Dental industry v. public policy org, media, lawyers: who’s exploiting whom? (TX)

In response to the ongoing assault against Dental Service Organizations (DSOs), a recent Daily Caller op-ed termed this effort Anatomy of a liberal hit job citing how the George Soros-funded Center for Public Integrity (CPI) initiated the dental industry attack by partially funding a PBS documentary  entitled “Dollars and Dentists.”  The program – described as “a thinly veiled docu-lobby on behalf of socialized dentistry” – claims Kool Smiles, the largest Medicaid-focused DSO in Texas and the nation’s largest Medicaid-focused dental provider, and other DSOs both overcharge patients and over-diagnose treatments as a means by which to boost revenues.  With Lawsuit Abuse Awareness Week still underway, an important awareness point worth highlighting is the calculated engineering of harm for seemingly contrived legal actions.  And the DSO assault seems exactly such an effort.

As many traditional dental practices move toward a model providing care for a small number of high-margin patients, an underserved market often accessing dental care through government programs or consumer credit has emerged.  DSOs, for-profit businesses (like any other dental practice) providing non-dental administrative and other support services to dentists or groups of dentists, have found opportunity.  However, to be profitable and maintain a sustainable business model in this low reimbursement environment, cost controls, efficient operational practices and higher patient demand are necessary.

Upon identifying these DSO success components, the legal industry in concert with a narrowly-focused media are exploiting a challenging business climate by redefining these operational elements as grounds for legal action with a strong predatory bent.

Not all press related to the DSO industry is necessarily out of line.  Some “bad apples” appear to have been identified and deserve strict disciplinary measures, even perhaps criminal prosecution.  It’s important, however, to not use too broad a brush in painting the entire industry as corrupt.

DSOs offer great opportunity for dental consumers and taxpayers.  After an in-depth review of Texas reimbursement claims, renown economist Arthur Laffer found DSOs are not only providing critical services to an underserved patient base including many children on Medicaid receiving first-time dental care access, but that DSOs are providing more cost-efficient and conservatively administered service than the average Texas dentist.

While critics have accused DSOs of maximizing profitability by performing sometimes questionable, high-reimbursement procedures, Laffer’s study of state of Texas claims records found DSO’s rate of procedures performed to be 10 per the average patient while an average non-DSO patient had 12 or more.  Similarly, the average DSO per patient charge was $483.89 compared with $711.54 for other types of dental practice patients.  Specific review of Kool Smiles indicated eight procedures per patient and a cost of $345.45, less than half of non-DSO dentists.

But Laffer was hired by Kool Smiles to conduct the study, critics will say.  And indeed he was, however, the company had no input nor control over Laffer’s methodology and Laffer maintains the independence of the study results and his opinions.  The Laffer DSO study provides in-depth discussion of research materials – both the source and nature.  The study additionally includes correspondence with CPI/Frontline, producers of the “Dollars and Dentists” program, who declined providing the “Medicaid data, methodology and analysis” used in their report claiming “we dont give  out our unpublished work product.”

The Daily Caller article ends saying that if CPI is embarrassed by Laffer’s significant contradiction of its alleged findings, “its representatives sure haven’t said so.”  It goes on to say:

Neither have they apologized for slandering Kool Smiles and the entire dental industry. In fact, when asked by Arthur Laffer to produce the data that presumably undergird its report — and PBS’s “Dollars and Dentists” — CPI, which bills itself as “one of the country’s oldest and largest non-partisan, non-profit investigative news organizations,” flatly refused.

ProPublica, billed as “an independent, non-profit newsroom that produces investigative journalism in the public interest,” recently asked Are High-Volume Dental Chains Exploiting Kids on Medicaid?  Perhaps the better question is if a high profile public policy organization is aiding a predatory legal industry’s exploitation of those profitably servicing an underserved population desperately in need?

Lou Ann Anderson is an advocate working to create awareness regarding the Texas probate system and its surrounding culture. She is the Online Producer at, a Policy Advisor with Americans for Prosperity – Texas and a Director of Women on the Wall. Lou Ann may be contacted at

Commentary, Featured
  • Dong Mark

    Many people go through embarrassing situations because of missing teeth. It affects their well-being and prevents them from enjoying simple things in life like eating their favorite dish or leading business meetings.

    Thanks for excellent article.

    Dallas Dentist