Another Black Eye

In mid-November, the image of dentistry was dealt another glancing blow, this time via television. The good news is that the impact has been limited thus far to the area served by the Los Angeles television market. This TV report concerning Denti-Cal fraud didn't possess the coast-to-coast clout demonstrated by the massive circulation of Reader's Digest and its early 1997 report on discrepancies in dental treatment planning.

The concern here is that this report could still spawn the interest of television journalists in other markets to present additional reports like this one, which was factual in content but unbalanced to the extent that we believe it contributes to an unfair indictment of the dental profession at large.

It is either ironic or a coincidence that the Fox station in Los Angeles initiated its "undercover investigation" after the CDA Update published a report on the Denti-Cal fraud problem in the Sept. 17, 1997, issue.

It would be easy to pass this matter aside with the notion that only a few dentists are engaged in this activity and that it will not have significant impact on the image of the profession. However, review of some of the facts about the fraudulent activity and some details of how it was reported will be helpful to understanding why we believe that the impact of this report is a severe black eye for the profession! It will heal, but not without more conscious attention to the solution of the problem.

Our first realization that this form of organized fraud had been occurring was a telephone call from a dentist colleague in spring 1997. He reported that one of his dentist friends in Los Angeles had complained that patients with Denti-Cal coverage coming to his office were being paid $10 and supplied transportation to go elsewhere for their dental care.

A concern that we had with the November television report is that it focused on the fraud by dentists, their intermediaries, and the patients who were guilty of the crime. Only the state government and taxpayers were listed as the victims of this scam. There was no mention of the harm to the honest dentists who incorporate treatment of Denti-Cal patients into their practices, only to have their patients or potential patients stolen at the front door. It is unfortunate that the report failed to mention that honest dentists are victims of this crime as well.

A major problem with the report is one that frequently occurs with such media investigations. Not a single dentist was interviewed, nor was any representative from the profession offered an opportunity to comment on this problem, although efforts by CDA had been undertaken unsuccessfully once the association became aware that a program was being prepared. Other than the station's undercover work (with hidden cameras in some instances), the 11.5 minutes of this two-evening report was devoted to the reporter's voiceover on videotaped "capping" activity inside and outside of several dental clinics in Los Angeles and one in the suburb of Lynwood. Interspersed were clips of an interview with the director of the Medi-Cal Fraud Division.

The facts revealed in the report are as follows. A "marketer" ostensibly hired by the dentist, employs "cappers" to find the dentist patients and binds the cappers to a phony agreement in which they "agree" not to pay those patients for coming to that dentist's office. If the capper encounters legal problems, the marketer will deny any business relationship with the capper. Under the terms of the agreement, the capper is paid as much as $2,000 plus per week, based upon the number of patients he or she steers to the dental clinics. Despite the phony contract, the capper makes payments to the patients ranging from $10 to $30 plus, in some cases, gifts from their proceeds. In one of the dental offices, the receptionist is filmed distributing "gift certificates" for a large supermarket chain while informing the patients that the coupons are good for anything they wish, from food to alcohol. There are obviously many incentives in the various schemes, with cell phones and pagers being among the premiums offered.

These schemes reportedly contribute to an estimated 10 percent of the annual Denti-Cal budget that is consumed by fraud. This was described as a pyramid scheme, where the person at the top, the dentist, makes money by overbilling for treatment that is never done, or for procedures that are unnecessary. The report described a patient that had 14 "fillings" placed in a short appointment that day. The reporter stated, "Greedy, unscrupulous dentists appear to be using others to become the richest link within the chain," and described the scenario whereby the dentists successfully distance themselves from the scam.

The cappers transport the patients to these offices from distances as far away as Bakersfield, according to the report. It was interesting to note that these cappers had vans clearly identified with painted signage proclaiming "Dental/Medical Transportation," but at the same time it was discouraging to find that ONLY dental scams were mentioned.

Another disheartening factor was that no specific information was provided to support how widespread this scam was (beyond its monetary contribution to overbilling fraud), although "widespread abuse" was the reference made by the director of the Medi-Cal Fraud Division in his interview. Neither was there any indication that there was a significant effort under way that would control or eliminate the problem. These factors taken together represented the most negative aspect of the manner in which this report was presented.

It was disturbing to have the viewing public told that "greedy, unscrupulous dentists" were masterminding a scam in which they were able to successfully distance themselves from the actual criminal activity (violation of Article 6, Section 650 of the California Business and Professions Code), which was putting from $400,000 to $900,000 in additional income into their pockets at the expense of California's taxpayer-supported public assistance program.

It would have been nice to hear that "a few dentists" were responsible and that progress was being made in eliminating this scam. Instead, the viewer was left with the impression that a significant amount of criminal activity by dentists, including overbilling, was victimizing this state program and the patients it serves, without resolution.

Perhaps it will take some ethical dental colleagues whose practices are being damaged by the activities of those involved in these scams to come forward with evidence that will be helpful in resolving an unpleasant public relations nightmare for the dental profession. Given the ease with which the TV crew was able to record activity and uncover evidence, resolution of the problem and healing of this wound seem overdue.