their practices. That risk wasn’t assumed lightly, especially considering the extensive legal actions in play in Texas over dental Medicaid.
The entire dental profession as well as the public owes a debt of gratitude to this cadre of orthodontists. Yet not one of these dental heroes seeks praise. If you ever happen to meet one of these special colleagues at a dental meeting, or on the golf course, please shake their hand and thank them.
The Atlantic’s “Truth About Dentistry”
The Atlantic recently published what seemed to be a hit piece on the entire dental profession by exposing the alleged abuses of a single California doctor, John Roger Lund, who was charged criminally by the Santa Clara County District Attorney in 2016 for both consumer and insurance fraud. Lund was initially arraigned on 28 fraud counts involving alleged unnecessary dental treatments.
The Atlantic detailed several of the alleged abuses Lund inflicted on patients. Lund seemingly was masterful in gaining the trust and confidence of patients, whom he then allegedly manipulated for gross over-treatments to his personal financial benefit.
The report elaborated upon the virtues of evidenced-based dentistry, which would have had no impact upon a crooked charlatan dentist. The Atlantic’s author droned on and on about multiple accepted dental therapies having little or no proven efficacy, according to evidenced-based dentistry.
However, there was no reporting on the fiscal costs of double-blind clinical studies with valid numbers of human test subjects. There was no mention of the fact that the overwhelming number of dental research studies (over 90%) are funded by manufacturers, who usually have the power to close down a study when they feel its outcome is unfavorable. Similar evidenced-based problems exist in medicine and testing of pharmaceuticals.
The Atlantic also expansively extoled the negatives of dentistry being isolated and how dentistry should follow medicine’s example while failing to grasp the realities of the failing modern medical model.
The article also highlighted another healthcare reporter who widely promotes single-payer healthcare models. These systems have largely failed in those nations where they are implemented. Any relevance to the subject at hand of alleged abuses of Lund seemed a stretch beyond the absurd.
The young dentist who purchased Lund’s practice, Dr. Brendon Zeidler, preformed an exhaustive patient record audit involving many hundreds if not thousands of charts. Evidence was gained that apparently an abusive and excessive number of crowns, root canals, and incision-and-drainage procedures were delivered and billed for.
Zeidler next asked several colleagues to also review these records, and they came to similar findings. This service was provided gratis to serve the public welfare. The young dentist finally asked the senior professional, Lund, for his explanation. Lund’s response was unsatisfactory, and a civil legal action and later criminal action against Lund resulted.
Precious little attention was afforded the young doctor who stepped up. He sat down with multiple patients, one on one, and delivered the facts on their previous dental treatments. He knew he wouldn’t be well received by patients, who trusted the senior doctor, with whom they enjoyed a longstanding and trusted professional relationship. “Shooting the messenger” is an all too common reaction. Yet bound by his principles and professional code, this ethical junior doctor had little choice.
The media elected to point in myriad directions in a highly convoluted report that frequently missed salient points. Too little attention was delivered to a young dental professional who stood up for his patients’ interests. Anonymous colleagues within the dental profession audited hundreds of patient records for no remuneration, all to serve the best interests of the public. The easy and more lucrative path would have been to ignore or cover for sins of the past.
Cleveland’s MetroHealth Dental Residency Fiasco
In a horrific situation, Cleveland’s MetroHealth dental residency teaching program became an organized crime racket. The principals who profited from these convoluted scams were primarily a handful of doctors.
The dentists involved were eventually convicted in federal court and sentenced to extensive prison terms. The lead crime boss, Dr. Edward Hills, was also formerly president of the state dental board. This case represented a serious black eye to all of the Ohio dental community.
The community, including current and former Ohio State Dental Board members and the leadership of the state’s organized dentistry, was disgusted by the longstanding abuses and criminal violations of Hills and his crew. Very concerned dentists absolutely knew problems existed, but they were often powerless to act. Hills enjoyed protections in high government places.
One of Hills’ benefactors was a former executive director and attorney with the Ohio State Board of Dentistry, Lili Reitz. She served in her powerful regulatory capacity from 1996 to 2015. Reitz resigned from service to the dental board and accepted a plea deal with prosecutors for a $100 fine on a wrist-slap misdemeanor charge of disorderly conduct.
The former dental board executive director admitted to leaking the state’s confidential material to Hills. Reitz’s more extensive unlawful collusion was mentioned in the Hills’ indictment, and it’s widely assumed she cooperated with prosecutors under pressure.
This background is essential in understanding the risks that concerned doctors took in working with authorities to expose the criminal activities of Hills and his gang. Many didn’t trust state officials because of entrenched state corruption, but later gave their complete cooperation once federal authorities became involved. Further, these heroic doctors received zero monetary gain in doing the right thing in service to the dental profession and public welfare.
Others who assisted federal prosecutors were potentially even more vulnerable. These dentists included current and former hospital residents who were primarily foreign nationals. These doctors often only retained a limited visa status and feared a potential deportation process. But many of them placed the public interest above their own.
The mainstream media is only too quick to report abuses perpetrated by the dental profession, as it should. Doctors who violate the public trust must be exposed and face consequences for their actions.
What’s just under the surface are a plethora of benevolent professionals who pick up the pieces. Most of these doctors prefer anonymity. The public will rarely know of their acts of compassion and efforts with restitution and fair play. What the public may often perceive as a professional code of silence or a self-serving old boys’ club may in reality be far different. (Yes, admittedly, these negatives do also exist.)
Courageous dentists not only serve the public within their clinical practice, but many times stick their necks out. Hurdles may include corrupt and dysfunctional state regulatory boards, unethical state elected or appointed officials, and powerful moneyed corporate interests. It’s my honor to spotlight these special colleagues who willingly took risks in service to a greater good.
Dr. Davis practices general dentistry in Santa Fe, NM. He assists as an expert witness in dental fraud and malpractice legal cases. He currently chairs the Santa Fe District Dental Society Peer-Review Committee and serves as a state dental association member to its house of delegates. He extensively writes and lectures on related matters. He may be reached at firstname.lastname@example.org or smilesofsantafe.com.