For years, his company has been under fire over allegations its dentists performed painful, unnecessary work on children in a scheme to bilk Medicaid. Yet Kool Smiles’ chief dental officer, Dale G. Mayfield, since 2016 had a say in how dentists were being licensed and regulated all over Georgia.
Then Tuesday, Gov. Nathan Deal asked for and got Mayfield’s resignation. The action came as The Atlanta Journal-Constitution asked the governor’s office why Mayfield had remained on the Georgia Board of Dentistry after Kool Smiles agreed to settle a federal Medicaid fraud lawsuit for $23.9 million.
In that lawsuit, the U.S. Department of Justice accused the company of committing millions of dollars in Medicaid fraud in eight states, putting pressure on its dentists to rack up high-dollar claims, and subjecting children to excruciating procedures they didn’t need on baby teeth.
Kool Smiles clinics and their parent company, Marietta-based Benevis LLC, settled without acknowledging any wrongdoing.
Mayfield, through a company spokeswoman, declined an interview request from the AJC. But in a written statement, he said that “given the distractions that might be caused by news of the voluntary settlement between Kool Smiles and the government regarding services rendered more than seven years ago, I felt it was in the best interest of the board for me to step down.
“I have dedicated my professional career to expanding access to quality dental care to under-served families, including Georgia’s children and families,” the statement also said. “I look forward to continuing to advance these important causes, working closely with my colleagues both in Georgia and throughout the country.”
Deal appointed Mayfield to the board in February 2016. On Tuesday, the governor’s office asked him by phone to step down. Later in the day, Mayfield handed Deal a letter saying “it has been a pleasure to serve” but that he was quitting “effective immediately.”
Mayfield has been with Kool Smiles since 2006, according to the company’s website. Records filed with the Georgia Secretary of State’s office list him as the CEO, CFO and secretary of a company called Kool Smiles PTC, P.C., formed in 2007.
The 2013 federal False Claims complaint accused Kool Smiles of preying on unsuspecting, low-income children. It said the company founder, dentist Tu Tran, set up the business model that way, and the case singled out Mayfield as having “assisted in planning and implementing policies” to carry out the fraud.
The federal lawsuit also said Kool Smiles excessively put stainless steel crowns on baby teeth when less-expensive fillings would have sufficed. It accused the company of engaging in “upcoding” — billing Medicaid for services beyond what was actually done, or billing for services not performed at all.
Among the unnecessary work alleged by the federal government: root canals on baby teeth without proper anesthesia, while keeping parents out of the room to “keep hidden the child’s suffering.” Dentists were encouraged to restrain reluctant patients with papoose boards, where they’re wrapped in a cocoon-like fabric, the lawsuit alleged.
The complaint also described a high-pressure incentives program at Kool Smiles, where non-dentists in management positions pressured dentists to bill, bill, bill, offering gift cards and other rewards to employees who recruited new Medicaid patients.
The feds accused the company of such violations in eight states, including Georgia.
After the settlement, Benevis put out a public statement disputing the Justice Department’s allegations.
“The settlement agreement with the government does not relate to any claims regarding the quality of the dental care provided to patients,” the statement said. “Importantly, the settlement does not include any admission or determination of wrongdoing by the companies, their employees or any Kool Smiles dentists.”
One of the states included in the complaint was New Mexico, where Santa Fe dentist and industry consultant Michael Davis has been a persistent critic of Kool Smiles. In an article written for the Concerned Dentists of Texas website, Davis had called Mayfield’s appointment to the Georgia board “regulatory capture,” where a company needing regulation instead takes over the regulatory agency so that “the fox guards the henhouse.”
Davis told the AJC he believed Mayfield’s resignation was appropriate. “It should have been done much earlier. He should have never been appointed to that board. That’s an apparent conflict of interest, and Georgia deserves a lot better.”
Kool Smiles opened its first clinic on Candler Road, in DeKalb County, in 2002. About five years later, it came under scrutiny from the Georgia Department of Community Health, which began investigating what it called “patterns of over-utilization of services” and “unusual patterns of patient restraint,” along with “over-utilization of stainless steel crowns.”
A study of Medicaid claims found a child treated by Kool Smiles was five times more likely to receive stainless steel crowns, four times more likely to receive five or more stainless steel crowns, 40 percent more likely to have teeth pulled and three times more likely to be physically restrained during a procedure.
When the state moved to terminate contracts with the company, patients of Kool Smiles filed a class action lawsuit against WellCare and Peach State Health Plan, saying the state would be cutting off more than 100,000 needy children from access to oral care. The lawsuit was dropped 10 weeks after being filed.
Georgia then joined the multi-state federal complaint, which included allegations from three whistleblowers – two former Kool Smiles employees and one dentist who treated former Kool Smiles patients.
As the federal government was circling in 2012, the company turned a district manager in its Dalton office, Jennifer McGill, over to police for allegedly embezzling more than $112,000 in cash intended for bank deposits. With the district attorney pressing for jail time, McGill’s attorney, McCracken Poston, argued that Benevis was making a sacrificial lamb of her to deflect from U.S. Senate Finance Committee inquiries and a then-upcoming PBS Frontline report on the company.
The money had actually been spent on Kool Smiles’ intensive incentives program, Poston argued, on orders from McGill’s bosses. It went toward iPods, a popcorn machine, exercise equipment, visits from a masseuse and so many contests and prizes that the environment became “something between a game show and a sweat shop,” Poston said.
The jury in the case acquitted McGill after four hours of deliberating.
Poston told the AJC Wednesday that given the company’s track record, Mayfield shouldn’t have been put in a position to regulate other dentists.
A Benevis spokeswoman said in an emailed statement Wednesday that McGill’s contention that the money was used for incentives is false, and that the company terminated her for misconduct.
During 2016 and 2017, the Board of Dentistry handed down 135 orders, including 18 that were kept private.