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ADA responds to Senate report

Unnecessary procedures violate ethical codes

Washington—Corporate pressure or requirements that dentist employees perform unnecessary procedures in order to maximize profits, as alleged in a Senate report, would represent "a clear violation of the ethical codes of the profession as set forth in the ADA Code of Professional Conduct," the Association said.

"The Code states that 'professionals have a duty to act for the benefit of others' and that 'contract obligations do not excuse dentists from their ethical duty to put the patient's welfare first'," the Association said in a press release.

"The ADA strongly believes that any pressure applied to dentists in conflict with this code should be reported and pursued aggressively. Regardless of how they are employed, dentists must protect and promote the best interests of the patient above all else. That is the purpose of the ADA Code, by which all member dentists agree to abide," the Association said.

"We believe that all dentists, whether they are ADA members or not, should follow this code. States have legal and regulatory power to hold all dentists providing care within their jurisdictions to the same legal standards, regardless of who owns those dentists' practices. State dental boards should exercise that authority."

The Senate Finance and Judiciary Committees' "Joint Staff Report on the Corporate Practice of Dentistry in the Medicaid Program" was posted online at the Finance Committee website July 23.

The bipartisan Senate investigation focused primarily on organizations "that identify themselves as dental management companies" and treat Medicaid-eligible children "almost exclusively," said the 1,500-page report's 33-page executive summary.

"Notably, these clinics tend to focus on low-income children eligible for Medicaid," the summary said. "However, these clinics have been cited for conducting unnecessary treatments and in some cases causing serious trauma to young patients; profits are being placed ahead of patient care," the report asserted.

"In one case, the corporate structure of a dental management company appears to have negatively influenced treatment decisions by over-emphasizing bottom-line financial considerations at the expense of providing appropriate high-quality, low-cost care. As a consequence, children on Medicaid are ill-served and taxpayer funds are wasted."

The "discouraging report on ways in which some large dental practices are putting profits before patients … is particularly disturbing in that most of the alleged fraud and abuse of patients involved children," the Association said.

"Such conduct is inexcusable and should be prosecuted vigorously," said the ADA statement. "However, equally disturbing is the broad brush that implicates a whole class of practice models rather than focusing on actual offenders."

The Senate report included "a stated concern about the ability of the dental profession to provide access to care to millions of low-income families and other vulnerable populations," the ADA statement said. "But the causes of what amounts to a dental health crisis affecting these underserved Americans are complex and require a comprehensive set of solutions.

"The ADA, state dental societies and individual dentists have for decades wrestled with this situation as advocates before state and federal governments, in addition to their traditional roles as caregivers. There has been significant progress made, especially in bringing more children into dental offices for much-needed care. But much more is needed, especially with regard to young adults, who have the lowest rate of dental visits of any age group."