Smile Center settles 'excessive' treatment suit

2013 11 18 17 15 05 637 Gavel 200

The Texas-based Smile Center dental chain has settled lawsuits that accused the company of performing excessive and unnecessary treatments on children to "bilk" Medicaid of millions of dollars. The lawsuits involved 253 patients, including children who later developed complications that required emergency medical care.

Terms of the confidential settlement, which was announced December 2, were not disclosed.

"The case was settled to the mutual satisfaction of the parties," plaintiffs' attorney Tom Crosley told

However, an attorney with knowledge of the case estimated the settlement to be worth several million dollars.

Stephen Simpton, DDS, the owner of Smile Center, has denied the allegations, calling them "frivolous and unfounded," according to a San Antonio Express-News story. Dr. Simpton did not return calls for comment from

'Production machine'

Crosley filed one of the lawsuits on behalf of 23 children in 2011, which alleged that "children suffered physical injuries from dental instruments penetrating through their lips, teeth, and cheeks or gums." The complaint further alleged that Smile Center "subjected these children to its production machine for one primary reason -- to bilk Medicaid for financial gain."

State records show that Smile Center, which operates and manages six dental clinics in San Antonio, collected more than $55 million from Medicaid from 2008 to 2010, including more than $25 million in 2010 alone.

“The nature of their wrong is horrific because they took advantage of, and caused injury to, children who were their patients.”
— Teresa Alvarez, et al v. The Smile
     Center, et al

Smile Center solicitors were sent to community locations, including retail stores, grocery stores, and apartment complexes, where they sought children on Medicaid, luring them with balloons and candy, according to the complaint. The center even provided transportation to its clinics, where the patients were told they could win prizes such as new bicycles, technological devices, and other expensive toys.

The Smile Center set quotas for the solicitors and also clinic dentists and staffers, and gave them bonuses if they exceeded the quotas, according to the complaint.

The center also called patients who didn't come in for appointments and threatened to call and report them to Medicaid, resulting in ineligibility for benefits, the complaint stated. In at least two instances, a Smile Center employee filed "false and malicious" complaints with Child Protective Services, which were later found to be baseless, according to the lawsuit.

During treatments, children were routinely restrained and strapped to papoose boards. "The papoose boards were a way for Defendants to increase their rate of production and billing," according to the complaint. The clinics also commonly used Versed for conscious sedation. The sedation effects would often wear off before the treatments were completed. "The children would then feel their teeth being drilled and often experience unrelenting pain," the complaint stated. "The children would often scream and cry in pain and squirm as their bodies were strapped to papoose boards."

Many of the children had pulpotomies and stainless steel crowns that were unnecessary and/or inappropriately performed, according to the lawsuit. Many of the stainless steel crowns fell out because they were the wrong size, and the teeth later had to be extracted, the complaint stated.

In one case described in the lawsuit, a 2-year-old boy who was strapped to a papoose board in 2009 had 10 pulpotomies and 10 stainless steel crowns done in only 25 minutes. The child later developed complications and had to go to an emergency room for care.

Another case involved an 8-year-old boy who had 11 pulpotomies, one extraction, and 11 stainless steel crowns during a 40-minute procedure. The boy later developed complications, including abscesses, that required remedial dental care.

And a 6-year-old girl had 12 pulpotomies, four extractions, and 12 stainless steel crowns done in only 13 minutes.

Failed to meet standard of care

All of those treatments were performed by Song Hun Hong, DDS, one of the dentists named in the lawsuits, who is also known as Mark Hong. Dr. Hong's dental license was suspended in New York state in 2010 following charges that he failed to treat periodontal disease in three patients, according to the New York Office of Professions website.

Dr. Hong billed Medicaid more than $1.5 million for pulpotomies and stainless steel crowns on children's teeth in 2010, according to the lawsuit.

A trial was set to begin on December 2 against Dr. Hong, the only remaining defendant in the 2011 case. But his malpractice insurer agreed to a confidential settlement with 82 plaintiffs who he treated.

Dr. Hong filed for bankruptcy in 2012.

In August, the Texas State Board of Dental Examiners found that Dr. Hong "failed to meet the standard of care" when treating patients from March 2009 to December 2011. He was suspended for 90 days, fined $10,000, and ordered to pay restitution to some patients or their insurer. Dr. Hong is currently serving a seven-year probation. He could not be reached for comment.

In another case described in the lawsuit, a 4-year-old boy had his lip perforated while he received 10 stainless steel crowns from Max Kerr, DDS, in 2010 and had to be taken to an emergency room for stitches.

The Smile Center business model "encouraged, promoted, condoned and required unnecessary and excessive dental services, all of which was to fulfill its motive for profit at the expense of the unnecessary treatment and attendant suffering" of the children, the complaint stated. The chain's gross negligence and fraud caused the children "physical and mental pain and anguish," which resulted in "physical impairment and disfigurement in the future."

"The nature of their wrong is horrific because they took advantage of, and caused injury to, children who were their patients," the complaint stated.

Last year, the Smile Center suffered legal setbacks when a state district judge dismissed a defamation lawsuit brought by the center and its owner, Dr. Simpton, against WOAI-TV and its reporter, as well as attorney Crosley, who filed one of the lawsuits against the center.

The Smile Center was subsequently ordered to pay Crosley $108,000 in sanctions and attorneys' fees, and had to pay $70,000 in sanctions and attorneys' fees to WOAI-TV, according to the San Antonio Express-News.

A 2012 lawsuit accused Dr. Simpton of similar complaints about soliciting children eligible for Medicaid to increase profits.

The dental chain faces other legal cases as well. The Texas attorney general is investigating charges of Medicaid fraud against the Smile Center, and a civil investigation is also ongoing.

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