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Whistleblower allegations prompt Washington State Dental Association to file complaint against chain

December 10, 2018

By David Burger

Seattle — A pediatric dental chain is engaging in dangerous and deceptive practices, according to a complaint the Washington State Dental Association filed with the state health department in November.

The state dental association also alleges that the dental service organization that operates the chain of clinics is interfering in the dentist-patient relationship. The complaint from WSDA follows a complaint filed with the health department by a former employee of the clinics claiming that the chain — ordered by the dental service organization — is reusing dental mouthpieces intended for single-use only to keep costs down, putting patients at risk.

The former employee whistleblower contacted the Washington State Dental Association, which further looked into her claim after her allegations of widespread misconduct.

The complaints are directed at Lone Peak Management Group, based in Colorado Springs, Colorado, which operates three clinics under the name Smiles 4 Kids in Tacoma and Lacey, Washington, and collectively manages about 50 dental clinics in 12 states. Private equity firm Tailwind Capital owns Lone Peak.

The former employee, Lisa Walker, was a co-manager of a clinic in Tacoma for nearly five years before she resigned in February over what she said were deep reservations over the business practices of the dental service organization. In an interview with the ADA News, she said the dental service organization put profits ahead of patient safety. She alleged that the requirement of the reuse of Isolite mouthguards ignored the manufacturers' warnings that the devices must be discarded after one use to prevent the transmission of infectious pathogens.

Ms. Walker said her motivation to come forward was "to protect the children, number one."

Lone Peak serves a high percentage of Medicaid-eligible children, according to Ms. Walker.

Ms. Walker provided the Washington State Dental Association with internal emails that were sent during her time with one of the clinics. In one email, which was included in her complaint, a Lone Peak executive lamented the fact that "our expenses would go through the roof if we didn't find a way around" the single-use requirements.

The emails also describe how Lone Peak ignored concerns raised by a clinic dentist about the reuse of the single-use mouthguards. Lone Peak allegedly directed dental office staff to deceive that dentist. "We should probably hide our open Isolites on the days we know she is coming in," said a Lone Peak executive in an email included in the complaint. "In the meantime, just make her happy when she is around and then go back to business as usual when she leaves."

On top of the concerns about the alleged reuse of mouthpieces, the Washington State Dental Association filed the complaint to protest the dental service organization's alleged directives to clinics in regards to patient care, said Dr. Christopher Delecki, president of the Washington State Dental Association. Washington law, he said, prohibits corporations, including dental service organizations, from practicing dentistry, which includes limiting or imposing requirements on the materials, supplies, instruments in the provision of treatment. The state law also says dental service organizations are prohibited from limiting or imposing requirements on the materials, supplies, instruments or equipment a dentist deems necessary to provide diagnoses or treatments consistent with the standard of care.

"One of my motivations is that they seem to be taking advantage of the Medicaid population," said Dr. Delecki. "Decision-making can not be corrupted by financial gain."

Bracken Killpack, executive director of the Washington State Dental Association, echoed Dr. Delecki's concerns. "Our priority is to safeguard the dentist-patient relationship from interference," he said. "There needs to be accountability for those that negatively affect that relationship."

The Washington State Dental Association also alleges that the chain orchestrated a kickback scheme that generated nearly $170 for Lone Peak every time a patient was administered general anesthesia, generating substantial additional profit for Lone Peak.

In addition, Mr. Killpack said that dentists and staff in Lone Peak offices were allegedly directed to engage in a system of self-referral to affiliated clinics for specialty dental services such as oral surgery and orthodontics.  Such a system, he said, would likely ignore patient preferences and in many cases result in families traveling significant distances to affiliated clinics when other qualified providers were nearby.

One email, included in the Washington State Dental Association complaint,  appears to confirm the allegation. "Patients in your office should NOT be given options to where they would like to go for their wisdom teeth extractions," reads the email from a Smiles 4 Kids regional manager. "Referring patients anywhere else is [sending] OUR business and money away and is therefore unacceptable."

The state dental association said that state law prohibits soliciting and receiving kickbacks in return for the referral of Medicaid patients.

According to Mr. Killpack, the Washington State Department of Health has opened active investigations into Lone Peak, and Ms. Walker said investigators from the state have interviewed her.

The Washington State Dental Quality Assurance Commission, the state's licensing board, is also investigating Dr. Justin VanBibber, a dentist named in Ms. Walker's complaint, according to Carol Sue Janes, an attorney representing Dr. VanBibber, in an email to the ADA News.

Dr. VanBibber allegedly helped orchestrate the dental service organization's directives, according to the complaint.

KIRO-7, a news station in Seattle reporting on the story, asked Dr. VanBibber for an interview. Instead, he sent a statement: "Our practice is committed to providing the highest quality care and patient safety is our top priority. We always use sterilized equipment for all examinations and procedures. The allegations are highly misleading, riddled with inaccuracies and are being raised by a misinformed and disgruntled former employee."

Tailwind did not respond to request for comments. Dr. VanBibber's attorney said that the allegations were not accurate and that they would "prepare our substantive response" at the end of December.