Saturday, November 17, 2018

New Complaints About Lone Peak Management Group and Smiles 4 Kids Dental Clinics



Pediatric dental chain faces new complaints

By: Alison Grande
Updated: Nov 16, 2018

A new complaint was filed against a local pediatric dental chain, Smiles 4 Kids. The chain is managed by Dr. Justin VanBibber and owned by Lone Peak Management.
The latest complaint was filed by the Washington State Dental Association with the Department of Health and the Dental Quality Assurance Commission.
The complaint alleges the dental offices in the chain, only refer patients to their other practices for oral surgery or orthodontia.
Dr. Chris Delecki is the president of the Washington State Dental Association.
"They're failing to disclose the fact the patient has other options besides their self-referrals to their own managed practices," said Dr. Chris Delecki, President of the Washington State Dental Association.
"Patients are often being asked to travel from Tumwater to Tacoma for their orthodontic care and these are Medicaid patients and for many of them transportation is one of the biggest things they face.
he complaint includes an email apparently sent by the Smiles for Kids Regional manager to office managers.
"Patients in your offices should NOT be given options as to where they would like to go for their wisdom teeth extractions -- referring patients anywhere else is sending OUR business and money away and is therefore, unacceptable."
Read the entire report here.









Thursday, November 15, 2018

Washington State Dental Association: LOCAL DENTAL CLINICS OPERATED BY LONE PEAK MANAGEMENT ENGAGED IN DANGEROUS AND DECEPTIVE PRACTICES

image
Contact: Bracken Killpack
206.973.5227; bracken@wsda.org
LOCAL DENTAL CLINICS OPERATED BY LONE PEAK MANAGEMENT
ENGAGED IN DANGEROUS AND DECEPTIVE PRACTICES, COMPLAINTS ALLEGE
Practice at Smiles 4 Kids, Kids Dental, Family Orthodontics Put Patients at Risk
and Cost Low-Income Families
TACOMA – November 13, 2018 – The Washington State Dental Association (WSDA) has filed a new complaint with the Washington State Department of Health, alleging dental clinics operated by Lone Peak Management Group, LLC (Lone Peak) are engaging in dangerous and deceptive practices.
The WSDA complaint is just the latest complaint against Lone Peak, which operates more than a dozen clinics in Washington state, specializes in pediatric dentistry, and serves a high percentage of low-income, Medicaid-eligible patients.

The WSDA complaint was filed after research into Lone Peak practices. It alleges that the chain arranged a kickback scheme that generated nearly $170 for Lone Peak every time a patient was administered general anesthesia. Disguised as a “facility use fee” charged to the anesthesia provider, these payments far exceeded fair market value of the record-keeping Lone Peak provided the anesthesia provider, generating substantial additional profit for Lone Peak.

Dentists and staff in Lone Peak offices also were directed to engage in a system of self-referral to affiliated clinics for specialty dental services like oral surgery and orthodontia. This system ignored patient preferences and in many cases resulted in families traveling significant distances to affiliated clinics when other qualified providers were nearby.

Internal Lone Peak documents cited in the complaint clearly demonstrate the profit motive behind this policy: “Patients in your office should NOT be given options as to where they would like to go for their wisdom teeth extractions,” reads one email. “Regardless of how near/far the office … referring patients anywhere else is sending OUR business and money away and is therefore unacceptable.”

Previously, Seattle’s KIRO 7 TV reported on another whistleblower complaint against Lone Peak, filed by a former office manager who left the company after refusing to follow directives from company managers to re-use dental mouthpieces that are intended for single-use only.
Internal company emails cited in the whistleblower complaint show Lone Peak putting profits ahead of patient safety. In one email regarding the reuse of mouthpieces, a Lone Peak executive lamented the fact that “our expenses would go through the roof if we didn’t find a way around” the single-use requirement.

The emails also describe how Lone Peak ignored concerns raised by at least one clinic dentist about the reuse of single-use mouthpieces. Lone Peak agents directed dental office staff to deceive that dentist: “We should probably hide our open Isolites (mouthpieces) on the days we know she is coming in,” wrote a Lone Peak agent. “In the meantime, just make her happy when she is around, and then go back to business as usual when she leaves.”

“The concerns brought forward by the whistleblower and uncovered by our team are deeply troubling and represent a dangerous corporate intrusion in the doctor-patient relationship,” said Dr. Chris Delecki, president of the Washington State Dental Association. “This speaks to what can happen when corporations are allowed to directly or indirectly own dental practices. In this environment, corporations can direct, question and over-rule the decisions dentists make in how to best treat their patients. This is why our association has consistently advocated for state laws to prohibit this type of interference and why we have engaged in bringing these practices to light.”

Washington law prohibits corporations, including dental service organizations (DSOs), from practicing dentistry, which includes directing a dentist’s treatment plan; limiting or imposing requirements on how a dentists uses equipment or materials in the provision of treatment; or limiting or imposing requirements on the materials, supplies, instruments or equipment a dentist deems necessary to provide diagnoses or treatments consistent with the standard of care.

Lone Peak is a DSO headquartered in Colorado that manages approximately 50 dental clinics in 12 states, including Washington. Lone Peak is owned by Tailwind Capital, a private equity firm whose stated mission is to transition businesses to become “larger, more profitable enterprises.”

Documents received by WSDA indicate that certain executives of Lone Peak may also have been involved with the Small Smiles dental chain DSO, and a number of Lone Peak dental offices formerly may have been Small Smiles dental offices. Small Smiles was included in a scathing 2013 US Senate report that found the chain performed unnecessary services and that its business model deceptively gave managers rather than dentists control over the clinics. The report also recommended that Small Smiles be excluded from participating in the federal Medicaid program. 

Small Smiles and its parent company, Church Street Health Management (CHSM) have faced litigation before. In 2012, Small Smiles paid $24 million to settle allegations of Medicaid fraud brought by the U.S. Department of Justice. And in 2015, Small Smiles agreed to pay nearly $39 million in claims for alleged “unnecessary, inappropriate, unsafe, and excessive dental procedures.” Church Street Health Management has since declared bankruptcy.
 
The most recent complaints here in Washington also name Justin VanBibber, a Utah-based dentist who serves as the nominal head of the clinics engaged in the kickbacks and the mouthpiece reuse practice. He is listed as a practicing dentist on Lone Peak clinic websites in Washington, but the profile for his South Jordan, Utah practice lists him as a resident of Utah.
The Washington State Department of Health has opened active investigations into Lone Peak’s and VanBibber’s practices.


About the WSDA
The Washington State Dental Association’s 4,400 member dentists are committed to solutions that prevent disease and ensure quality oral health for all Washingtonians. WSDA empowers its members to advocate for and provide optimal oral health care.






















Saturday, November 03, 2018

Law Offices of James R. Moriarty: $5.1 Million Settlement in Whistleblower Case Involving Samson Dental Partners, LLC and ImmediaDent of Indiana, LLC

HOUSTON, Nov. 2, 2018 /PRNewswire/ -- Samson Dental Partners, LLC and ImmediaDent of Indiana, LLC agreed to pay $5.1 million to the federal government, the State of Indiana, and a whistleblower dentist to resolve a qui tam case with fraud allegations, according to the legal team for the dentist.

A settlement agreement was entered into among the U.S. Department of Justice (on behalf of the Office of Inspector General of the U.S. Department of Health and Human Services), the Medicaid Fraud Control Unit of the Office of the Indiana Attorney General, and Jihaad Abdul-Majid, DDS.

The qui tam complaint alleged that the defendants engaged in illegal corporate practice of dentistry and various types of fraud, including fraudulent billing, excessive and unnecessary treatments of excessive patients, and a sustained pressure by non-dentists in management positions to place corporate profits over patient care by exerting undue influence on dental care decisions.

Dr. Abdul-Majid, who will receive $925,000 plus expenses, attorneys' fees and costs, is represented by Charles S. Siegel, of Waters & Kraus, LLP, of Dallas; Daniel Hargrove, of The Hargrove Law Firm, P.C., of San Antonio; James R. Moriarty, of the Law Offices of James R. Moriarty, of Houston; and Joseph D. Satterly and Paul Kelley of Satterly & Kelley, PLLC, of Louisville, Ky.

According to the settlement, the federal government and the state of Indiana contend that they have certain civil claims against Samson Dental Partners, LLC and ImmediaDent arising from the submission of false claims for payment to Medicaid during the period from Jan. 1, 2009, through Sept. 30, 2013, for the following conduct:

  • Samson Dental Partners, LLC engaged in the corporate practice of dentistry in violation of Indiana state law by exerting obtrusive influences over ImmediaDent's medical professionals and staff by rewarding production and disciplining for not meeting production objectives and directing personnel in a manner which compromised clinical judgment;
  • Samson Dental Partners, LLC and ImmediaDent upcoded simple tooth extractions and improperly billed them as surgical extractions; and
  • Samson Dental Partners, LLC and ImmediaDent improperly billed for scale and root planing (deep cleaning) when they were either not performed or not medically necessary.

ImmediaDent operates nine dental care practices in Indiana. Samson Dental Partners, LLC, headquartered in Kansas City, Mo., provides administrative and other support services to ImmediaDent.

The case is "United States ex rel. Jihaad Abdul-Majid, et al. v. ImmediaDent Specialty, P.C., et al.," Civil Action No. 3:13-cv-222-CRS in the U.S. District Court for the Western District of Kentucky. The case was originally filed on Feb. 20, 2013 by Dr. Abdul-Majid. The federal government and the state of Indiana intervened in the case in September 2018.

The lawsuit alleged violations Federal False Claims Act, 31 U.S.C. § 3730(b), and the Indiana False Claims and Whistleblower Protection Act, Indiana Code 5-11-5.5-4.

The settlement agreement is neither an admission of liability by SDP and ImmediaDent nor a concession by the federal government and the state of Indiana that their claims are not well founded.

CONTACTS:

Charles S. Siegel
Waters & Kraus, LLP
(214) 357-6244
siegel@waterskraus.com
www.waterskraus.com

Daniel Hargrove
The Hargrove Law Firm, P.C.
(210) 710-2867
dh@hargrove-law.com

James R. Moriarty
Law Offices of James R. Moriarty
(713) 528-0700
jim@moriarty.com
www.moriarty.com

Joseph D. Satterly
Satterly & Kelley, PLLC
(502) 785-8758
jsatterley@satterleylaw.com
www.satterleylaw.com

Paul Kelley
Satterly & Kelley, PLLC
(502) 785-8758
pkelley@satterleylaw.com
www.satterleylaw.com

SOURCE Law Offices of James R. Moriarty

Related Links

http://www.moriarty.com

Friday, October 26, 2018

Smiles 4 Kids Dental Clinics Under Investigation in Washington State

Smiles 4 Kids is “managed” by Lone Peak Management Group (LPMG), located in Colorado. Tailwind Capital.  In January 2017, Tailwind Capital purchased a controlling interest in LPMG for $55M.  Waller Law Group represented LPMG.  In press releases at the time, it was stated LPMG had nearly 50 clinics in 12 states.  As of March 2018 I counted 59 clinics and 73 known business entities. But as always, I could be wrong. (smile)

Let me just say this is only the tip of the iceberg about this company.

Below is the excellent report, by Alison Grande, that aired October 25, 2018 on KIRO7 News.

Whistleblower: Local pediatric dental chain reusing disposable tools
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By: Alison Grande
Updated: Oct 26, 2018 - 6:19 AM

The Washington State Dental Quality Assurance Commission is investigating after a whistleblower complaint accused a local pediatric dental chain of re-using dental tools.

Lisa Walker quit her job as the office manager at the Smiles 4 Kids at Allenmore Hospital in Tacoma after she says the dentist overseeing the businesses, Dr. Justin VanBibber, told her to re-use disposable Isolite mouthpieces.

"That we re-use the Isolites, he asked that I put them in the cold sterile and re-use them on patients and I refused," said Lisa Walker.

The Isolite Mouthpiece package is clearly labeled "Disposable. Do not re-use. Re-use can result in the transmission of infections, pathogens."

Isolite mouthpieces are used to keep the airway clear during a dental procedure. "It suctions out the blood, the saliva, pus, tooth decay, you name it -it keeps the airway free of debris," described Walker.
"The worry for my kids and it was my worry for all kids is that,  I mean we have hepatitis B, hepatitis C, there's HIV, I mean there's numerous numerous diseases and long-term illnesses that can be contracted through blood."

Read entire story here.






Thursday, September 13, 2018

Massachusetts Dentists Support Independent Practitioners

13 Sep 2018 Jill Tanzi, DDS

Todays Dental News

Most dentists in the United States have not heard of the Massachusetts Dentists Alliance for Quality Care. We are a group of dentists who are passionate about private practice and maintaining an excellent standard of care in our profession and for our patients.

In recent years, many of us have felt that organized dentistry’s advocacy for private practice has declined. In all fairness, not every dentist is in private practice. Many are working for dental service organizations (DSOs), academia, insurance companies, and other fields. The ADA and state organizations represent all dentists, not just one special interest group.

Last year, several dentists in Massachusetts decided to seek legal advice and petition our Attorney General in response to a contract received from Delta Dental of MA (currently called Total Choice PPO). Not only did we raise enough money to file a formal petition with the Attorney General, but we also formed a group that has grown to more than 60 members today.

In July, we voiced our concerns to the Division of Insurance at a hearing regarding a “new fee methodology” proposed by Delta Dental that would automatically decrease reimbursements to the entire network of Premier providers in the state. To date, we continue to educate our legislators and advocate for private practice dentists, as well as mentor students and recent graduates.

Although Delta Dental’s new for-profit Total Choice PPO was approved in our state, Delta continues to sell the non-profit Premier plan (96% of dentists in Massachusetts are Premier providers). In June of this year, it was announced that our state dental society decided to make a deal with Delta Dental of MA to cut all of the Premier dentists’ reimbursements by 10%.

This 10% “recalibration,” a euphemism for lower reimbursements, will affect that 96% of dentists in our state. Conversely, the Total Choice plan that offers a larger 30% discount has not been less popular with employers in Massachusetts and has far fewer contracted participating dentists.

Many dentists in our state understand these subtleties and were extremely upset by the decision of the leadership of the Massachusetts Dental Society, while other dentists may not be paying attention to these small details or fear retribution for getting involved.

Now is not the time to sit back and let others figure out the details that affect the future of our profession. Do you recall what has happened to primary care physicians? Not only have they been forced to work increasingly faster by insurance companies, but the quality of patient care also has suffered as a result. This is especially important for the younger generation of dentists to understand, as they will need to work faster and longer hours to try to make a living with ever decreasing reimbursements and huge amounts of student loan debt.

It is our hope that organized dentistry in our country will learn from the mistakes of the American Medical Association and try to slow the corporatization of dentistry and the reliance on dental benefit companies. We would like to see more support for the private practitioner members who, in fact, serve most patients in our country.

The Massachusetts Dentists Alliance for Quality Care is continuing its work on behalf of our profession. We believe that by educating our legislators, we will have a stronger voice in our state government. We also believe there is hope for our future and welcome as many dentists who are interested in becoming part of this movement to join our group.

Stand up, fellow dentists. It is time to make your voice heard. The time to make a difference is now!

Dr. Tanzi, a graduate of the University of Maryland School of Dentistry, has more than 18 years of private practice experience. She started The Dentist at Hopkinton in Hopkinton, Mass, 15 years ago near the starting line of the Boston Marathon. Passionate about issues facing dentists and private practice, she is also a founding member of the MA Dentists Alliance for Quality Care, which advocates for private practice dentistry and high quality dental care for patients. She can be reached at jilltanzidds@hopdent.com

Related Articles:

Massachusetts Dental Society Strikes Delicate Balance in Delta Dental Discussions

Massachusetts Dentists Continue Battle Against Delta Dental

Emerging Advocacy Groups Support Small Business Dentistry

Saturday, September 01, 2018

Krista Szewczyk Posed as Dentist for 7 Years. Prosecutors and Dental Board Fail

Szewczyk was first accused of illegally performing dental procedures in 2012.  The District Attorney at the time decide not to pursue charges citing a conflict of interest since her husband was a Deputy Sheriff in Paulding.

Apparently, Szewczyk posed as a dentist through her mini-DSO, County Dental Providers. She also is reported to have performed dental procedures in the homes of patients.

At least one patient was sent to the hospital due to an abscess in his throat the size of a tennis ball.

People Magazine website reports:

In an interview with Atlanta TV station WGCL, Szewczyk said: “It’s definitely a personal vendetta” by the prosecutor. She added, “Sad situation … and I’m confident it will be handled in a timely manner.”Krista Szewczyk mugshot

The investigation into Szewczyk dates to 2013, when the Georgia Board of Dentistry alerted the district attorney’s office to complaints about Szewczyk, who ran a business called County Dental Providers starting in 2011 that contracted with independent licensed dentists to come in and work on patients, Donovan says.

The state board’s 2013 alert prompted a criminal investigation at the time that led to a single charge in Paulding County accusing Szewczyk of performing dental services without a license, the district attorney says. But on the DA’s recommendation, Szewczyk was enrolled in a pretrial diversion program that did not require her to enter a plea, and instead allowed for the charge to be dropped if she successfully completed the program.

“This was the only instance of which we were aware at the time, so we just said, ‘Don’t do this anymore,'” says Donovan. “I got a notice saying she had completed the program about the same time I heard from the Board of Dentistry that she was back at it again.”

There are indications Szewczyk is associated with Heartland Dental on her LinkedIn page which has been removed. Additionally her picture appears on Group Dentistry Now blog.

index


Heartland Dental Winter Conference, January 2018.






Related:

The Atlanta Journal-Constitution-Woman accused of posing as a dentist also under investigation in Cobb

Thursday, August 23, 2018

Why Picket Aspen Dental?

Why Picket Aspen Dental?

by Linda Reynolds

B.A.D. Soldier


What is B.A.D.?

B.A.D. is the acronym for Boycott Aspen Dental. We are a cause that primarily seeks to give a voice to the Aspen Dental victims who are not strong enough to speak out on their own. Alone we are faceless along with all the other Aspen Dental victims, but as a group we have a BEAUTIFUL face of courage with a BOLD name.  We desire to help victims of Aspen Dental because we too are a handful of victims that have been hurt; some of us worse than others.


Why has B.A.D. been created?

B.A.D. was created after experiencing my own personal Aspen Dental horror story, and after reading endless so it seems, online negative reviews about similar Aspen Dental experiences. I saw a need to create a centralized website so people can see the magnitude of thousands of voices screaming out the injustices of Aspen Dental; people who have never had their dental horror story told much less appropriately addressed by the company who caused the damage (ADM). B.A.D. is not about one individual; B.A.D. is a cause that seeks to bring Aspen Dental Victims together. We are one voice and one face: Boycott Aspen Dental.

How did you hear about Aspen Dental?

My insurance had limited options, and Aspen Dental was one of them. I searched the actual dentist for negative reviews, and couldn’t find any. Dr Mark Habermeyer was new at Aspen Dental, but he had several years of prior experience. It was just a simple crown replacement, so I made the appointment asking myself, “How could I go wrong?”

Unfortunately that one visit will cost $5000 to fix the errors made by the staff that day.

I’m still getting treated for this issue that was caused April/May of 2017, so I’m not sure if more will be added to that figure later.


Did Aspen Dental attempt to compensate for your pain and trouble?

They refused to refund my money at the time of the incident, which was when www.twothirtydentalcaution.org was created. Not a word was heard from Aspen Dental

until June of this year when I received a call from a staff member at Aspen Dental to say they’ve decided to refund my money. What? Over a year later they are doing this? So I get the check for $408, and then another call comes in a few weeks later to offer a settlement. Unfortunately they chose a figure I put out there a year ago, and which no longer covered all that I had gone through. Aspen Dental knew B.A.D. was soon to be revealed, and this apparently was their first vain attempt to stop it.

What do you mean by “vain attempt”?

They showed absolutely no concern whatsoever for all the pain I’ve endured. They attempted to entice me with a low ball offer, but what they failed to consider is I  already had concluded and accepted that I wouldn’t be getting any money from Aspen Dental. The plans for B.A.D. were in place (March 2017 is when the idea was conceived), so I was very suspicious when I received the first call that came a year afterthe incident with no previous attempts on record made by Aspen Dental to rectify this.

After they realized I wasn’t going to take the bait of the second call with the low ball offer, three ladies from Aspen Dental Management Corp offices in Syracuse, NY called me again to attempt to convince me to take the low ball offer. When that didn’t work, they hired an attorney with threats to close us down, and yes that low ball offer was included once more.

What about the threat of a lawsuit?

The day Aspen Dental sues its victim is the day the world will know that Aspen Dental is guilty of all they are accused of doing and more. This victim will never shut up. They don’t have the power to destroy B.A.D. like they would like us to believe. For example, if by chance they were able to have our websites removed with their money, well there was a day we didn’t have the Internet and word still traveled about upcoming events. We will revert back to sending telegrams if we have to, but B.A.D. will be around for months, years and decades to come. Aspen Dental we are not going away until you stop hurting innocent people.

Does Boycott Aspen Dental have an attorney?

We are suiting up for battle, let’s leave it at that.

What is on the agenda of B.A.D. for the short term?

Please visit our website www.boycottaspendental.com to learn of our current goals as we are planning our grand opening October 6, 2018. That’s when we will reveal our first fundraiser for an Aspen Dental victim to be chosen by member voting. We will also have our first Aspen Dental picket on that day (locations to be announced).

What is on the agenda of B.A.D. for the long term?

To tell as many people who will listen, Stay Safe; Stay AWAY from Aspen Dental!

To have an annual picket at every Aspen Dental location until Aspen Dental STOPS preying on innocent people, often times low income seniors, people with disabilities and children of low income families. If you are an Aspen Dental Victim or know someone who is, please consider joining B.A.D. today!

Sunday, August 19, 2018

FLOSS Dental owner had questionable dental past before closures


imageAugust 16, 2018 AUSTIN (KXAN) — A lawsuit filed within Travis County details allegations against Dr. Clinton Herzog from FLOSS Dental, including that he is not a licensed dentist.

Plaintiffs claim Herzog collected hundreds of thousands of dollars from investors to open multiple locations for his dentistry in Austin, then never bought them and left the city. They also say the State Board of Dental Examiners suspended his license in 2015, but allowed him to practice under certain conditions.

In 2016, Herzog voluntarily surrendered his license to practice, which the plaintiffs said they were not aware of. According to Texas State Board of Dental Examiners records, Herzog was accused of advertising that his offices had multiple "elite" providers for Invisalign services, but he was the only "elite" provider. Herzog is also accused of advertising dental services that "were free or discounted without disclosing the prices of associated services," according to his non-disciplinary remedial plan.

FLOSS Dental workers on Fifth Street in Austin told KXAN Herzog "left town" and they could not get a hold of him…

See report and read entire article here.


Image result for Clinton Herzog   Image result for Clinton Herzog

Is this the same Clinton Herzog? You decide.

Clinton Herzog – January 5, 2018 Charged with Driving While Intoxicated and Possessison of PG1 (Penalty Group 1*) Controlled Substance


Image result for Clinton Herzog

*Penality Group 1(usually Heroin, Meth or Cocain) Possession of less than one gram is a State Jail Felony which may result in confinement in a Texas State Jail Facility for a minimum of 180 days and maximum of 24 months along with a fine up to $10,000.

Related:

Clinton F. Herzog, DDS - Order of Tempoarty Suspension, April 28, 2016

The Happy Hour dentist who offers patients free booze before a cleaning, May 2011

Monday, July 16, 2018

Kool Smiles featured on CBS Whistleblower Series



 

Benevis/Kool Smiles Response to CBS Report:
Dr. Greenwald and Dr. Rai blew the whistle on Kool Smiles after they say they witnessed unnecessary dental procedures performed on children. CBS reached out to the company for a comment and they provided the following statements:

Statement from Kool Smiles:
"Our patients and their safety are our top priority and we will continue to work toward our mission of ensuring every child in America has a dental home. The settlement reached in December 2017 addressed treatment provided between 2009 and 2011, and was unrelated to the quality of dental care provided to patients. The company's compliance and quality assurance programs lead the dental industry and we continue to implement ongoing measures to ensure every patient receives the best care."

This past December, 2-year-old Zion Gastelum died four days after visiting the Kool Smiles office in Yuma, Arizona. Zion's death occurred just days after the Whistleblower suit was settled. The case had been in litigation for almost a decade.

Statement from Kool Smiles regarding death of Zion Gastelum:
"Kool Smiles treatment protocols follow the guidelines and best practices established by the American Dental Association and the American Academy of Pediatric Dentistry. Treatment is provided only after conducting a consultation and obtaining the informed, written consent of the patient's parent or guardian. Our dedicated dentists, anesthesiologists and the rest of our Kool Smiles family mourn this tragic loss."

Saturday, June 23, 2018

Dr. Behzad Nazari, D.D.S., ET AL. v. The State of Texas; Xerox Corp; and Xerox State Healthcare, LLC, f/k/a ACS State Healthcare, LLC, n/k/a Conduent Business Services, LLC

Despite all the claims, counter-claims, third, forth and fith party claims, here is the the short version:

Texas withheld reimbursement from several dentists due to a high suspicion of Medicaid fraud. Dr. Nazari, his clinic Antoine Dental and others argued they needed and deserved their money for all the honest and much needed work they had done on so many children with terrible orthodontic deformities and rotten baby teeth. They were the saving grace to the underserved population as they saw it.

Being royally pissed, Nazari suesTexas and Xerox (NYSE:XRX) (ACS) demanding his money.

The Feds (that is us, the US taxpayers) says “Hey Texas, we pay 50% of all you spend on Medicaid, and we want our money back!

Texas says, “We really have that kind of cash to hand back, we spent it already. But we will try to get it from Xerox. They ran the show down here for years. In fact we knew nothing about this until Byron Harris did a series of reports for WFAA in Dallas. We learned about it on the local evening news!”

Texas sues Xerox, under whatever name Xerox was using at the time. The suit ends up at the Texas Supreme Court.

Texas tells the Texas Supreme Court justices, it was no seeking actual damages from Xerox in a civil Medicaid fraud suit in a civil Medicaid fraud suit accusing the company of signing off on $1.1 billion in claims for orthodontic services without properly vetting them, and therefore the remedies it has sought aren't subject to proportionate responsibility calculations.

Xerox says that it is wrongly facing sole liability in the matter, despite the fact it trained paid employees to basically rubber stamp “Approvals” as fast as they could. Additionally, in early testimony it was learned they trained the dentists how to game the systems.

Yesterday, June 22, 2018, the Texas Supreme Court handed down its decision. Xerox, it is all on you guys. Pony up the $2 Billion!

Now, doing business as Conduent Business Services (CNDT) reports are that Conduent’s “benefit wallet” is empy and they will probably settle for $500 Million. 

Related:

Dentist the Menace blog posts on this matter

Case Details and Documents

Opinions posted on the SCOTX Blog

December 6, 2017 Oral Arguments Video

Saturday, April 28, 2018

Emerging Advocacy Groups Support Small Business Dentistry

image

20 Apr 2018 Michael W. Davis, DDS

Small business dentistry is increasingly establishing advocacy groups designed to address specific issues. Areas of concern range from protecting the doctor/patient relationship against the intrusion of the insurance industry and corporate dentistry to honest evaluation and solutions for the public’s “access to care.”

These associations are springing up in a variety of different states. Because of their distinctive smaller sizes, they are highly attuned to specific predicaments unique to a given state. Larger national groups may have multiple and conflicting agendas, which too often grind effectiveness to a standstill. These smaller spearhead organizations often serve as the initial testing ground for addressing and solving challenges. Many times, state dental associations will later pick up the banner and carry forth with their added weight and power of membership.

Three organizations that exemplify this movement are the Concerned Dentists of Texas (CDoT), the Concerned Dentists of Washington State (CDWS), and the Massachusetts Dentists Alliance for Quality Care (MDAQC). Each of these relatively small associations is free to examine problems unique to its specific state and discover optimal mechanisms for local problem solving. They aren’t handicapped by the political or economic motivations of a faraway distanced leadership. They aren’t bogged down by neverending and do-nothing committee meetings. And, they lack multiple layers of leadership hierarchy, which often hinders effective action…

Read Dr. Davis’ entire article here.

Thursday, February 22, 2018

Southern Dental Alliance and Sale to Pouschine Cook Capital

Keep in on your radar.


Sept 2017:

Deloitte Advises Southern Dental Alliance on Sale to Pouschine Cook

Deloitte Corporate Finance acted as exclusive financial advisor to Atlanta-based VSM Management d/b/a Southern Dental Alliance on its sale to Pouschine Cook Capital Management and its co-investor group.

Southern Dental is a multi-specialty dental service organization in the Southeastern U.S. with 32 clinic locations across eight brands.

“DCF’s assistance was indispensable for us throughout the transaction process, offering both expertise in the space and extensive resources. We are excited about our future growth prospects and the new partnership with Pouschine Cook,” said Mark Lakis, CEO of Southern Dental.

Tom Harbin, managing partner at Source Capital, echoed the sentiment, “DCF’s deep knowledge of the dental space was invaluable and helped lead to a successful transaction. We could not be more pleased with the outcome.”


http://www.abfjournal.com/dailynews/deloitte-advises-southern-dental-alliance-on-sale-to-pouschine-cook/

Monday, February 05, 2018

So far only 2 states have released their share of the $23,900,000 Benevis/Kool Smiles Dental Fraud Settlement

So far only 2 states have released their share of the $23,900,000 Benevis/Kool Smiles Dental Fraud Settlement that covers a 3 year period of Jan. 2009 to Dec. 2011. 

Arkansas - $478,500
Massachusetts – $1+M (the state is to receive $1,700,000 with a portion of that going back to the Federal Government)

They started their business model of “Abuse Children; Collect Medicaid $” in June of 2002 with Drs. Frick (Tu Tran) and Frack (Thein Pham) and Kool Smiles still at it today; it will soon be 16 years! 

One must never forget  Dr. Tu M. Tran and Dr. Thien Chi Pham were dentists working at Smile High Dentistry in Colorado. Smiles High Dentistry is part of the Small Smiles Dental chain in 2001.

That leaves 13 years of the same fraud and abuse that has gone unchecked.

Below is a post from Massachutches Attorney General Maura Healey’s facebook page which nearly caused me to have a seziure.

180118 MassAG facebook post

I have to comment:

"This is a story of an enormous company defrauding Medicaid and pushing unnecessary procedures onto kids. We investigated and reached a settlement. Now millions will be returned and this company will change its practices forever."

ARE YOU KIDDING ME!

First, that statement left out the fact these unnecessary procedures were accomplished whereby small children, even babies, were tied up and tortured for speedy traumatic and painful procedures.

This has been going on in state for over 15 years. MassHealth state auditors noted in a published report Kool Smiles and it's cousin Small Smiles had a high incident of crowns back in 2005 or 2006. I have that report somewhere, I’ll find it and post it for you.

In a report you state “With this settlement, we’re recovering more than $1 million for the state and will ensure this company cannot use these practices in the future.”  That is the most naive thing I've ever heard in my life. They were doing it before auditor walked in, while auditors were there, the minute auditors walked out the door and while they were signing this Settlement Agreement.

Question Attorney General Maura Healey: How much did Mass get in 2010 when Small Smiles was sanctioned $24M? Did they change their business practices? Uh...no! Actually, they doubled down! Small Smiles even signed a 5 year Quality of Care Corporate Integrity Agreement.

Imagine the millions of dollars pillaged and the number of children abused by this “enormous company”.

This is state-sanctioned child abuse, you just can't paint it any other way.


Virginia’s Attorney General Facebook page posted about the settlement as well.  Of course I had to comment:

180126 Virginia AG facebook-Kool Smiles settlement w-comment

As I’ve pointed out before, as far back as 2009 Kool Smiles has had representative on the Virginia Department of Medical Assistance (DMAS) Dental Advisory Board (DAC). First David Strange, the Paul Walker.  Small Smiles had representitives as well.

In January 2010 a similar “Settlement” was reached with Small Smiles Dental Centers—Kool Smiles’ step-cousin 2 times removed. 

Small Smiles even went to far as to signed a 5 year Quality of Care Corporate Integrity Agreement and agreed to pay nearly $24M (nearly $27M when you add in the separate amount for the state of New York.) plus interest.

By February 2012, Small Smiles filed for Chapter 11 Bankruptcy protection. Three years later in February 2015 Small Smiles filed Chapter 7 Bankruptcy.  It still owed $26,049.276.61 from the January 2010 settlement. 

image


What happened to Small Smiles?

They simply sold a few clinics to Kool Smiles, Adventure Dental (also root with Small Smiles) and DentaQuest, also operated by former Small Smiles executives and kept a few for themselves, esepcially in Georgia and South Carolina.





Saturday, January 20, 2018

Evidence shows Benevis, LLC / Kool Smiles Dental Centers Knows the Laws.

Screen shot from Benevis website January 20, 2018:

Benevis website 1-20-2018


They simply believe the laws don’t apply to them.
Ad from the Kentucky Dental Association Website.

Benevis KDA ad

Benevis, (formerly NCDR, LLC) is owned by FFL Partners and operates Medicaid dental clinics under the name Kool Smiles Dental, focused on children (perferably under the age of 5 from the looks of things).  However they operate a disturbing non-Medicaid division under the corporate umbrella of PSBB, PC, Inc. with Dale Mayfield CFO, Secretary and CFO.  Mayfield is the Chief Dental Officer at Kool Smiles.  In 2016, Mayfield was appointed to the Georgia Board of Dentistry by Governor Nathan Deal. (try not to puke if you read this link)

Monday, January 15, 2018

$23,900,000.00 Benevis / Kool Smiles Dental Clinic Settlement Agreement with DOJ

This is for the period of January 1, 2009 through December 31, 2011.

That is 3 years.

They have been in business with this exact same business model since 2002, when FFL Partners found Dr. Tran and Dr. Pham at the Denver Small Smiles Dental Clinic and offered them an opportunity of a lifetime; to start their very own Medical Mill and become “owner dentists”.

It’s now January 2018. 

So, 15 years, right? This settlement covers 3 of 15 years.

The way I see it, they should pony up an additional $286,800,000.00.

I don’t see any Corporate Integrity Agreement; let’s hope that is a seperate Agreement yet to be released.

$23,900,000.00 Benevis Kool Smiles Dental Settlement Agreement with DOJ - January 2018

Related:

September 2009 Office Score Card

FY 2011 Texas Kool Smiles Stainless Steel Crowns Billed

Tuesday, January 09, 2018

Mother speaks out against Yuma, AZ Kool Smiles Dental Clinic

A mother is speaking out following the death of two children who visited a dental office in Yuma.

Nearly six years later, Elva Aranda is sharing her experience at Kool Smiles, who claims her daughter was being choked by a dental assistant in Summer 2012.

"It was a horrible experience, a horrible experience because when you see someone else hurting your child, you feel helpless," said Aranda.

Aranda says while her daughter was getting her regular checkup, the dental assistant was acting aggressively towards her daughter during the procedure. She claims the dental assistant was adding pressure to her daughter's neck as if she was choking her without realizing it.

"You know the suction tool, she started putting that into my daughter's mouth, and that was making her "gag". I'm here looking at my daughter, and I'm seeing her gag because that tool was shoved in her mouth and I started comforting here saying "it's okay, you're going to be okay" but I did not see that this lady had her whole hand shoved into my daughter's neck choking her."

Read the entire report here.


In 2016, 4 year old Liseth Lares died just days after visiting the same Yuma, AZ Kool Smiles clinic as 2 year old Zion Gastelum

YimageUMA, Arizona --

Two children, one dentist's office, each meeting the same tragic fate.
An Arizona mother is suing Kool Smiles in Yuma after her 4-year-old daughter died days after she visited the dentist's office in January 2016.


Francisca Lares said she is heartbroken, because she was only trying to do the right thing in getting care for her daughter, KNXV reports.


But when little Liseth Lares developed a fever, family attorney Marco Mercaldo said the dentist sent the girl home after a "relatively cursory exam."


"Told the mom essentially there is nothing to worry about, she'll be fine," Mercaldo said. "Unfortunately, the infection spread and she died of the infection."


Mercaldo argues Liseth could have survived the infection if Kool Smiles had given her the proper treatment.

Read full report here.

Friday, January 05, 2018

2-year-old Zion Gastelum dies after dental appointment at Kool Smiles

Image result for abc15 logoYUMA, AZ - An Arizona family is left confused, devastated and looking for answers about just what happened during a young boy's dental appointment.

The family of Zion Jay Gastelum said the 2-year-old died after a dentist appointment in Yuma last month. Zion's uncle told ABC15 the child's parents took him to Kool Smiles Dentist on December 16 for a crown and filling, and somehow either during or after the process, it appears Zion stopped breathing. 

According to family, Zion was transported to Yuma Regional Medical Center and then flown to Maricopa County, where he died several days later.

Read more here

Thursday, December 14, 2017

Boston Dental Group, LLC vs Affordable Care, LLC

Boston Dental Group, LLC (see more info at the end) and Affordable Care, LLC (Affordable Dentures and Implants) seem to be in a heated lawsuit in Nevada’s Federal Court.  I’ve not looked at the initial Complaint, (case no. 2:15-cv-01636) but I have read (link below) BDG’s Reply in Support of Partial Summary Judgement.  Appears BDG sued (for what I’m not sure) then Affordable Care filed a counter-suit., that seems to sound a whole lot like a SLAPP suit (boy, I’ve been there…lol).  But at this point in the story, I’m not even sure who is cheating who, as the song goes.

Link to Plaintiff’s Reply in Support of Partial Summary Judgement (24 pages) filed August 25, 2017 in United States District Court, District of Nevada.

Anywho…I’ve pulled out some interesting items in this pleading and posted below.  More interesting, much of the this pleading is redacted and all the exhibits are filed “Under Seal”.

Enjoy!

Page 3, Line 3

“The question of the legality of Affordable Care’s management agreements with dentists
goes straight to the heart of whether Affordable Care has enforceable trademark rights. All of
Affordable Care’s claimed rights in its “dental services” trademarks are purportedly through
“oral licenses” it has with independent dental offices around the country. If the financial
arrangements with those dental offices are illegal, this illegal activity cannot form the basis of
any trademark rights, and Affordable Care’s has trademarks are unenforceable.”

Page 3, Line 12

The illegality of Affordable Care’s management agreement was an issue throughout this case and multiple discovery requests by BDG sought information concerning this illegal arrangement.
Despite the numerous discovery requests, Affordable Care refused to identify any
witnesses or produce any financial documents on this issue. Regardless, Defendant did produce
its 2007 Management Services Agreement which is illegal on its face (prior to this case being
filed Affordable Care produced an unsigned copy of this document which began the
conversation on the illegal nature of its arrangement with its dentists).
Now for the first time, Affordable Care decides to bring forth a witnesses and a handful
of select documents to claim that the 2007 illegal management agreement was just a copy-andpaste template and the fact that both it and the Nevada dental office signed the agreement was meaningless. Such a claim is simply unbelievable.

Page 4, Line 12

“Moreover, the specific allegations that Affordable Care’s trademark is unenforceable and
that it has unclean hands due to a violation of Nevada law has been in issue throughout this case,
including in the pleadings and throughout discovery.


In BDG’s Answer to Defendant’s Counterclaim, BDG states the following affirmative
defenses, among others:


Defendant’s counterclaims are barred by unclean hands.
Defendant’s trademarks are invalid and/or unenforceable.
       See BDG’s Answer to Counterclaim, Doc. 10, p. 5, lines 24-25. (Filed under Seal)


In addition to the pleadings, both before and after this lawsuit was filed, counsel for
BDG repeatedly informed Affordable Care that its management agreement with its Nevada
dentist was illegal under Nevada law.
This is apparently what prompted Affordable Care to
amend its management agreement with its Nevada dentist and back-date it to January 1, 2016
.”

Page 5, Line 15

“Affordable Care’s actions constitute the illegal practice of dentistry in Nevada and cannot form
the basis of any claimed trademark rights for dental services.”

Page 5, Line 19

“As set out in more detail in BDG’s Motion to Strike, Affordable Care failed to name Mr.
Steelman
as witnesses and failed to produce the financial information it now claims address
BDG’s arguments concerning trademark priority and the unenforceability of Defendant’s
trademarks. This declaration and these documents should be stricken and not considered by this
court.”


Page 5, Line 24

“Not only was this witness not identified during discovery and these documents not
produced, BDG requested this information and Defendant Affordable Care refused to produce
it. Specifically, BDG requested an identification of all witnesses and documents related to
financial information of the Las Vegas affiliated practice, including:

REQUEST FOR PRODUCTION NO. 9:
Please produce documents sufficient to show for Nevada and California
Affordable Care’s and any Nevada or California Licensee’s monthly and annual
net profit from goods for services sold under Affordable Care Marks from 2007 to
the present.


RESPONSE: In addition to the foregoing General Objections, Affordable
Care objects to this request as irrelevant to this action and not reasonably
calculated to lead to the discovery of admissible evidence. Neither Plaintiff’s
action for declaratory relief of non-infringement nor Affordable Care’s
counterclaims for trademark infringement, false designation of origin, and unfair
competition involves evidence of profit from goods or services sold under
Affordable Care Marks. See Doc. 32-7 as Exhibit 7, p. 3. (Filed under Seal)


INTERROGATORY NO. 11:
Please state in detail the factual basis, including, but not limited to,
identification of all documents and persons, all sums and amounts received by
you from your affiliated practices located in California and Nevada.


ANSWER: In addition to the foregoing General Objections, Affordable
Care objects to this Interrogatory because the revenue that Affordable Care has
received from its affiliated practices in Nevada and California is not relevant to
Plaintiff’s claims and defenses, or Affordable Care’s counterclaims, which all
relate to the use of the AFFORDABLE DENTURES Marks
. Affordable Care
further objects to this Interrogatory because the information sought in this
Interrogatory is not proportional to the needs of the case.

INTERROGATORY NO. 13:
Please state in detail the factual basis, including, but not limited to,
identification of all documents and persons, of all reimbursements, including, but
not limited to, fee-for-service methods of reimbursements paid to you and/or paid
by you to your affiliated dental practices located in California and Nevada.


ANSWER: In addition to the foregoing General Objections, Affordable
Care objects to this Interrogatory because Affordable Care’s financial relationship
with its affiliated practices in Nevada and California is not relevant to Plaintiff’s
claims and defenses, or Affordable Care’s counterclaims, which all relate to the
use of the AFFORDABLE DENTURES Marks. Affordable Care further objects
to this Interrogatory because the information sought in this Interrogatory is not
proportional to the needs of the case. See Doc. 32-5 as Exhibit 2, p. 9-10. (Filed under Seal)


Affordable Care cannot refuse to produce this information or identify witnesses during
discovery and then attempt to get into evidence a new witness and select documents because it
now suits them.”

Page 7, Line 17

“C. Defendant’s Arrangement with its Nevada Dentist is Illegal Under Nevada
Law

1. The Evidence of Record in this Case Demonstrates that Affordable Care
Operated Illegally in Nevada.

Page 9, Line 9

“In addition to the fact that Affordable Care’s surprise declaration and exhibits were
never produced and should not be considered, this untimely evidence contradicts the evidence
that is properly of record in this case, including the sworn testimony of Affordable Care’s only
witness,
Adam Siegal who testified (redacted) See Exhibit 5, Adam Siegal Deposition, p. 28 lines 17-24”

This was echoed by Dr. Cher Y. Chang who owns the Nevada dental practice. She
testified as follows: (redacted) See Exhibit 6, Cher Y. Chang, DMD Deposition, p. 12, line 16 - p. 13, line 19. (Filed under Seal)

As set out in detail in BDG’s Motion, this is a clear violation of Nevada law. See NRS
631.395 (“A person is guilty of the illegal practice of dentistry or dental hygiene who . . . 10.
Except as otherwise provided in NRS 631.385, owns or controls a dental practice, shares in the
fees received by a dentist or controls or attempts to control the services offered by a dentist if
the person is not himself or herself licensed pursuant to this chapter.”) emphasis added; See also
NRS 631.215(2)(h)(1) (stating that a person who provides goods or services to a dental practice
may not, “[p]rovide such goods or services in exchange for payments based on a percentage or
share of revenues or profits of the dental practice, office or clinic.”)”

Page 9, Line 24

“Even if this Court were to consider the declaration of Mr. Steelman and the undisclosed
Vegas Financial Statements and Vegas Fee Statements, the arrangement between Affordable
Care and its Nevada dental office appears to be illegal under Nevada law.”

Page 9, Line 28

“This is abundantly clear from the Vegas Financial Statements and the Vegas Fee Statements. (redacted) (See 2016 Management Services Contract, Doc. 54-1 as Exhibit A-4, p. 21 AFCA 0009190). (Filed under Seal)

Page 11, Line 6

“Mr. Steelman’s claim that the amounts paid by the Nevada dental practice are
contractually “fixed” simply does not hold up to scrutiny.

”Page 11, Line 15

“Affordable Care’s sham “fixed” fee simply does not stand up to scrutiny and is illegal under Nevada law.

Moreover, Affordable Care has not identified a single state where this type of arrangement
would be legal.
Affordable Care’s business practices appear to violate the laws of every, or
nearly every, state it operates in
.”

”Page 11, Line 20

“Illegal Activity Cannot Form the Basis of Any Trademark Rights
Affordable Care’s arrangement with the Nevada dental office is illegal under Nevada
law and cannot form the basis of any trademark rights. CreAgri, Inc. v. USANA Health Scis.,
Inc., 474 F.3d 626, 630 (9th Cir. 2007).” (Filed under Seal)

“In this case, BDG, a company owned by a licensed Nevada dentist, is merely seeking a
declaratory judgment that Affordable Care’s trademarks for dental services are invalid and
should be cancelled. Affordable Care (not BDG) filed a counterclaim for trademark
infringement. Thus, while Affordable Care’s priority date in this case is when it first obtained
enforceable trademark rights in order to bring its counterclaim, the relevant priority date for
BDG is when it first began using its allegedly infringing mark, namely when it opened its first
dental office in January 2008.”

“As detailed above, Affordable Care’s illegal practice of dentistry in Nevada was not
lawful commercial use and cannot form the basis of any trademark rights which pre-date BDG’s
use of its Affordable Dental mark. Plaintiff Boston Dental Group’s trademark rights in its
Affordable Dental mark, which began at least as early as January 2008, therefore have priority
over Affordable Care’s illegal activity.s



Adam Siegal-VP-Mrktg-Affordable Care


S. Paul Steelman, Jr-Affordable Care CPA-VP

Boston Dental Group, LLC

Registered Agent and Managing Member:

David Tawei Ting, DMD
6960 Westcliff Dr., Ste 200
Las Vegas,NV  89145

Ting has as least 36 companies where he is the registered agent according to a search of the Nevada Secretary of State’s website.

Some of the more interesting ones are:

Affordable Dental At Laughlin, LLC
Affordable Dental at Westcliff, LLC
BDG Coaching, LLC (what exactly is being coached?)
Boston Dental Group at Anthem, LLC
Boston Dental Management, LLC
C and T Dental Laboratory, LLC
Cambridge Dental Consulting Group
Cambridge Dental Technology, Inc
Dapha Dental Technology, Inc.
Dentisting, LLC (huh?)
Friendly Ting, PC
Haider, Ting and Chung, LLC
Handpiece Club, LLC
Looting, LLC (WHAT!  I could run with this like Forrest Gump)
Vita Smile, LLC