Small Smiles Dental Centers was a privately-owned US chain of

dental clinic Dentistry, also known as dental medicine and oral medicine, is the branch of medicine focused on the teeth, gums, and mouth. It consists of the study, diagnosis, prevention, management, and treatment of diseases, disorders, and conditions of ...

s focused on serving children from

low-income Poverty is the state of having few material possessions or little

income

families. The parent company, Church Street Health Management (CSHM), has its headquarters in Suite 520 of the Castner-Knott Building in Nashville,

Tennessee Tennessee ( , ), officially the State of Tennessee, is a landlocked state in the Southeastern region of the United States. Tennessee is the 36th-largest by area and the 15th-most populous of the 50 states. It is bordered by Kentucky to th ...

. As of 2010, Church Street (previously known as Forba Holdings LLC or FORBA) was the largest dental management company in the United States, and for a period it was the largest dental chain for children in the United States. As of March 2014, Small Smiles had 53 offices, and it stated that it served hundreds of thousands of children annually. As of September 2021, Small Smiles appeared to have one location in

Reno, Nevada Reno ( ) is a city in the northwest section of the U.S. state of Nevada, along the Nevada-California border, about north from Lake Tahoe, known as "The Biggest Little City in the World". Known for its casino and tourism industry, Reno is the ...

. Throughout the chain's history, it faced accusations of providing unnecessary dental care and improper restraint of child patients. In January 2010, it gained national attention when FORBA settled

False Claims Act The False Claims Act (FCA), also called the "Lincoln Law", is an American federal law that imposes liability on persons and companies (typically federal contractors) who defraud governmental programs. It is the federal government's primary litigat ...

allegations with the

United States Department of Justice The United States Department of Justice (DOJ), also known as the Justice Department, is a federal executive department of the United States government tasked with the enforcement of federal law and administration of justice in the United Stat ...

for $24 million. As of January 1, 2011 FORBA changed its name to its current name, Church Street Health Management. The new name was a reference to the street address of the company's corporate headquarters. It filed for Chapter 7 bankruptcy on February 5, 2015. Small Smiles clinics operated under multiple names, including Children's Dental Clinic, Indian Springs Dental Clinic, Oklahoma Smiles, Small Smiles Dentistry, Texas Smiles, and Wild Smiles.

History

As a family practice

Small Smiles originated from a dental office that was opened in 1928 in

Pueblo, Colorado Pueblo () is a home rule municipality that is the county seat and the most populous municipality of Pueblo County, Colorado, United States. The city population was 111,876 at the 2020 United States Census, making Pueblo the ninth most populo ...

. Initially Small Smiles was a family-owned business headed by the Italian American DeRose family of Pueblo and a

Denver, Colorado Denver () is a consolidated city and county, the capital, and most populous city of the U.S. state of Colorado. Its population was 715,522 at the 2020 census, a 19.22% increase since 2010. It is the 19th-most populous city in the Unit ...

dentist named William Mueller. Bruno DeRose, the founder of the practice, had graduated from dental school in 1928. The DeRose Dental Clinic opened that year.Continuing a Legacy of Service Gift Establishes Endowed Chair in Dentistry
"
Archive
. ''Creighton Magazine''. Northern Hemisphere Winter 2006. p. 43. In 1961 Edward DeRose, the father of Michael DeRose began practicing dentistry. After

Medicaid Medicaid in the United States is a federal and state program that helps with healthcare costs for some people with limited income and resources. Medicaid also offers benefits not normally covered by Medicare, including nursing home care and per ...

was established in 1967, the Pueblo DeRose office was one of the first ones to accept Medicaid. Michael DeRose, a graduate of the

Creighton University Creighton University is a private Jesuit research university in Omaha, Nebraska. Founded by the Society of Jesus in 1878, the university is accredited by the Higher Learning Commission. In 2015 the university enrolled 8,393 graduate and undergra ...

dental school began practicing at Small Smiles in 1982. According to Michael DeRose, Dan DeRose provided some management and marketing services. Mueller and Adolph Padula, an uncle of Michael DeRose, each had some financial interest in some clinics. In 1995, the second Small Smiles clinic opened in Colorado Springs, Colorado. Business increased after the clinic opened. Throughout the 1990s, three additional Small Smiles offices opened in Colorado and

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. Michael DeRose subsequently bought into a chain of dental clinics in North Carolina, Medicaid Dental Centers, operating Smile Starters and Carolina Dental Center clinics.Watson, Stewart.
Medicaid dentists pay taxpayers back $24 million
"

''

WCNC-TV WCNC-TV (channel 36) is a television station in Charlotte, North Carolina, United States, affiliated with NBC. The station is owned by Tegna Inc. WCNC-TV's studios are located in the Wood Ridge Center office complex off Billy Graham Parkway ...

''. January 20, 2010. Retrieved on May 15, 2013. In 2000, the Small Smiles company began expanding throughout the United States. During that year, FORBA, LLC (FOR Better Access) was formed, providing dental care to children across the United States. In May 2004, the DeRose family had a financial stake in 21 dental clinics in eight states, including

Arizona Arizona ( ; nv, Hoozdo Hahoodzo ; ood, Alĭ ṣonak ) is a state in the Southwestern United States. It is the 6th largest and the 14th most populous of the 50 states. Its capital and largest city is Phoenix. Arizona is part of the Fou ...

, Colorado,

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Indiana Indiana () is a U.S. state in the Midwestern United States. It is the 38th-largest by area and the 17th-most populous of the 50 States. Its capital and largest city is Indianapolis. Indiana was admitted to the United States as the 19th s ...

Kansas Kansas () is a state in the Midwestern United States. Its capital is Topeka, and its largest city is Wichita. Kansas is a landlocked state bordered by Nebraska to the north; Missouri to the east; Oklahoma to the south; and Colorado to th ...

North Carolina North Carolina () is a state in the Southeastern region of the United States. The state is the 28th largest and 9th-most populous of the United States. It is bordered by Virginia to the north, the Atlantic Ocean to the east, Georgia and ...

, and

South Carolina )'' Animis opibusque parati'' ( for, , Latin, Prepared in mind and resources, links=no) , anthem = " Carolina";" South Carolina On My Mind" , Former = Province of South Carolina , seat = Columbia , LargestCity = Charleston , LargestMetro = ...

. The clinics altogether employed 70 dentists. By May 29 of that year, the dental clinics that had most recently opened were in Florence, South Carolina and

Kansas City, Kansas Kansas City, abbreviated as "KCK", is the third-largest city in the U.S. state of Kansas, and the county seat of Wyandotte County. It is an inner suburb of the older and more populous Kansas City, Missouri, after which it is named. As of ...

. Vogrin said that the DeRose family "built something of a dental dynasty." As of October 2004, within the State of Colorado, Small Smiles had clinics in

Aurora An aurora (plural: auroras or aurorae), also commonly known as the polar lights, is a natural light display in Earth's sky, predominantly seen in high-latitude regions (around the Arctic and Antarctic). Auroras display dynamic patterns of bri ...

Colorado Springs Colorado Springs is a home rule municipality in, and the county seat of, El Paso County, Colorado, United States. It is the largest city in El Paso County, with a population of 478,961 at the 2020 United States Census, a 15.02% increase since ...

Denver Denver () is a consolidated city and county, the capital, and most populous city of the U.S. state of Colorado. Its population was 715,522 at the 2020 census, a 19.22% increase since 2010. It is the 19th-most populous city in the Unit ...

, Pueblo, and Thornton. As of that year, the vast majority of low income children on Medicaid in El Paso County went to Small Smiles. The company also had an advertising agreement with Colorado Springs School District 11.Vogrin, Cary Leider.
Small Smiles involved in child restraint law change
" ''

Colorado Springs Gazette ''The Gazette'' is a Pulitzer Prize-winning daily newspaper based in Colorado Springs, Colorado, United States. It has operated since 1873. History The publication began as ''Out West'', beginning March 23, 1872, but failed in its endeavor. ...

''. Published October 28, 2004. Published online on January 20, 2010. Retrieved on October 1, 2012. As of May 20, 2004, the Colorado clinics had 25 dentists. Two were pediatric dentists and the others were general dentists. According to a phone survey from the ''Colorado Springs Gazette'', aside from Small Smiles, few other Colorado Springs dental offices took patients who were on Medicaid.Vogrin, Cary Leider.
Dentists move to clear reputations, Three file complaint to remove names from disciplinary database
" '' The Colorado Springs Gazette''. May 20, 2004. Retrieved on October 3, 2012
Available at

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. By 2004, '' The Colorado Springs Gazette'' reported that Small Smiles used papoose boards almost 7,000 times in one 18-month period. According to Colorado state records, Michael and Edward DeRose said that they used papoose boards so that they could do dental work on larger numbers of children in a more rapid manner. Small Smiles dentists from other states learned the papoose board method in Colorado and began practicing the method in other states. As a result, a Colorado Board of Dental Examiners appointed committee established a new Colorado state law forbidding the usage of papoose boards for children unless a dentist has exhausted other possibilities for controlling a child's behavior, and if the dentist uses a papoose board, he or she must document why the papoose board was used in the patient's record. In a related development, Medicaid Dental Centers came under fire in 2003 when

Charlotte, North Carolina Charlotte ( ) is the most populous city in the U.S. state of North Carolina. Located in the Piedmont region, it is the county seat of Mecklenburg County. The population was 874,579 at the 2020 census, making Charlotte the 16th-most populo ...

reported on several traumatic experiences by its patients, including liberal uses of papoose boards and one child having 16 of his baby teeth capped in one sitting. A May 9, 2004 story in ''The Colorado Springs Gazette'' revealed that the children underwent large amounts of dental work at the clinics. In a 14-month period until May 20, 2004, the clinics charged over $16 million in

dental charges, and records from the Colorado state government revealed that many children each had over 10 teeth drilled and given silver caps within a single visit. The State of Colorado Medicaid office placed a daily limit on stainless steel crowns to slow the payments. In April 2004, Michael DeRose said that the children at Small Smiles had severe dental needs. The Colorado State Dental Board also reported Edward DeRose, Michael DeRose, and Mueller to two national databases that serve as clearinghouses for information on actions filed against dentists. The DeRoses and Mueller filed a complaint asking the board to have their names removed. 47 Small Smiles dental clinics and other associated practices had opened in 16 states in a period of less than six years after the company began expanding throughout the U.S.

Post-DeRose

In 2006, the DeRose family sold its share of Small Smiles.Watson, Stuart.
Medicaid dentists pay taxpayers back $24 million
" ''

''. January 20, 2010. Retrieved on October 1, 2012. In September and October 2006 the assets of Forba Dental Management aka FORBA, LLC were acquired from the DeRose family by a group of investors led by the

Carlyle Group The Carlyle Group is a multinational private equity, alternative asset management and financial services corporation based in the United States with $376 billion of assets under management. It specializes in private equity, real assets, and ...

, Arcapita Bank, and American Capital Strategies. Sanus Holdings, LLC was created for purchasing FORBA, LLC's assets. Sanus Holdings later became Small Smiles Holding Company, LLC. The sales price was reported to be $435 million. A revolving line of credit was opened by

CIT Group CIT Group (CIT), a subsidiary of First Citizens BancShares, is an American financial services company. It provides financing, including factoring, cash management, treasury management, mortgage loans, Small Business Administration loans, le ...

. and in September 2006, the operation relocated to Nashville, Tennessee. After the ownership change in 2006, Small Smiles and its various clinics have pledged to be compliant with standards set in state and federal healthcare guidelines, as well as guidelines from the American Academy of Pediatric Dentistry. A Pediatric Dental Advisory Board was established in 2007 to assist Chief Dental Officer Stephen Adair in meeting quality of care standards. In 2007, reporter

Roberta Baskin Roberta Baskin is an American journalist and nonprofit director. She co-founded and served as Executive Director of the AIM2Flourish global learning initiative, hosted at Fowler Center for Business as an Agent of World Benefit at the Weatherhead ...

WJLA-TV WJLA-TV (channel 7) is a television station in Washington, D.C., affiliated with ABC. It is one of two flagship stations of Sinclair Broadcast Group (alongside dual Fox/ MyNetworkTV affiliate WBFF hannel 45in Baltimore), and is also s ...

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, and her crew filmed the opening ceremony and operations at a newly opening Small Smiles clinic in

Langley Park, Maryland Langley Park is an unincorporated area and census-designated place (CDP) in Prince George's County, Maryland, United States. It is located inside the Capital Beltway, on the northwest edge of Prince George's County, bordering Montgomery County. ...

. Her crew filmed video of screaming children, bound with papoose boards, as technicians performed dental work. She filmed the lead dentist discussing production goals and stating that his clinic's dentists perform many baby root canals per day. Interviews with several former employees who either resigned or were fired after speaking out against the company's practices revealed other abuses, including dental staff conducting

X-ray An X-ray, or, much less commonly, X-radiation, is a penetrating form of high-energy electromagnetic radiation. Most X-rays have a wavelength ranging from 10 picometers to 10 nanometers, corresponding to frequencies in the range 30&nb ...

s on children even though they were not certified to do so. The film and the investigative report aired on television led to legal action unfolding. This sparked other stations across the United States to investigate area Small Smiles locations. In April 2008, Michael A. DeRose and Letitia L. Ballance settled with the United States and North Carolina to resolve False Claims Act allegations that their Medicaid Dental Center (MDC), previously known as Smile Starters and Carolina Dental Center, made false or fraudulent Medicaid claims. MDC agreed to pay $10,050,000 and to not contest that their dentists performed unwarranted pulpotomies and placed stainless steel crowns. A

Kentucky Kentucky ( , ), officially the Commonwealth of Kentucky, is a state in the Southeastern region of the United States and one of the states of the Upper South. It borders Illinois, Indiana, and Ohio to the north; West Virginia and Virginia ...

woman named Debbie Hagan started a blog, "Dentist the Menace," which criticized the use of papoose boards at Small Smiles. Her blog included lists of documents, media accounts, other reports, and Hagan's research. Journalists used Hagan's blog to research the issue. Authorities from the State of New York contacted Hagan as part of their investigation of Small Smiles. On November 14, 2008, FORBA Holdings, LLC brought a lawsuit against Hagan, alleging

copyright infringement Copyright infringement (at times referred to as piracy) is the use of works protected by copyright without permission for a usage where such permission is required, thereby infringing certain exclusive rights granted to the copyright holder, s ...

. The suit was dismissed on April 16, 2009, at FORBA's request. On September 28, 2009, a lawsuit was filed by FORBA Holdings, LLC against the company's former owners (LICSAC, LLC, DD Marketing, Inc., DeRose Management, LLC and LICSAC NY, LLC), citing breach of contract. On February 26, 2010, the case was dismissed with prejudice, with each party paying their own legal fees. In January 2010, the

US Justice Department The United States Department of Justice (DOJ), also known as the Justice Department, is a federal executive department of the United States government tasked with the enforcement of federal law and administration of justice in the United State ...

settled

allegations against FORBA Holdings, LLC. Under the settlement, FORBA will pay $24 million plus interest to the US and several states. The investigation was spurred by three ''

qui tam In common law, a writ of ''qui tam'' is a writ through which private individuals who assist a prosecution can receive for themselves all or part of the damages or financial penalties recovered by the government as a result of the prosecution. Its ...

'' lawsuits filed by former employees in Maryland, Virginia and South Carolina in late 2007 and early 2008. The US Justice Department found that FORBA was liable for: Under the agreement, FORBA entered into a

corporate integrity agreement A corporate integrity agreement (CIA) is a document outlining the obligations that a company involved in health care in the United States makes with a federal government agency or a state government as part of a civil settlement. On the federal lev ...

with the Office of the Inspector General of the

Department of Health and Human Services The United States Department of Health and Human Services (HHS) is a cabinet-level executive branch department of the U.S. federal government created to protect the health of all Americans and providing essential human services. Its motto is ...

. Investigations into individual dentists continue with the company's cooperation. In response, company chairman and CEO Michael Lindley posted a statement on the firm's website stating "…We entered into the settlement to avoid the delay, uncertainty, inconvenience and expense of litigation, and did not admit any liability." Hagan said that she was glad that the settlement caused a financial loss for Small Smiles. She argued that this was not enough because the involved persons should also have received prison sentences and because the victims themselves needed financial compensation. On January 25, 2010, just days after the settlement was announced, a

class action A class action, also known as a class-action lawsuit, class suit, or representative action, is a type of lawsuit where one of the parties is a group of people who are represented collectively by a member or members of that group. The class actio ...

suit was filed in the

U.S. District Court for the Northern District of Ohio The United States of America (U.S.A. or USA), commonly known as the United States (U.S. or US) or America, is a country primarily located in North America. It consists of 50 states, a federal district, five major unincorporated territori ...

. Currently operating under a corporate integrity agreement with the U.S. Department of Health and Human Services, Church Street's network of associated dental centers continues to serve low-income families, and recently began opening new clinics and featuring new services such as orthodontics and adult care. In February 2012, the company filed for

Chapter 11 Bankruptcy Protection Chapter 11 of the United States Bankruptcy Code ( Title 11 of the United States Code) permits reorganization under the bankruptcy laws of the United States. Such reorganization, known as Chapter 11 bankruptcy, is available to every business, whet ...

. As of December 2012, Small Smiles treated about 500,000 children each year. In December 2012

NBC News NBC News is the news division of the American broadcast television network NBC. The division operates under NBCUniversal Television and Streaming, a division of NBCUniversal, which is, in turn, a subsidiary of Comcast. The news division's var ...

revealed it had investigated 63 Small Smiles clinics over a preceding three-year period and discovered continued accusations from former employees, parents, and government investigators that the clinics performed below standard and unnecessary procedures on children.

Chuck Grassley Charles Ernest Grassley (born September 17, 1933) is an American politician serving as the president pro tempore emeritus of the United States Senate, and the senior United States senator from Iowa, having held the seat since 1981. In 2022, h ...

, a member of the

U.S. Senate The United States Senate is the upper chamber of the United States Congress, with the House of Representatives being the lower chamber. Together they compose the national bicameral legislature of the United States. The composition and pow ...

, said that the company was scamming taxpayers and causing abuses to children in order to generate revenues. David Wilson, the CEO, said in a statement that "Patients are at the center of everything we do at CSHM. CSHM LLC supports our affiliated dental centers so that they can continue to provide access to quality dental care. Our dental centers serve approximately one million patient visits per year, primarily to children in communities with under-served access to dental care." After Channel 4 Action News ''

WTAE-TV WTAE-TV (channel 4) is a television station in Pittsburgh, Pennsylvania, United States, affiliated with ABC. It has been owned by Hearst Television since the station's inception, making this one of two stations that have been built and signed o ...

'' began an investigation on Small Smiles, the

filed a report saying that taxpayer dollars were wasted in Small Smiles and recommended that its Medicaid access be terminated. The report accused Small Smiles clinics of performed unnecessary dental work and performing procedures too quickly.Alltucker, Ken.
Senate probe targets dentists with Phoenix ties
" ''

The Arizona Republic ''The Arizona Republic'' is an American daily newspaper published in Phoenix. Circulated throughout Arizona, it is the state's largest newspaper. Since 2000, it has been owned by the Gannett newspaper chain. Copies are sold at $2 daily or at $3 ...

''. Thursday July 25, 2013. Retrieved on July 26, 2013. The 1,500-page report was prepared by Grassley and

Max Baucus Maxwell Sieben Baucus ( Enke; born December 11, 1941) is an American politician who served as a United States senator from Montana from 1978 to 2014. A member of the Democratic Party, he was a U.S. senator for over 35 years, making him the long ...

. This bipartisan report of the US Senate further advised Small Smiles Dental be excluded as a Medicaid provider. CSHM LLC stated that "We do not believe that this report adequately reflects the current operations of CSHM LLC (CSHM or the Company)." In 2014, the Inspector General's Office announced that the management company Church Street Health Management will no longer be allowed to use Medicaid, Medicare, and other health programs of the federal government. CSHM, LLC filed for Chapter 7 bankruptcy on February 5, 2015.

Governance

Members of FORBA's Pediatric Dental Advisory Board included Paul Casamassimo, Chair of the Department of Pediatric Dentistry at Ohio State University and Chief of Dentistry at Nationwide Children's Hospital; Joe Bernat, Chair of the Department of Pediatric and Community Dentistry at the State University of New York-Buffalo School of Dental Medicine; Arthur Nowak Professor Emeritus at the University of Iowa Colleges of Dentistry and Medicine; and Anupama Tate Director of Pediatric Dentistry at Children's National Medical Center in Washington, D.C.

References

External links

* * {{webarchive , url=https://web.archive.org/web/*/http://cshm.com , date=* , title=Church Street Health Management website * U.S. Department of Health and Human Services **
CORPORATE INTEGRITY AGREEMENT BETWEEN THE OFFICE OF INSPECTOR GENERAL OF THE DEPARTMENT OF HEALTH AND HUMAN SERVICES AND FORBA HOLDINGS, LLC
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March 13, 2012 amendmentArchive
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May 15, 2012 amendmentArchive
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ABC 7 TEAM Investigation: Small Smiles Dentistry
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" Monday November 5, 2007. **

" * ttp://www.grassley.senate.gov/about/upload/2011_11_18-CEG-and-Baucus-to-Church-Street-Health-Management.pdf Letterfrom

United States Senator The United States Senate is the upper chamber of the United States Congress, with the House of Representatives being the lower chamber. Together they compose the national bicameral legislature of the United States. The composition and powe ...

Archive
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Colorado State Board of Dental Examiners Colorado (, other variants) is a state in the Mountain states, Mountain West subregion of the Western United States. It encompasses most of the Southern Rocky Mountains, as well as the northeastern portion of the Colorado Plateau and the wes ...

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Before the State Board of Dental Examiners State of Colorado Case No. 2004-000131 Cease and Desist Order To: Edward DeRose, D.D.S.
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Before the State Board of Dental Examiners State of Colorado Case No. 2004-000132 Cease and Desist Order To: Michael DeRose, D.D.S.
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Before the State Board of Dental Examiners State of Colorado Case Nos. 2005-001705, 2006-00302 Stipulation and Final Agency Order
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Dentist the Menace
- Debbie Hagan's blog Dental companies of the United States Health fraud Companies based in Nashville, Tennessee Companies based in Pueblo County, Colorado Pueblo, Colorado Health care companies based in Tennessee 2015 disestablishments in Tennessee Companies that have filed for Chapter 7 bankruptcy 1928 establishments in Colorado American companies established in 1928 American companies disestablished in 2015