Wednesday, July 27, 2016

Dental Insurance Rip-Offs… Consumers Beware!

 

imageDr. Michael W. Davis maintains a general dental practice in Santa Fe, NM. He serves as chairperson for Santa Fe District Dental Society Peer-Review. Dr. Davis also provides a fair amount of dental expert legal work for attorneys. He may be contacted via email: MWDavisDDS@comcast.net

 

 

One of the biggest scams facing dental consumers are products sold to them, which are misrepresented or falsely presented as dental insurance. The reality is usually quite different. Other times the product sold to the public is truly dental insurance, but it has virtually no value or entirely no value to the consumer. The bait presented to the potential dental patient is low- cost monthly payments for insurance. Unfortunately in too many cases, the dental consumer is hustled out of their money with little or nothing to show in cost savings or benefits.

Bogus Dental Insurance Plans

There are swindlers who sell consumers all sorts of insurance plans for low-cost monthly payments. Sadly, the plan administrators failed to secure the services of any healthcare providers, assuming these bogus insurance plans even have an administrator. All legitimate dental insurance programs must be registered within the states they do business within. They must comply with each state’s rules and regulations for dental insurance. A check with your state insurance commission will provide you with a listing of all duly and lawfully registered insurance providers. If the dental insurance company providing the plan isn’t listed, that’s a red flag warning. Stay far clear of that company.

Discount Programs

Discount programs for dental services are too often presented in a deceptive format, which gives the impression of dental insurance. For that reason, numbers of states have outlawed these discount plans. In no case are these dental discount plans regulated by the state insurance commission. However, numbers of state attorney generals have attempted to close down these dental discount card programs, in service of the public interest.

Some discount dental programs are sold by independent companies, with little or no background history available. They may or may not even have enrolled dentists, who participate and honor their discount cards. Too often, the few dental clinics which do accept these discount programs artificially inflate their fees, to offset any consumer savings. Other dental clinics find these discount plans work to get customers in the door, for more profitable bait-and-switch scams or hard-sell upselling of additional services. Unfortunately, consumers attracted to purchase these discount cards are frequently financially disadvantaged, and not particularly sophisticated in dishonest business dealings. They are primed for the plucking.

Large corporate dental clinics also sell dental consumers a variety of discount dental plans, which are administered under their company. Again, numbers of states have outlawed these plans, because they too closely resemble lawful insurance programs, which they are definitely not. Some corporate dental outfits manipulate and misrepresent their fees in a variety of ways, such that patients purchasing a discount plan actually may have no cost savings, or actually pay more, than patients utilizing standard dental insurance.

Sales of dental discount plans have become so lucrative, that bonafide dental insurance companies have entered into this racket. It’s highly profitable for them, as they don’t need to register these plans as insurance vehicles with any state regulatory commission, and they aren’t as subject to state or federal auditing. Moreover, these discount plans cost the insurance company no outlay of expenditures for patient dental benefits. Since there is no remuneration paid to dental providers by the insurance company (only a promise by dental clinics to discount fees), the insurance company has little incentive to monitor or audit billings from dental providers. Unfortunately, too often the same bait-and-switch and hard-sell upselling we see with corporate dental clinics, also happens with dental clinics accepting dental discount cards sold by an insurance company. Once again, consumers get screwed.

Dishonest Dental Insurance

Dishonest dental insurance has become a highly popular swindle, especially since the inception of the Affordable Care Act (ACA) and the various state insurance exchanges. Yes, these are genuine dental insurance programs, many of which are specifically designed to cheat consumers. With all the new changes in the insurance industry, many state regulators are ill-equipped to provide appropriate oversight. In this deceitful quagmire of the insurance industry, consumers are at risk. Let’s examine some of the more popular methods of gaming dental patients.

Numbers of health insurance companies today sell dental insurance at an additional upgrade fee. What often isn’t disclosed to the plan purchaser is that the dental coverage is fully embedded in the medical insurance plan. The consumer is sold on dental insurance, which covers preventive dental services, along with many restorative services. What isn’t disclosed is that the consumer often must reach the medical deductible limit of $5-6,000, before they become eligible for dental benefits.

Saturday, July 23, 2016

Association of Dental Support Organizations Tax Return Comparison 2007 thru 2013

Association of Dental Support Organizations Tax Return Comparison 2007 thru 2013

Nashville Based Marquee Dental Partners: Just Another DSO

Am I the only one to notice that every Dental Support Organization (DSO) markets themselves as the grand poohbah of the DSO industry? Marquee Dental Partners, who launched in October 2015 with a $35 Million investment from Chicago Pacific Founders, says they are the premiere of DSO’s. 

Let’s look at this up-and-coming DSO.

According to their website, they now own 19 practices in the Southeast. The headline reads, “Marquee Dental Partners Acquires Bryant Dental, Expands to 19 Practices in Southeast “.

By “acquire” I assume the 19 practices were not given to them, right? Must have bought them, right? So now they own them, right?

July 2016: Bryant Dental – 3 Locations - Alabama - Founder - W. Forrest Bryant, DMD
May 2016: Save-On Dental – 5 Locations - Alabama - Co-founder Dr. John Denton
May 2016: Signature Smile – 2 Locations - Alabama - Dr. L. Don Wilson and Dr. Kristen Bentley
January 2016: Winfree and Denton Cosmetic and General Dentistry – 1 Location - Hermitage, TN - Dr. Terry  Winfree, DDS, and Dr. Greg Denton, DDS
December 2015: Bohle Family Dentistry – 1 Location - Paducah, KY- Dr. Chip Bohle, DMD
October 2015: Embassy Dental – 7 Location - Nashville, TN - Founder Dr. Warren Melamed

With each “acquisition” Marquee Dental Partners releases a statement that claims:

“...to have entered into an affiliation agreement”
“…provide dentists with both support and clinical autonomy they need”
“…seamless transition”
“…acquired the business end of [clinic]
(fill in the blank founder/dentist) will continue to either be actively involved or continue to provide high quality care for patients.

Checking the Tennessee Secretary of State Website I found the following:

Marquee Dental Partners, LLC , a Delaware company, entity filing date 2/12/2015

Name: CPF Dental, LLC (Chicago Pacific Founders Dental, LLC)
Formed in: Delaware
Original Address: 23 Northumberland, Nashville, TN 37215 (home of James Usdan and Lisa Butlak)
Principal Office Changed on April 2016 Annual Report to: 2025 21st Ave, Ste 204, Nashville, TN 37212
Number of members: 1 (likely James Usdan)
Assumed names: Embassy Dental and Marquee Dental Partners
Consent Given to Name Change from” No value To: TN Dental Professionals, PC

TN Dental Professionals, PC has assumed names listed as:

Winfree & Denton
Winfree and Denton Cosmetic and General Dentistry
Embassy Dental
Marquee Dental Partners

There is also a TN Dental Professionals, II PC started February 1, 2016. No assumed names, yet. Registered Agent is Donald R. Moody, 511 Union St. Ste 2700, Nashville, TN 37219-1791.

From Marquee Dental Partner Website:

Marquee Dental Partners Launches with $35 Million in Funding to Support Dental Practices

October 13, 2015

Nashville, TN – October 13, 2015 – – For many dental practices in today’s market, the pressures of performing administrative and billing functions prevent them from focusing their attention where it’s most needed: their patients. Launched with a $35 million capital commitment from Chicago Pacific Founders, Marquee Dental Partners provides dentists with both the support and the clinical autonomy they need to succeed.

Friday, July 22, 2016

Daisy Lynn Torres’ Needless Death Raises Questions

In March, Daisy Lynn Torres’ parents took her to Austin Children’s Dentistry in Austin, Texas to have stainless steel crowns placed on two teeth. After the dentist got his hands on Daisy, he suddenly found she needed a total of 6 crowns. This is the classic bait and switch dentistry I hear so often which sadly has become the norm.

During the procedure something went terribly wrong and baby Daisy went into cardiac arrest. 911 was dispatched and Daisy was taken to the hospital where she was later pronounced dead. According to the heart wrenching story in People Magazine, Daisy’s mother, says her daughter was “dead before she even left the dentist office”.

Fast forward to July 15, 2016, NBC affiliate KXAN in Austin published a story suggesting Daisy Lynn, didn’t need the procedure. Not exactly a shocker. 

“One can only speculate as to why any treatment was performed considering no indication of dental disease or pathology was seen in the dental radiographs (x-rays) in the dental visit dated 03/29/2016,” writes Robert Williams, a forensic odontologist. While the initial x-rays prior to work being done showed no disease, the report does note that x-rays taken after the child’s death indicated four teeth appear to have dental work performed on them. According to the report, the child’s teeth had been prepared to have stainless steel crowns placed on them.

“It is possible that the partially erupted teeth may have had a congenital enamel defects but not necessarily requiring treatment with a child of this age,” the report notes. “No evidence that the child was in any type of pain was ever notated in the dental record and no pulp vitality test was ever performed.”

According to KXAN, the initial report from the Travis County Medical Examiner mentioned a difference of opinion between Dr. Michael Melanson and the forensic odontologist, and it wasn’t until the station requested the entire report was it revealed just exactly how much those opinions differed.

The report also states Austin Children’s Dentistry has suspended Dr. Michael Melanson. However, I find no evidence of the any disciplinary actions taken by the TSBDE. In fact, as of July 22, 2016 Dr. Michael P. Melanson’s dental license shows no Disciplinary Actions whatsoever.

160722 Michael Melanson dental lic-clean

Of course Austin’s Children’s Dentistry says of course no evidence was found that the child needed the procedures, it had been removed; the standard boilerplate statement. 

“The report reveals no surprises to us. By the time the forensic odontologist evaluated Daisy, all evidence of dental disease had already been removed by the dentist, as expected. A treating dentist always has the advantage of pre-treatment visual exams, clinical findings, and x-rays on the patient; as well as knowing the patient’s dental history, unlike a forensic odontologist. The treating dentist in Daisy’s case will present all of the evidence that justified Daisy’s treatment if called on to do so.”

Well, I’m certainly waiting for Austin Children’s Dentistry and Dr. Michael Melanson to be “called on to do so”.

Just two months prior to Daisy Lynn’s death, 4 year old Navaeh Hall had gone to Diamond Dentistry in Houston where Dr. Bethaniel Jefferson's treatment left Navaeh severely brain damaged. The Texas State Board of Dental Examiners placed Dr. Bethaniel Jefferson’s license on temporary suspension. “In essence what happened is this child was chemically and physically suffocated,” stated Jim Moriarty, the attorney reprsenting Navaeh Hall and her family. Was this also what happenedd to Daisy Lynn Torres?

Here are my questions:

1. Was little Daisy and these parents victims of Bait and Switch Dentistry at Austin Children’s Dentistry? I believe they were.

2. Who owns Austin Children’s Dentistry? There is substantial evidence to suggest it is owned and operated by Tal Shohomy, a Wall Street trader, who also owns/operates White Angel Veterinarian Clinic. where his wife is a veterinarian.

Tal Shohamy Bio from White Angel Verterinarian Clinic:

Tal Shohamy Bio

3. Was Dr. Melanson being pressured to overtreat in order to bilk Medicaid/Insurance? We know it is common these days to “milk the cow dry” as it was so eloquently stated by Small Smiles dentists.

4. Where was this anesthesiologist who was supposedly monitoring Daisy? Chatter in the dental community suggests he wasn’t even in the room with Daisy.

5. Is anyone suing this dentist, owners and clinic? If not, why the hell not!

6. Has a complaint been filed with the Texas State Board of Dental Examiners? I would hope so!

Wednesday, June 29, 2016

American Dental Association’s Strange Bedfellow, Wonderbox Technologies

Dr. Michael DavisDr. Michael W. Davis maintains a general dental practice in Santa Fe, NM. He serves as chairperson for Santa Fe District Dental Society Peer-Review. Dr. Davis also provides a fair amount of dental expert legal work for attorneys. He may be contacted via email: MWDavisDDS@comcast.net

 

 

American Dental Association’s Strange Bedfellow, Wonderbox Technologies
By: Michael W. Davis, DDS

On June 8, 2016, the American Dental Association (ADA) announced its collaboration with Wonderbox Technologies.1 The effort is designed to provide a centralized computerized credentialing service for doctors, at no cost to ADA member dentists. This database could be accessed by third party payers such as insurance companies, government entities, hospitals and clinics, as well as employers. The desired result is a more streamlined credentialing process with elimination of duplicative efforts.

Obviously, such a databank will contain highly confidential material. The consequences of a data breach could easily compromise doctors, but also potentially damage entities legitimately attempting to access data for dentist credentialing. Personnel at Wonderbox Technologies and the ADA involved in safeguarding private information must maintain the highest levels of ethics and meticulous safety protocols.

Craig Kasten is the board chairman and co-founder of Wonderbox Technologies. Formerly, Kasten was co-founder and co-owner of Doral Dental, an interstate dental Medicaid administrator. Doral Dental was bought out by DentaQuest, in 2004 for a reported $108 million.

Craig Kasten and Doral Dental gained notoriety during the federal criminal trial of today convicted felon (66 months), John Ford on bribery scheme charges.2-4 Former Tennessee state senator, John Ford was commonly known as “Mister 10%”. This referenced his alleged unlawful skim on state government contracts.

John Ford(2)

Doral Dental paid through a consulting firm over $400,000 to John Ford, in order to secure an $18 million state contract to administer dental Medicaid in Tennessee. Prior to the payment, Senator Ford spoke vociferously against the services of Doral Dental in Tennessee. The astonishing turnaround was 180 degrees, once payment was assured.

During the trial of John Ford, the defense wanted to call upon the testimony of Craig Kasten. Kasten agreed, but only under the condition the government offered him immunity. The prosecution declined to offer immunity, and in turn, Kasten invoked his Fifth Amendment right against self-incrimination. US Assistant Attorney Eli Richardson stated about not offering Craig Kasten immunity, “(He) is not a candid witness; he is not a reliable witness.”

In short order after acquisition of Doral Dental by DentaQuest, DentalQuest dismissed all senior management formerly associated with Doral. On March 23, 2005, Doral Dental (acquired by DentaQuest prior year) released an internal investigation which pointed the finger at Kasten and other former Doral executives for the deals with Sen. John Ford. Craig Kasten, nor any former director or management of Doral Dental, has ever been indicted for activities centering on the criminal bribery actions of John Ford. John Ford

One is left to speculate on the vetting process employed by the ADA in selection of their corporate collaborators. The concept of a centralized database for doctor credentialing on its face seems highly constructive. This would benefit dentists, as well as those legitimate parties seeking data for the credentialing process. However, the integrity of those “guarding the henhouse” of a doctor’s personal and professional identity must be beyond reproach.

 

 

References

1. http://www.ada.org/en/publications/ada-news/2016-archive/june/ada-wonderbox-create-comprehensive-credentialing-website

2. http://www.iclassifiedsnetwork.com/contentitem/74145/1259/tenncare-contractors-were-slow-to-divulge-deals-with-ford

3. http://nashvillecitypaper.com/content/city-news/fords-attitude-toward-doral-dental-makes-180-degree-shift-testimony-shows

4.https://news.google.com/newspapers?nid=1683&dat=20050324&id=_70aAAAAIBAJ&sjid=dEUEAAAAIBAJ&pg=6300,3161534&hl=en

Saturday, June 18, 2016

Brit Teen Review’s Sunny Malouf and “My House”

Sunny is the daughter of Richard Malouf, disgraced Texas dentist and former owner of All Smiles.  A couple of years ago he and his outlandish house built on taxpayers money were in the news often in Texas.  I guess he didn’t get enough coverage to feed that massive ego.

This is so funny I don’t even know what to say. 

Enjoy!

What I don’t understand is why the authorities in Texas never found this just as outrageous.

Didn’t he sue WFAA for taking aerial photos of his place a couple of years ago. Interesting.

Here is the link to her youtube channel where the video resides.  Don’t miss those comments. Also note the 278,000 views, with 2,545 LIKES and 15,834 DISLIKES.

https://www.youtube.com/watch?v=tFUVvCQWPqk

If anyone is looking for a place to live, the place is for sale for a mear $32,347,000.00.

.  Don’t miss all the pictures! It’s awesome.

http://www.briggsfreeman.com/search/property-details.asp?streetaddress=10711-Strait-LN-Dallas-75229&npg=1&Cg=SingleFamily&SN=10711%20Strait&source=qlist&pn=29076

Saturday, April 09, 2016

Is Florida paying dentists a “per patient” fee on top of reimbursement for services?

Is Florida paying dentists a “per patient” fee on top of reimbursement for services? It sure sounds that way in this sworn statement by Dr. Jodi Mason.  Dr. Mason was interviewed in connection with the Florida Medicaid Fraud Contol Unit’s investigation into Howard Schneider, DDS.  Her last statement was a bit more revealing that I suspect was expected as the interview concluded.  Personally, I think that is where the real questioning would have started if the goal was learning more about the widespread dental fraud in Florida.

This interview was posted by News 4 in Jacksonville and can be found here:

http://media.news4jax.com/document_dev/2016/02/03/Dr.%20Mason_2048400_ver1.0.pdf

State of Florida Office of Attorney General Medicaid Fraud Control Unit
Howard Schneider, DDS, Jacksonville, Floridia
OAG Number: MFC-15-00381
May 12, 2015 Interview of Dr. Jodi Mason by David Schwab
Dr. Mason worked at the Duval County Health Department from 2007-2008 and from 2009-2011, before opening her own practice.

Dr. Mason was asked by Schwab to tell him about working on patients after they had seen by Dr.
Schneider. Dr. Mason said that she spent the majority of her time that she was at the Health
Department working on patients that had been treated by Dr. Schneider. Any of the patients of the
Health Department that needed a pediatric dentist, which was a significant number of patients, were
either referred to either Dr. Schneider or Dr. Klein. Those patients would then return to the Health
Department for their care after their treatment needs were taken care of by Dr. Schneider or Dr. Klein (Dr. Klein passed away in 2008).

Schwab asked Dr. Mason what kind of issues the patients that had seen Dr. Schneider came back with.
Dr. Mason said "As best as I can recall. There were a lot of abscessed teeth that had been restored with
nerve treatments and a crown and the crown had come off. I mean, it was like if Dr. Schneider had
done crowns the crown was gone, if Dr. Schneider had done a filling the filling was gone. So, the teeth
that he had done fillings on they needed crowns or needed to be taken out, or the teeth that he had
fixed needed to be taken out, um, because they either had an infection and he fixed that, instead of
taking it out or, um, they got an infection after he fixed it. Um, so a lot of infections, um, so, yeah."
Schwab asked Dr. Mason if the crowns that she had to replace looked like they had been cemented on
or just forced on the tooth. Dr. Mason said "At the point I saw them the crowns were gone, there was
no crown there, usually we didn’t see a loose crown or anything it was, the crown was gone. Um, very
rare that the patient or parent actually brought the crown in you know, and if they did I don’t think that
I would’ve, I would remember, if there would have been cement inside of it or not, though."

Schneider pull quoteDr. Mason said that she has some patients at her practice now that were patients of Dr. Schneider, but she said it is a very low number. The patients that she does have that went to Dr. Schneider have the same issues as the issues the patients she saw when she was with the Health Department; as far as crowns being gone. Schwab asked if the patients that she sees from Dr. Schneider now at her practice are Medicaid. She is not a Medicaid provider and the Medicaid patients that she does see pay cash for the procedures that she performs. Dr. Mason said that she would work on putting together a list of Medicaid patients that she is treating at her practice.

Dr. Mason said that parents of patients that had been treated by Dr. Schneider told her about their child having scratches and bruises. Dr. Mason said that when she heard those types of stories she would encourage the parent to report the abuse. She said that she never saw any of the scratches or bruises by the time the child got to her. She also stated that even when she was at the Health Department she encouraged people if they didn’t think that the work was done properly or the child was abused to report it.

Schwab asked her if she ever used the papoose board. She said that she has used it twice in the last
year; she said that she usually will use it only for frenectomies (a procedure to cut a piece of skin
under the tongue, or lip, to allow more movement of the tongue or lip). Usually if they are under two,
or three years old, and the parents uncomfortable or unable to hold the child still enough to do certain
procedures which are short procedures she would use the papoose board. Dr. Mason also said that she
did use one a little more often when she was at the Health Department, but she only used it on cases
where there was an infected or broken tooth that had to come out. She said that she does not practice
like that and advised Schwab that she does not do conscious sedations at her office for safety reasons.

Schwab asked Dr. Mason if she was treating a patient that was "fighting” did she ever hold them down
by their throat. Dr. Mason said "No." Schwab then asked Dr. Mason have she ever held a patient
down by their throat, pinch their nose and put your hand over their mouth. Dr. Mason said "No. I
know that was a technique hand, hand over mouth was a technique that was used, somewhat used you
know, with a couple of generations ago dentists, you know back before they had gloves." Schwab
asked Dr. Mason about putting their hand in the child’s mouth so they could not breathe. Dr. Mason again said "No, I think that would be counter intuitive."

Dr. Mason said that if there are behavior issues that preclude doing procedures safely she has an
Anesthesiologist that comes in and can do I.V. sedation. It is expensive because the Anesthesiologist
set their fees and is usually out of network. She said that based upon her experience as being a Dental
Assistant, then working at the Pediatric Dental facility at the University of Florida, she has the ability
to determine if she is going to be able to get through to the end of the procedure safely.
Dr. Mason said unless it’s an emergency they don’t hold anyone or against their will. The parent is in
the room and either the parent will be holding the child or they would be right there. I would tell Mom
"I am going to hold her head and I need you to hold her arms." We would do that for a couple of
minutes and then we would take a break.

Schwab asked Dr. Mason if she thought that having the parent in the room with the child helps the
child stay calm. Dr. Mason replied sometimes it does, sometimes it doesn’t, but it depends on the type
of parent. She clarified saying that any time it gets to that point or if you have those behavior issues,
even if they are less calm with Mom in the room, she would still want Mom in the room to see what
was happening. That way if you hear screaming you know what is going on. Dr. Mason said that there
are some of her patients’ parents that do not want to be in the room, therefore, she lets the parent
decide.

Schwab asked Dr. Mason if the children that had been to Dr. Schneider showed more fear, and
anxiety, than children that had not been to Dr. Schneider. Dr. Mason said, "That part of it, it wasn’t
just fixing the work at the Health Department. It was working through or trying to work through all
those behavior and anxiety issues, you know, here, it’s a lot less of it. But, the children are truly afraid
and very, very scared, and it just takes a little more time to build that relationship, ok, we’re not going
to do anything that is scary here, um, and there are some of those we have been able to work through."

Dr. Mason then said, "This is part of the reason I left and it was because I kind of got tired of
censoring my words from parents because I didn’t want to bad mouth other people’s work." Dr.
Mason continued "It got back to my supervisor that I wasn’t happy with the care that people were
receiving there, and he made me have lunch with Dr. Schneider. He like set up a lunch so that I could
meet him and see what a nice man he was to provide this service for these children, and um, that was
the day I decided to leave, was after I had to have lunch with him."

June 13, 2016 is the date set for the fraud case against Dr. Howard Schneider of Jacksonville, Florida

April 4, 2016
JACKSONVILLE, Fla.
- A trial date has been set for embattled pediatric dentist Dr. Howard S. Schneider, who is facing 11 counts of Medicaid fraud.

Schneider, 78, pleaded not guilty to those charges and one count of scheme to defraud.

More Jacksonville Headlines

His lawyers argued unsuccessfully last month to have the charges dismissed.

Schneider's trial is set to begin June 13.

Schneider remains free on $110,000 bond and is now living in St. Simons Island, Georgia.

Read the entire story here.

Friday, April 01, 2016

14 Month Old Daisy Lynn Torres dies after visit to Austin Children’s Dentisry

Austin Children's DentistryAustin, Texas – 14 month old toddler, Daisy Lynn Torres, died March 29, 2016 after visiting Austin Children’s Dentistry in what spokesperson, Sarah Marshall, says was a “fairly routine” procedure that required anesthetics.

As pale and frightened as Marshall looked on camera, I suspect she was scared to death to actuall “speak”. Marshall also said, they have been in business for 40 years! Really? She also  told KVUE-TV “these types of procedures are done all the time”. Really?

I wonder if the routine part actually means that their office routinely sedates children unnecessarily for unnecessary procedures in order to bilk Medicaid or other insurance.  Let’s face it, we are talking Texas here, right?

According to Daisy’s mom—as reported in a follow-up report by KVUE-TV—Daisy was only supposed to have two cavities fixed, then about 15 minutes into the procedure, they came and told Daisy’s mom they were going to go ahead and do 6—4 stainless steel crowns on top, and 2 on the bottom.

Daisy’s mom told KVUE reporter Kris Betts, about 10 minutes later, the dentist returned saying Daisy was having a “difficult time”. After taking her mom back to see her, they assured her mom that she was fine. Shortly thereafter, an ambulance was called. The ambulance took Daisy to North Austin Medical Center. Her mother followed the ambulance to the hospital. Upon arriving she was told Daisy was already brain dead.

So what happened?

Wednesday, February 24, 2016

Are you a Pacific Dental “owner” or “employee”?

This is to all the poor souls who have found themselves in Pacific Dental Hell.

If you are associated with Pacific Dental and one of their many clinics and feel you are not getting your cut as promised by the company, I would love to hear from you.  If you are a member of the support staff and notice things that just don’t seem right, I.E. taking too many x-rays, over-treatment, etc., I would love to hear from you.

If you know of—or even suspect—fraud taking place in any clinics associated with Pacific Dental, remember Whistleblowers, get a piece of the pie so to speak when they file a Qui Tam lawsuit.

Be that as it may, I’m gathering information—that I will post later— where I will shed more light on the full scope of the scam and how they are screwing their “owner” dentists.

cckaddie@yahoo.com

Tuesday, February 23, 2016

A Fart By Any Other Name Still Stinks, Part 1

Obviously the condemed Small Smiles Dental Centers are still operating and expanding in South Carolina.

2016-02-19 16.56.22Small Smiles of Myrtle Beach is operating as Oceanside Dental-Kings Highway Dental Health Center, PC

Michael Alessi, DDS

Jeremy Bondurant, DDS

Edmond R. Proctor, Jr. DDS, MS

DANIEL SPEARS, DDS

 

 

 

 

 

 

 

 

 

2016-02-22 09.48.18

 

Small Smiles of Florence, SC is operating as Bright Start Dental-Irby Street Dental Health Center, PC

Desinta Speller, DDS

Stella Faria, DDS

Edmond R. Proctor, Jr. DDS, MS

Daniel Spears, DMD

 

 

 

 

 

 

 

 

2016-02-16 12.40.01

Small Smiles of Columbia, SC is operating as Capital City Dentistry-Two Notch Road Dental Health Center, PC

Me’Chell James DMD

Kristin L. Robertson, DDS

Edmund R. Proctor, DDS, MS

DANIEL SPEARS, DMD

 

 

 

 

 

 

 

 

 

2016-02-22 13.04.04

Small Smiles of Spartanburg, SC is operating as Sparkle City Dental – Whitney Road Dental Health Center, PC

Dianah V. Barable, DDS

Mary Johnston DMD

Anna Y Kamdar DMD

J. Lee Moor, DMD

DAN SPEARS, DMD

 

 

 

 

 

 

 

 

The former Small Smiles in Greenville, SC operates as under Pleasantburg Drive Health Center, PC. The North Charleston South Carolina Small Smiles operates under Rivers Avenue Dental Health Center, PC. All of the above listed Professional Corporations were registered on July 30, 2014 with Dan Spears as the Registered Agent.

Moving over to Georgia, Daniel Spears is still listed as an officer of the former Small Smiles of Savannah, GA which is now operating as Savahhah Smiles Youth Dentistry, PC. with the princial office as 4746 Wehunt Trail SE, Smyrna, GA. with Todd Bjur, DDS as CFO and CEO.

160101 Savahhan Smiles Youth Dentistry PC-dan spears-todd bjur-ga-sos

 

 

 

 

 

 

 

 

 

Two new PC’s were filed in January 2016 at the South Carolina Secretary of State: Wesmark Dental Health Center, PC in Sumter, SC and 45 Wesmark, LLC; the Registered Agent for both of these corporation is also Dan Spears.

Below is the record on Dr. Proctor at the South Carolina Dental Board.  He is not listed as having a licenses in North Carolina, but does appear in the College of Diplomats of the American Board Of Pediatric Dentistry.(ABPD), as does the former Chief Dental Officer of Small Smiles, Dr. Steven Adair. The ABPD should not be confused with the American Academy of Pediatric Dentistry (AAPD). Amazingly, Dr. Proctor was issued a South Carolina dental license just days prior to the creation of all the professional corporation registered to Dan Spears; 16 days to be exact.

Edmund R Proctor DDS

 

 

 

 

 

 

 

The address for Dr. Proctor in North Carolina, according to the ABPD website is 1056 Meadowlands Trl NW and although it can be found associated with “Clinton Children’s Dentistry” the address is that of a home, not a dental clinic, and Clinton is Clinton, New Jersey.

According to the New Jersey Dental Board website, Dr. Proctor was issued a dental licenses there in 1983 and at one time had a couple of clinics.

Edmund Proctor, Jr New Jersey dental lic

 

 

 

 

 

Getting back to Dr. Todd Bjur, DDS, a long time Small Smiles dentist—as is Daniel Spears—according to the Georgia Secretary of State website, Dr. Bjur and Dr. Terrence  VanDiver are officers in the other former Small Smiles clinics in Georgia, as is a company, Paranet Corporation Services, Inc.

Oh, and according to the 2016 annual reports, the prinicpal office address for the other Georgia clinics is 401 Church Street, Suite 2210, Nashville, TN 37219.

Youth Dentistry of Macon-Terrence Vandiver DDS-ga-sos

 

 

 

 

 

 

 

 

 

Clearly, folks in Nashville are still involved and the new corporation structure is meant to continue the confusion.

 

Related:

American Board of Pediatric Dentistry overview

Tuesday, February 09, 2016

Federal Court Decision on Dental Specialties- Interview with Frank R. Recker, DDS, JD

 

Dr. Michael DavisDr. Michael W. Davis maintains a general dental practice in Santa Fe, NM. He serves as chairperson for Santa Fe District Dental Society Peer-Review. Dr. Davis also provides a fair amount of dental expert legal work for attorneys. He may be contacted via email: MWDavisDDS@comcast.net

 

 

 

Frank R Recker, DDSDr. Recker began his career in general dentistry in Cincinnati, Ohio during which time he served as a member of the Ohio State Dental Board. When the laws prohibiting dental advertising were overturned in the early 1980’s, he was charged by the Board to rewrite Ohio’s advertising laws. In the 1980’s he left the clinical practice of dentistry and began a legal career consisting solely of dental issues, dental board defense, and the First Amendment Right of dentists. Since that time, he has appeared before over 50% of the dental boards in the country representing dentists, and has litigated every case, in state or federal courts, involving dental advertising.

Dr. Recker is a Life Member of the American Dental Association (ADA), the American Association of Dental Boards (AADB), a Fellow of the American College of Dentists (ACD), a Fellow of the American College of Legal Medicine (ACLM) and a member of multiple state and local dental societies. He is licensed to practice dentistry in Ohio and Florida, and admitted to the Bars of Ohio, Kentucky and Florida, as well as multiple federal courts throughout the country, including the United States Supreme Court.

 

INTRODUCTION

Dr. Frank R. Recker was the lead attorney representing plaintiffs American Society of Dentist Anesthesiologists (ASDA), American Academy of Implant Dentistry (AAID), American Academy of Oral Medicine (AAOM), and the American Academy of Orofacial Pain (AAOP) in the recent case against the Texas State Board of Dental Examiners (TSBDE) and Texas Society of Oral and Maxillofacial Surgeons (TSMOFS). Federal District Judge Sam Sparks ruled in favor of plaintiffs, in US District Court for the Western District of Texas, Austin Division (case no. A-14-CA-191-SS). Plaintiffs have a Constitutional right of commercial free speech. Judge Sparks’ ruling of January 21, 2016 can be accessed at this link: http://images.magnetmail.net/images/clients/AAID/attach/TEXAS_JAN_21_16.pdf

 

INTERVIEW

Dr. Davis:  Dr. Recker, I want to thank you for taking the time and effort to discuss with our readers, the merits and potential implications of this landmark case. As a former attorney/dentist member for the Ohio State Dental Board and also a practicing dentist, I know you place the public interest in a paramount position. How does Judge Sparks’ ruling positively impact the public welfare? How will the public benefit?

Dr. Recker:  The public benefits by having access to more truthful information about a dentist’s skill, knowledge and experience, which are reflected in certain credentials earned in various areas of dentistry. The Court recognized this, saw that the organizational plaintiffs were credible, bona fide and deemed worthy of holding themselves out as specialty organizations with the individual dentist/plaintiffs being entitled to hold themselves out as ‘specialists’ in their respective areas. Every practicing dentist understands that turf wars exist between various ADA recognized specialties. The regulation at issue protected ADA specialties, not the public.

You recall that the AAP came very close to changing its organizational name to include ‘Implant Dentistry.’ So you see an ADA recognized specialty nearly abandoning an underlying precept of the ADA specialty recognition process and attempting to falsely imply to the public that implant dentistry is an ADA recognized specialty, and a ‘subpart’ of the AAP. AAOMS also advertises as the ‘specialists’ in implant dentistry. These are misleading statements to the public, and made solely upon their respective opinions, and economics. There is no ADA specialty in implant dentistry, and implying so doesn’t change that reality and only risks confusing consumers.

There simply is no ADA recognized specialty in Implant Dentistry, Oral Facial Pain, Oral Medicine, and Dental Anesthesia. The public would clearly benefit if they knew that these specialties exist, but not recognized by the ADA.pull quote

As dentists who have been members of the ADA for many years, when we think ‘specialty’ we are conditioned to only think of the ADA. We don’t consider the fact that the ADA is a political body and its ‘Specialty’ decisions are ripe with considerations that should be excluded, such as competition, economic effects, and dental politics. The ADA specialty recognition process is effectively ‘dead.’ No other group will seek specialty recognition and be subject to such a process. There was a time, perhaps, that it made sense. But much has changed since the 1950’s, and the ADA House of Delegates made that painfully clear when it considered Anesthesia as a recognized specialty in October 2012.

Moreover, many potential ‘specialty’ areas of dentistry could never comport with the ADA requirements for ADA recognition. These areas include special needs dentistry, geriatric dentistry, cosmetic dentistry, forensic dentistry, and other focused areas that consist of real ‘specialists’ in those segments. Indeed, even a Board Certified (ABGD) general dentist might deserve the title (albeit perhaps a politically incorrect moniker) ‘specialist in general dentistry.’

 

Dr. Davis:  Numbers of doctors have expressed their concerns over this federal court decision. Some believe state dental boards have lost an ability to effectively regulate the practice of dentistry. Others fear any dentist who takes a weekend educational course at a Holiday Inn, may then be able to advertise a specialty status. Thus, dental specialty standing will have little to no meaning for the public. Can you address some of these concerns?

Dr. Recker:  First, there is no evidence that ‘dental specialty standing’ means anything to the public. When taking depositions of survey ‘experts,’ they give their own opinion (not having a clue about what an ‘ADA recognized specialty’ is or how it comes to be) that a ‘specialist’ in any area of endeavor is someone who has acquired additional education, training and experience in a specific topic or area. That is indeed a very true answer. When Courts declare the sole reliance on an ADA specialty for advertising purposes to be unconstitutional, it will not specify what a constitutional option might be. It cannot legislate a ‘fix.’ But based on the cases over the past 15 years, a ‘bogus’ credential or certification could not meet judicial opinions as to ‘bona fide’ and ‘legitimate.’

I try to tell my American Board of Dental Specialties (AADB) colleagues that a board ALWAYS has the right and the power to determine such a bogus credential as inherently misleading, because it has no underlying rigorous, objectively verifiable criteria upon which to deem itself a specialty credential. While a dental board may not be able to define ‘pornography,’ it will know it when it sees it, i.e., ‘specialist in cosmetic dentistry’ based upon a week long course provided by a company that produces veneers, etc.

 

Dr. Davis: Some dentists have expressed their frustrations over what may viewed as unfair insider influence, at American Dental Association (ADA) House of Delegates (HoD) meetings. Organizations petitioning for ADA specialty standing and fully meeting the standards of specialty status (via the ADA’s Commission on Dental Accreditation or CODA) have met with roadblocks. In the case of the specialty of dental anesthesiology, insider groups have stymied attempts at specialty standing for over three decades. Obviously, your clients must feel exasperated by entities which place protection of economic turf foremost. The recently formed American Board of Dental Specialties (ABDS) seems a response to this obstructionism. http://dentalspecialties.org/about-the-abds/

Dr. Recker:  I do see this point in the evolution of dental specialties as one that clearly offers the opportunity for advancement in training, education and experience in all non-ADA recognized specialties and for developing a fair and objective alternative for determining dental specialties. The ABDS (American Board of Dental Specialties) was formed to model the ABMS medical model. It is intended to be a joint cooperative between an independent entity (ABDS) and, hopefully, organized dentistry (ADA). The decisions of the ABDS relative to specialties will not consider competition, political issues, or turf wars. It will not be a decision made by a group of competitors who could be economically or politically affected by their own decisions. While such a statement is not intended to be critical of the ADA specialty recognition process, it is a simple reality.

While the four organizational clients in the Texas litigation have been critical of the ADA process, they simply came to realize that the ADA process is the ADA, trade association, process. If you don’t like the game, don’t play it. From a constitutional standpoint, the ADA can do whatever it wants relative to being deemed an ‘ADA recognized specialty.’ But when it comes to simultaneously deciding (by state adoption of only ADA specialties in advertising) the commercial free speech rights of dentists who may not even be members of the ADA, the First Amendment will intervene.

 

Dr. Davis:  In my reading of Judge Sparks’ ruling, and in particular the deposition of the TSBDE executive director, I was taken aback by an unwillingness or inability of state regulators to place the public interest to the fore. Defendants didn’t seem to make a case beyond a blind obedience to ADA rules and protocol. Please comment, Dr. Recker.

Dr. Recker:  The State Board of Texas couldn’t produce even one consumer complaint about dental advertising, of any kind. However, they did produce multiple complaints by dentists against other dentists! The Board did not concern itself with what might actually benefit the public, or assist the public in making informed choices. Just look at the dental anesthesia observation made by the Court.

A dentist/anesthesiologist in Texas was allowed to announce a practice concentration or limitation to dental anesthesia, but only if ‘General Dentist’ was included in the ad. That nonsensical requirement is hardly calculated to prevent the public from being ‘mislead,’ as opposed to protecting segments of the dental profession who want to monopolize the provision of general anesthesia services with the ‘help’ of the Board of Dentistry. Perhaps state boards will become more sophisticated and objective as a result of the FTC v NC Board decision. But I think it will take time for the average dentist to absorb developments in the law, and how their traditional thinking needs to evolve with the law.

 

Clearly, as the depositions indicated, members of the Board don’t know the details of the ADA specialty process. And interest into how that process works should be paramount to any dental board member before they limit the advertising by licensees to only ‘ADA recognized specialties.’ If they simply wanted to gain an insight into that process, they need only read the transcript of the 2012 HOD discussion of anesthesia’s application for specialty recognition. And in this age of obvious FTC scrutiny, I am amazed that there hasn’t been an antitrust challenge yet. But my concern is simply the First Amendment, and it provides sufficient protection to ‘unlock’ a state’s total deference to the ADA as the exclusive means to announce

 

Dr. Davis: I realize this case was adjudicated in federal district court in Texas. Other states like Florida and California have had similar judgements. Do you believe there will be protracted legal battles in numbers of future courts, or the will the ADA House of Delegates step-up and take more reasonable measures towards specialty acknowledgements?

Dr. Recker:  I am very hopeful that the ADA will acquiesce to the realities of the legal arena. That could result in ADA participation in the ABDS process. The ABDS is also hopeful that the ADA recognized specialties apply for ABDS recognition. A court would not challenge a state law that allowed specialists, recognized as such by the ADA or the ABDS, to advertise as specialists. Only when a law limits or prohibits commercial free speech will it be challenged. I would hope that protracted legal battles could be avoided by constructive dialog among the interested stakeholders in this issue. Ultimately, the ADA House of Delegates will need to decide if they want to work with the ABDS, or continue to resist any designation of specialty that is not their own. If states decide to continue to adhere to only ADA specialties, more states will pay more money in defending such a position. As we know, the States of California and Florida paid almost two million dollars collectively in their unsuccessful attempts to limit specialty recognition to only ADA determinations.

 

CONCLUSION

Dr. Davis: Dr. Recker, this has been a very detailed and highly insightful discussion. I realize legal issues in dentistry may seem overly complicated and “in the weeds”. However, it’s positive to see these matters fully open in the light of day. We all benefit from transparency in the process. I know numbers of readers may wish to contact you on matters relating to dental law.

Dr. Recker:  I feel strongly that any dentist wishing to learn about these issues should carefully read several relevant court decisions that explain the legal rationale underlying past First Amendment challenges about advertising credentials, and specialties. And, as a Life Member of the ADA, I completely understand a dentist’s ‘mother and apple pie’ allegiance to the ADA. But I also feel that diverting the specialty process to an independent outside entity will enhance, and prolong, ‘mother’s’ quality of life!

To that end, I would be happy to communicate with any person or group about these issues, via email or phone, time permitting. Recker@ddslaw.com; 800-224-3529.

Related:

Supreme Court of the United States Opinion - North Carolina State Board of Dental Examiners v Federal Trade Commission.

Sunday, January 31, 2016

Attorney James R. Moriarty Responds to CRIME WATCH DAILEY: Pediatric dentist accused of mistreating young patients

For 6 years I have attempted to stop what I consider to be highly abusive dental mistreatment of our youngest and most vulnerable children, mostly without significant success. 

Dental abuse ranging from lying to the moms, pulling teeth without pain relief, grossly excessive use of stainless steel caps, unnecessary baby root canals and widespread use of physical restraint devices on infants as young as 18 months. 

For reasons I cannot comprehend, many of the honest and legitimate dentists sit silently, the dental boards responsible for policing dentist do nothing and most of the criminal and civil state authorities charged with protecting the public, and the taxpayers do little or nothing.  

I can identify hundreds of dental offices secretly and illegally owned by private equity firms ranging from the money behind the propane gas we use to cook on in the back yard, billionaires from the middle east and even the husband and wife who started one of the largest computer companies in the world.  

I've complained at every level of county and state government and produced evidence to show this illegal and abusive conduct.  All almost for naught.

One 27 year old Medicaid mom, severely pissed off by the visible and obvious abusive treatment of her daughter single handedly brought this guy down.  Turned down by the police, ignored by the dental board and refused by lawyers who she sought to hire to stop this behavior, she turned to Facebook and the court of public opinion and then the stuff hit the fan. 

My hat is off to this mom.  She has done more to protect the public than legions of trial lawyers, endless numbers of state and local authorities and every sit-on-their hands dental board in the country.

My hat is also off to John Phillips, a brilliant, aggressive young lawyer who does not tremble at the thought of fighting  mano on mano in the court of public opinion. 
 


​Please watch this 15 minute video (3 segments):​


 


http://crimewatchdaily.com/2016/01/25/pediatric-dentist-accused-of-mistreating-hundreds-of-his-young-patients/


 
Law offices of James R. Moriarty
4119 Montrose, Suite 250
Houston, TX 77006

(713) 528-0700 office
(713) 528-1390 FAX
(713) 857-1212 cell
jim@moriarty.com
moriarty.com

Tuesday, January 12, 2016

Contrasting Dental Medicaid Enforcement: Florida versus Texas


Dr. Michael W. Davis


Contrasting Dental Medicaid Enforcement: Florida versus Texas
By: Michael W. Davis, DDS

Dr. Michael W. Davis maintains a general dental practice in Santa Fe, NM. He serves as chairperson for Santa Fe District Dental Society Peer-Review. Dr. Davis also provides a fair amount of dental expert legal work for attorneys. He may be contacted via email: MWDavisDDS@comcast.net




Introduction
Both Florida and Texas share similarities in that both states have long standing Republican state legislatures, state attorney generals, and state governors. Likewise, both states enjoy highly diverse ethnic and economic population demographics. However, each state handles enforcement of dental Medicaid very differently.

Dental Medicaid fee schedule rates in Texas are some of the highest nationally, while Florida’s are at or near the bottom.1,2,3 Texas has attracted a huge bevy of corporate dental chain Medicaid providers, headquartered both in-state and out-of-state. Florida has a paucity of such interstate dental Medicaid corporate providers.

Although dental Medicaid fee schedule payouts are substantially higher in Texas, both states’ fee schedules fall below the UCR (usual and customary rates) of the average insurance company. With dental Medicaid remunerations below the overhead costs of most private dental practices, only a minority of licensed dentists sign on as Medicaid providers. Those doctors who obtain Medicaid credentialing generally do so to serve a limited number of patients on a charity basis, or work in the public sector. There are some disturbing exceptions.

There are a minority of “outlier” dentists whose goal is to scam the Medicaid program, and make little effort to cover their tracks.4-7 Added to this number are many more devious Medicaid fraudsters, in which only skilled dentist auditors can identify.

Florida dental regulatory authorities have been quicker to turn over cases of suspected Medicaid fraud and abuses to their state’s attorney general’s office. This has occurred far less frequently in Texas, despite Texas being a far more populous state with far greater numbers of dental Medicaid providers.

Extent and Examination of Dental Medicaid Fraud and Abuses
We’ve already learned from the recent limited examination (four states) by federal Health and Human Services- Office of Inspector General (HHS-OIG), that approximately 9-11% of dental Medicaid providers are grossly over-the-top in abusive Medicaid billings.4-7 These specific providers are termed “outliers”. Depending on the state reviewed, one-third to 50% is employed by large group practices (primarily corporate dental chains called “dental support organizations”, “DSOs”). One must remember, these are the worst of the Medicaid program violators, and not the majority with scams designed to “fly under the radar”. Outliers only represent the easy to identify, low hanging fruit.

Typically the cleverer Medicaid fraudsters (non-outlier cheats) upcode Medicaid services or provide gross over-treatment, which isn’t discovered as easily by a HHS-OIG audit.8 One common fraud technique is upcoding of dental sealants on permanent teeth, to multiple surface posterior resin restorations.9 Others place multiple steel crowns on deciduous (baby) teeth, which have minimal to no evidence of dental decay, or are soon to naturally exfoliate (naturally come out).10,11  Another favorite dental Medicaid scam has been the service of a pulpotomy on deciduous teeth (baby tooth root canal), into teeth with little caries (tooth decay) near the tooth’s nerve.12-14 In fact, the author has specifically heard this referenced as a “preventative pulpotomy”, in interviews with former corporate dental employees. Of course, the bitter cynicism and avarice towards the patient’s welfare by this terminology of “preventative pulpotomy” shouldn’t be lost on the dental profession, auditors, or the general public.
­­­­­­­
Perhaps unique to Texas, we saw an entrenched old-boy element of the dental profession work to alter and amend standard accepted dental terminology, to expand Medicaid eligibility. Texas Medicaid orthodontics (corrective movement of teeth) eligibility required “ectopically erupted teeth”. Insiders simply changed the Medicaid definition of “ectopically erupted tooth” from the dental industry standard definition, to include any tooth which may be malpositioned, angled, tipped, slightly rotated, etc.15  These schemers circumvented the intent of the law, and lined their pockets either through providing direct Medicaid services or for-profit courses to dentists, on how to beat the system.16

An additional component of Texas dental Medicaid fraud-by-design was Medicaid payments not for completion of an orthodontic case, but for payments on a per-visit basis. Obviously, financial incentive was established to continually yo-yo patients in active treatment, in and out of a dental office. No consideration was afforded to transportation challenges for disadvantaged children. Further, there was a serious disincentive to complete orthodontic treatment in a timely manner, in the patient’s best interest. In the years 2009-2011 Medicaid orthodontic payments in Texas outstripped the payments for all other 49 states combined.17

Texas declined to provide dental Medicaid oversight and monitoring on the state level, and delegated this responsibility (for a significant fee to the taxpayer) to the highly discredited Xerox Corporation.18,19  The federal HHS-OIG agreed with Texas, that Xerox failed in their contractual obligations of dental Medicaid oversight. However, the federal Inspector General stated the State of Texas is ultimately responsible for the disturbingly remiss oversight.20

In fact, services of Xerox were so egregiously lax, that’s it’s difficult to see this as anything other than political pay-to-play. All the while, dental Medicaid fraudsters, both large and small were free to ply their trade in fraud-craft. Texas state authorities provided the illusionary mantle of oversight via a wasteful model of collusion, with big business/big government crony capitalism.

The most common Medicaid unlawful scheme of non-profit dental clinics (federally qualified health centers or FQHCs) is via abuse of “patient encounters”.21 To date, we’ve only see this frequent Medicaid scam addressed by government regulators to much extent in Washington and New York.22,23  This particular abuse of taxpayer money is a favorite with certain public health clinics, Native American title 638 clinics, and non-profit healthcare facilities. Generally we don’t see rank-and-file healthcare providers managing this particular fraud mechanism. Usually fraud is generated though the unlawful systems of directors and managers (some are physicians and dentists), who enjoy very inflated salaries and benefits, by cheating programs designed to serve the disadvantaged.

To its credit in Texas, the non-profit United Medical Centers Board of Directors (Maverick, Kinney, and Val Verde Counties) recently terminated employment of their Chief Executive Officer and Medical Director after an internal investigative audit.24 Unfortunately, I expect another miracle from the waters of Lourdes, before I anticipate Texas authorities to file a civil or criminal case against these Medicaid cheats within the public sector.

One would like to assume nonprofit organizations are distanced from scamming taxpayers. However, that assumption has proven inaccurate and very dangerous. Schemes defrauding the dental Medicaid program are highly pervasive, lucrative, and relatively easy to pull off. Dental Medicaid fraud and abuses are ubiquitous both in the private and public sectors. The largess which comes to those who defraud American taxpayers from dental Medicaid scams has in fact become an entrenched and fully accepted dental industry model of business.  

Handling and Mishandling of Dental Medicaid Cases
Both Texas and Florida have historically operated under a failed enforcement model of “pay and chase”.25,26 Medicaid payments are made to providers (or their corporate beneficial owners, usually DSOs) year after year without question or examination. If an audit is eventually generated, it then becomes a massive records undertaking. Government regulators usually lack funds to retain meaningful dentist auditors, to thoroughly review patient records and billings. Behind the 8-ball, government prosecutors nearly always settle cases for pennies on the dollar, and no admission of wrong-doing by violators.

By contrast, the dental insurance industry mandates pre-authorizations prior to a provider billing for a vast number of patient services. Questionable services and payments are better “nipped in the bud”. Payments are better held in check, not as easily getting out of hand.

Payment holds from the private insurance industry generally are upfront from the onset, on an individual case-by-case basis. By contrast, Medicaid payment holds are usually well down the road, and may represent many hundreds of thousands of dollars or even several million dollars. Medicaid payment holds are formulated by deviations in billings, which are assumed to represent patterns of fraud and abuse. Obviously, a long-term pattern of abusive billings must be established, prior to control of taxpayer (public) monies. Private insurance companies, which have their own set of difficulties, rarely allow fiscal problems to build to this crisis level.


Texas
Dr. Tuan "Terry" Truong
The government’s prosecution of Dr. Tuan “Terry” Truong is a case worth examination.27 Dr. Truong was employed by Kool Smiles Dental in Abilene, Texas, for over a year. After conviction for Medicaid fraud, Dr. Truong was fined and sentenced to federal prison for 18-months. The statement released by Kool Smiles Dental acknowledged their full cooperation with the government’s investigation and prosecution. Yet, Kool Smiles Dental monitors daily production metrics for each of their dentist providers. It seems inconceivable, corporate management didn’t fully realize the inappropriate and unlawful activities of Dr. Truong at a very early stage. Yet, government prosecutors were very willing to accept a low level dentist Medicaid cheat for a guaranteed felony conviction, versus those pulling the strings at higher levels. One is left to wonder what real rats could be convicted, if Dr. Truong were offered a deal to finger corporate management at the DSO level, or even private equity level.

Former Texas Attorney General (today Governor) Greg Abbott gave much ballyhoo to his settlement deal with alleged dental Medicaid fraudster, Dr. Richard Malouf for $1.2 million dollars.28 This settlement only represented pennies on the dollar for the true extent of the alleged fraud (many $10s of millions of dollars). Naturally, there was no admission of wrong-doing by Dr. Malouf, former owner of All Smiles Dental. 

Thursday, January 07, 2016

I found this ad found on Craig’s List; posted January 6, 2016.  My first thought is Reachout Healthcare America until I read the "Non For Profit". 

Thursday, December 10, 2015

The Smile Center–San Antonio Settlement Reached

December 10, 2015 By Patrick Danner

The last of the one-time Smile Center dentists accused in lawsuits of performing “unnecessary” or “excessive” treatments on minors that were then billed to Medicaid have settled the cases. Four dentists this week reached confidential settlements with some 100 patients who had filed medical malpractice claims in Bexar County. “Since 2011, we have filed several lawsuits on behalf of more than 250 children against the Smile Center or former dentists of the Smile Center,” San Antonio attorney Thomas Crosley said. “With this court approval of these last five lawsuits against former Smile Center dentists, we now bring to a close these tragic cases.” He added the cases were settled “to the mutual satisfaction of all parties concerned.” The Smile Center gained notoriety four years ago when WOAI-TV aired a series of stories on the chain of six dental offices. Some of the stories included parents who complained about dental procedures that allegedly left their children in pain.

Read the rest of the story here 

Read one of the Lawsuits here.

_______________________________________________________


 

Tuesday, December 01, 2015

Astroturfing by the Dental Support Organization Industry

clip_image002Dr. Michael W. Davis maintains a general dental practice in Santa Fe, NM. He serves as chairperson for Santa Fe District Dental Society Peer-Review. Dr. Davis also provides a fair amount of dental expert legal work for attorneys. He may be contacted via email: MWDavisDDS@comcast.net

 

“Astroturfing is the practice of masking the sponsors of a message or organization (e.g., political, advertising, religious or public relations) to make it appear as though it originates from and is supported by grassroots participant(s).”1. -Wikipedia

Introduction
It is imperative the so-called “dental support organization industry” (DSO industry) employ astroturfing techniques, as their entire business model is formulated on gross misrepresentations.2-12 In order to obfuscate the rule of law relating to the unlicensed and unlawful practice of dentistry, these corporate entities must misrepresent themselves as only providing limited nonclinical support services for their chains of dental practices. This is patently false, and has been challenged by numbers of legal rulings and studies. In reality, DSOs either represent the true beneficial owners and clinical management for vast numbers of dental clinics, or they provide management for the private equity beneficial ownership. Doctors only serve in a limited role as façade nominee owners. The word “support” is intentionally designed to deceive. The lies go on.

Forms of DSO Astroturfing
There are four basic designs of astroturfing utilized by the DSO industry. At the most basic level is DSOs placing bogus positive patient reviews with online rating services or their website. The next astroturfing technique involves individual dentists who openly advocate for the DSO industry. The third method employs hired public relations and public advocacy specialists. The final level, and often most challenging to prove, is hired lobbyists who direct public policy through directly influencing government agencies and government elected officials.

Bogus online Patient Reviews
Although this form of deceptive advertising is unlawful, violators are rarely discovered or sanctioned.13 The DSO utilizes existing employees or a retained service to generate positive patient reviews for dental services with online review sites, and/or their own website. Often the specific language utilized in the review is a tip-off, that the bogus reviewer is truly not a clinical dental patient, but working in the dental field.

Certain DSOs have such a disturbingly high degree of employee turnover and negative staff retention rates, they now resort to posting bogus positive reviews of current or former employees on employment websites such as Glassdoor.com and Indeed.com. One will generally see multiple low rated “one-star” reviews, intermixed with over-the-top glowing “five-star” reviews. Obviously, corporate astroturfing is in play.

Individual Dentists Espousing the DSO Agenda
On occasion, state legislatures will take up the cause of regulating and restricting the DSO industry to benefit the public interest. Bills will be presented to establish enhanced transparency in true beneficial clinic ownership. Clarification will be added to protect the doctor/patient relationship (contract), and patient rights such as the informed consent process, and always holding the patient’s interests paramount in clinical decisions. Truth in advertising and lending will be advocated. Mechanisms for bait-and-switch schemes will be discouraged.

Thursday, November 19, 2015

Cleaning up DSO's is Essential to Increasing Access to Dental Care for Low-Income Children

“…For most Americans, going to the dentist isn't at the top of the list of things we want to do, but we go anyway, because dental care is necessary for our health and well-being. However, many of the poorest children in America don't have the luxury of dreading a trip to the dentist.

According to the Centers for Medicare and Medicaid Services (CMS), 43 million children in the U.S., including half of all low-income children, receive health coverage through Medicaid. This coverage includes dental services as part of the Early and Periodic Screening, Diagnostic, and Treatment benefit.

“…While the DSO model has been successful, there remain areas of concern. A 2012 joint investigation by PBS's Frontline and the Center for Public Integrity (CPI) uncovered the questionable practices of some DSO's that raise red flags with state Medicaid officials.

The piece did, however, hold up one particular DSO as an ideal model that is "showing hope." Sarrell Dental, a nonprofit dental practice with 17 locations throughout Alabama, received a glowing review. However, some unsettling changes have occurred at Sarrell Dental since that Frontline broadcast.

In 2013, Sarrell Dental was acquired by Massachusetts-based DentaQuest. DentaQuest's President of Care delivery is Todd Cruse, who previously ran a company called FORBA Holdings LLC, a dental management company that provides business management and administrative services to 69 clinics nationwide known as "Small Smiles Centers."

Read the entire piece at Huffington Post