Dentists going to court over Medicaid cutoff

ATLANTA - A contract dispute between two insurance companies and a dental chain serving mostly children in low-income families is moving from the streets into a federal courtroom.

Kool Smiles, which has 10 offices across Georgia, filed a class-action lawsuit Wednesday in U.S. District Court in Rome attempting to block the termination of its contract with two of three HMO-like companies that run Georgia's Medicaid program.

The suit follows several rallies supporters have held at Kool Smiles offices.

Officials from WellCare and Peach State Plan have notified the chain that it is being dropped from their networks of dental providers at the end of this month.

Most of Kool Smiles' approximately 100,000 patients are enrolled with one or the other insurer.

"Seventy-one thousand children will be without a dental home," said Dr. David Strange, chief dental officer for Kool Smiles.

David Bear, a spokesman for Peach State Plan, wouldn't comment directly on the lawsuit, which he hadn't seen.

But he said the company's decision to drop Kool Smiles would not reduce access to dental care for Georgia children covered by Medicaid or PeachCare.

"Our focus is on access to quality health care," Bear said. "It has always been our focus and will continue to be."

The state Department of Community Health, which was also named in the suit, issued a statement denying that the dispute between Kool Smiles and the two managed-care companies has resulted in any children losing dental benefits.

The agency went on to reveal that it is investigating complaints against Kool Smiles from parents and other dentists.

The chain is accused of over-utilizing some services, including X-rays and stainless steel crowns, not practicing enough preventive care and overusing patient restraints like sedatives and restraining boards.

Strange called the accusations a "weak and feeble attempt" to take attention away from the two companies' plans to cut off Kool Smiles' patients from benefits.

"We have been audited multiple times by WellCare and Peach State Plan and have not been informed of one adverse finding," he said in a prepared statement.

"It is not a coincidence that the first time quality has been an issue was immediately after Medicaid patients filed the lawsuit."

A smaller, Conyers-based dental provider, Help a Child Smile, also joined the lawsuit.

It, too, has been put on notice that it is being dropped by the insurance companies.