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Dental company exploited poor children for profit, government says

January 20, 2010
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	 Photo by THE GAZETTE

Sterling Mustered screamed and cried at the sight of “anybody in scrubs” in the years following his one visit to Small Smiles Dentistry for Children in Colorado Springs.

“It was a classic abuse situation,” said his mother, Laura Mustered, a psychologist, “but it was done in a place of trust.”

The boy, 9, was just a preschooler at the time of his dental appointment in 2004. She was not permitted to be with him during the visit. He emerged with two fillings, bruise marks on his neck, and a story that the dentist climbed on top of him to hold him down.

He returned to the waiting room drenched in sweat and hysterical. His parents filed a police report, although criminal charges were never filed. The dentist he saw afterward questioned the necessity of the fillings.

Similar stories — many of them far worse — have come out over the years about Small Smiles and other clinics that are part of its national chain, FORBA.

On Wednesday, federal authorities announced the company will pay $24 million and interest to settle allegations that it was exploiting poor children to profit from Medicaid. Small Smiles’ dentists were accused of performing unnecessary or substandard root canals, extractions, caps and other procedures. Allegations also included the frequent use of papoose boards, which are immobilizing devices used to strap children down, and using unlicensed workers to administer anesthesia and X-rays.

The settlement, which comes after a lengthy nationwide investigation by multiple federal and state agents, includes changes to the corporation to try to prevent such practices from occurring again.

Investigations into individual dentists are ongoing, and FORBA is providing information about them to federal agents. Criminal charges are possible, said Tony West, assistant attorney general who oversees the Justice Department’s Civil Division.

“We will not tolerate Medicaid providers who prey on vulnerable children and seek unjust enrichment at taxpayers’ expense,” said Daniel R. Levinson, Inspector General for Health and Human Services, to reporters on Wednesday.

Small Smiles in Colorado Springs referred an interview request to FORBA’s corporate office, which released a statement:

“This comprehensive resolution encourages us to continue to focus on vital, high-quality dental care for children in America’s low-income communities, and allows us to build on the improvements implemented since the company was acquired in September 2006,” the statement reads. “We look forward to fulfilling our commitment to the dental health of underserved children for years to come.”

The Colorado Springs clinic is among 69 Small Smiles clinics across the country. Colorado also has clinics in Denver and Pueblo. Over the years, parents’ stories and questionable professional practices have made the chain and its clinics the subject of several investigative media reports. The Gazette analyzed Medicaid records on Small Smiles in 2004 in a special report that led to state rule changes. 9News has also investigated the Colorado clinics. Nationally, 20/20 reported on the issue in 2008.

The federal investigation was prompted by three whistle-blower lawsuits under the False Claims Act, which allows U.S. citizens to sue on behalf of the U.S. and share in the recovery.

Small Smiles in Colorado Springs, in a strip mall at Fountain Boulevard and Circle Drive, was formerly owned by Dr. Michael DeRose, a Pueblo resident who owned or co-owned several clinics in multiple states with his father, Ed DeRose and Denver resident William Mueller. In 2004, the Gazette reported on their clinics’ frequent use of papoose boards, which led to new state rules on the practice. DeRose said at the time: “We should be rewarded for what we do because we’re doing something that nobody else wants to do, and we work very hard.”

Don Meyer, a media specialist representing FORBA, said the Colorado Springs clinic’s current owner is Dr. Randall Ellis, who purchased Small Smiles from DeRose in 2006. “Since then, the company has dropped or changed many of the practices that took place under DeRose’s ownership,” Meyer said in an e-mail.   

The $24 million will not go to victims. The federal share will be about $14.3 million, and states will receive $9.7 million.

Under the settlement, FORBA will be subject to a five-year corporate integrity agreement in which HHS should be able to quickly detect improper practices. Part of that agreement requires external reviewers to monitor quality measures and reimbursement, and a chief dental officer to implement policies to ensure professional standards are met. FORBA released a list of measures it says it has already implemented, such as a patient feedback phone number, patient advocate, and additional training for its staff.

The investigation into FORBA was fueled in part by a Kentucky woman who, outraged by the use of papoose boards, started a blog and pulled together media accounts, documents and other reports, and did exhaustive research on the company. Debbie Hagan’s blog aided reporters covering the issue, and at one point she was contacted by New York authorities during the state’s investigation.

FORBA at one point sued her over her blog, Dentist the Menace, but the suit was eventually dropped, she said.
Her reaction to Wednesday’s settlement was mixed.

“I’m very glad that it’s hit their pocket at $24 million,” she said. “I am not very happy that somebody is not going to jail, and these children are not getting reimbursed for the horrible treatment that they have been through.”

For Laura Mustered, Sterling’s mother, the feeling was much the same. Her son, through some counseling and intensive work with his pediatrician and dentist, no longer fears people in scrubs. But, she said, it took a long time and a lot of counseling. Her family was privately insured, but they went to Small Smiles on a referral, and figured that as a pediatric dentistry, it would be especially good with children. She wondered if needy families would be able to afford counseling to help their children.

She was glad to see the allegations of fraud within the chain come to light, but she wondered if criminal penalties shouldn’t follow. “To me, if there’s a crime committed against a child, that’s heinous.”

Call Newsome at 636-0198. Visit the Pikes Peak Health blog at and the Gazette’s Health page at

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