Tuesday, September 02, 2014

CSHM still up and running, business as usual

Linda Zoeller at CSHM in Nashville still has a job and still filing questionable legal documents for Small Smiles, now known as (file in the blank) Youth Dentistry.

This was filed just today in Colorado.

140902 Springs Smiles Youth Dentistry, PC

Thursday, August 28, 2014

Is Dr. Michael Tarver losing it again?

Has Dr. Michael Tarver lost it again? An email this week from a family member of a 4 year old little girl seems to indicate Dr. Tarver’s abusive behavior continues.

“She is very well behaved, obedient and we always receive compliments in public on this. He yelled at her stating things like "If you won't open your mouth I'll do it for you!" My sister (her mom) was forced out of the room and my niece later revealed she was strapped down. Every time she gets still enough to let her mind wander she recants it and cries saying "Mommy I can't believe they hurt me".

Whom do I hold responsible? The regulators! They had him by the private parts and gave his access to innocent children and Medicaid dollars to support his lifestyle.

The regulators and investigators:

It was just less than a year ago, on September 4, 2013 when the Florida Department of Health issued an Emergency Suspension of Licenses against Dr. Michael Addair Tarver. Several reports from parent about Dr. Tarver and his wife detailed the outrageous behavior including altering patient records and abusive treatment of young patients. Police have been called to his office on several occasions.

Excerpts from various reports at the time:

I remember the patient because she was so badly misbehaved. She ran down the hallway kicking and screaming at the dental staff.  I didn’t put my hands over her mouth. The child had to be sedated due to her extremely poor behavior.”  Tarver was not charged, according to OPD, he had not committed any criminal offences.

“June 26, 2013 OPD received a complaint about a child that received a 1-1/2″ laceration in the middle of his forehead.  Tarver “claims” the child tripped over his own feet causing him to fall and hit his head. Tarver did not call EMS. When questioned by OPD Tarver said, “I am Emergency Medicine Certified, therefore I did not feel the need to contact EMS.” OPD notified DCF upon this investigation due to OPD being called out multiple times starting in June of 2012. The injury did require stitches.”

“In one incident a parent said that Tarver placed his hand over the nose and mouth of her child until the child lost consciousness.”

Florida State Attorney, Bill Gladson said his office was asked to investigate and said in an interview:

"Based on the evidence available, it was decided that no single allegation, if proven as alleged, would constitute the crime of child abuse such that any conviction could be sustained on appeal. This office did not review, and was not asked to review, any matter being investigated by the Department of Health or the Board of Dentistry,

Friday, August 22, 2014

Golly Gee..this is just shocking! NOT!

Anyone what to take a guess who the employs these unnamed dentists?  Kool Smiles and ReachOut have operations in Louisiana….just saying…

 

Feds look at Louisiana dentists for kids on Medicaid

By JANET McCONNAUGHEY

Associated Press August 20, 2014

NEW ORLEANS — About 5 percent of the Louisiana dentists treating children under Medicaid may be padding their numbers, overcharging, providing unnecessary treatments or even harming children, according to a federal study released Wednesday.

Auditors for the Department of Health and Human Services checked 512 dentists and 41 oral surgeons. Twenty-six dentists and one oral surgeon — paid a total of $12.4 million for pediatric dental work in 2012 — billed for extremely high numbers of children or amounts of money or showed other possible excesses, according to the report from department inspector general's office.

Some of the bills may be legitimate but they warrant scrutiny, said a copy of the report provided to The Associated Press before its general release.

"Some of these cases are pretty alarming," said Calder Lynch, chief of staff for Louisiana's Department of Health and Hospitals. He cited doctors with high numbers of fillings and "baby root canals," or pulpotomies. According to the report, one dentist billed for 31 procedures, including 13 pulpotomies, four fillings and 10 stainless steel crowns on one 3-year-old — all during the same visit.

Lynch said he believes many of the dentists described in the audit are among more than 20 his department is already investigating. It recently hired a second dental technician to go over records and will check all 27 people as soon as the federal department sends their names, he said.

That list was "still going through internal processes" Tuesday "but will most certainly be provided," Janna Raudenbush, spokeswoman for the Office of Inspector General, said in an email.

State Medicaid Director Ruth Kennedy wrote in a July 24 response included with the report that, as a result of the study, DHH hired Managed Care of North America on July 1. The company will manage dental benefits under Medicaid and the state's Bayou Health program — an insurance-based model that covers 900,000 of Louisiana's 1.4 million Medicaid recipients, mostly pregnant women and children.

The report said the 512 dentists averaged $264 per child, but six billed for more than $663 per child.

"These dentists received more than $2,000 per child for a total of 237 children," and one was paid $8,000 for work done on one child over three visits, the report said.

"Extremely high payments raise concerns about whether these dentists are billing for unnecessary services or services that they did not provide," the auditors wrote.

Overall, the dentists averaged 27 procedures such as cleaning, extraction or X-rays per day, but three billed Medicaid for 146 or more per day. One billed for 376 services in one day, the report said.

"If this dentist spent only 5 minutes performing each service, it would have taken over 31 hours to complete all these services," the auditors noted.

The auditors also checked on specific procedures, such as extractions, fillings, stainless steel crowns and pulpotomies. On the average, the dentists pulled out teeth from 11 percent of the children they saw, but six dentists extracted teeth from at least 40 percent of the children and one did so on 70 percent of the children he treated. Dentists who filled teeth did so for one-third of the children, but one did so for 92 percent.

The audit looked at Louisiana dentists and oral surgeons who billed Medicaid for at least 50 children in 2012.

One-third of the dentists worked for two dental chains, it said. The report did not identify the chains.

The DHHS report is the second in a series of state reports; the first found similar patterns in 23 of 719 dentists in New York State. That's about 3.1 percent.

The state reports are not being done in any particular order, Raudenbush wrote.

---

Online:

http://oig.hhs.gov/oei/reports/oei-02-14-00120.pdf

http://new.dhh.louisiana.gov/

Read more here: http://www.thestate.com/2014/08/20/3629464_feds-look-at-la-dentists-for-kids.html?rh=1#storylink=cpy

Two audit reports in 2 years… Hmmm…. So they should get this done in say… the 48 years!!! Unacceptable! 

Here is wherein a major flaw in reports fall… NO NAMES! That’s why the public doesn’t know the dangers of what lurks behind the doors and criminal keep setting up another shop! Aren’t investigators tired of chasing the same damn criminals!

Thursday, August 07, 2014

Dr. Michael Davis’ Series on Dental Scams- Parts I and II

 

Scams played on dentists: Part 1

By Michael W. Davis, DDS, DrBicuspid.com contributing writer

July 30, 2014 -- In a new three-part series, Michael W. Davis, DDS, details some of the ways dentists and dental offices are vulnerable to scams. This first part will introduce the series and discuss embezzlement and scams that are played on vulnerable employee dentists.

Dentists are played as marks for scams for several reasons. First, we are targeted because our earning potential is much higher than the general population. Traditionally, dentists have often operated in an isolationist bubble and often confer with colleagues on nonclinical matters only in unusual situations. The demanding focuses of the technical aspects of our profession often preclude us from closer examination of what may be obvious to others. We have blind spots. We are vulnerable.

Recently, courageous leaders in the dental profession such as Drs. Gordon and Rella Christensen have openly discussed embezzlement actions against them. These disclosures help dissolve any shame or guilt that other doctors/victims may carry. No one enjoys admitting they were scammed. However, open disclosures by victims help erode the smokescreen, which perpetrators depend on to pull off their scams.

Embezzlement

Embezzlement and employee theft against an owner/doctor can take many forms. The ADA estimates about a third of all dental offices will be or have been victims of embezzlement. Experts in systems management to prevent and investigate dental office embezzlement and fraud say estimates are greater than 50%. Regardless of the exact number, these risks are very real and potentially devastating to a dental practice.

The exact method of the scam can take on enough discussion to fill several volumes of books. In a common method, the office manager, who is generally valued and trusted beyond reason, pockets office receipts. These may be cash payments from patients that the office manager writes off.

Read the Rest of Part 1 on Dr. Bicuspid

 


 

Scams played on dentists: Part 2 -- Consultants and practice brokers

By Michael W. Davis, DDS, DrBicuspid.com contributing writer

August 6, 2014 -- In the second of a three-part series, Michael W. Davis, DDS, details some of the ways dentists and dental offices are vulnerable to scams. This part discusses unethical practice management consultants and practice brokers.

Who doesn't receive via email, fax, telephone, or mail a solicitation from a dental practice consultant on a weekly basis? As a young doctor, I saw many that would promise the "Million Dollar Practice." Today, those figures have grown to the $8 million, $10 million, or $12 million practice. The promises are ridiculously laughable. As the man once said, "If it seems too good to be true, it is."

A number of big-name consultants spend a great deal of time with legal actions brought forth from dissatisfied doctor clients. Using a boilerplate formula from a household name consultant has brought many a dental practice to bankruptcy or near bankruptcy. They may also have multiple endorsements from organized dentistry, which today is little more than paid advertising.

Simply because a consultant has exposure, with prolific publication of consulting articles, does not ensure his or her competency to manage the unique specifics of your dental office.

Here are some suggestions.

  1. Do a background check on former doctor clients who the consultant has served. Do they have philosophies and goals similar to yours? What were the specific objectives? Were goals met?

Read the Rest of Part II on Dr. Bicuspid

Sunday, August 03, 2014

Another Squabble with CSHM, Small Smiles Dental Centers and Owner Dentists—Small Smiles Reno—Who is extorting who?

I seldom tire of the spin found in legal pleading between owner dentists the illegal dental management companies such as CSHM but honestly it’s getting old.

Now that Dr. Jodi Kuhn purchased her clinics again and seems to have continued with business as usual in Colorado. Another turd has been thrown in the CSHM punchbowl by “owner dentist” Dr. James Mann in Reno, Nevada.  Dr. Mann was hired in October 2, 2006 and I’m positive he can be located as an employee of one of CSHM entities if someone looked.

 Dr. Mann filed suit against CSHM in May 2014.  The case was filed in Second Judicial District Court of the State of Nevada-Washoe County.  In like fashion, CSHM has filed a Complaint against Dr. Mann and Small Smiles Reno and asked for a Temporary Restraining Order. This was filed filed in Davidson County Tennessee Court on July 22, 2014.

In Dr. Mann’s lawsuit he claims he owns the Small Smiles clinic and is suddenly—after just shy of 8 years of employment—”concerned that CSHM’s heavy-handed control of Small Smiles is violating Nevada’s laws and regulations.”

I find It laughable that Dr. Mann is just now  “concerned”.  The public and government agencies have been concerned since 2004! How does Dr. Mann explain this?image

Mann claims despite all the name changes—FORBA, Church Street Health Management, CSHM, etc.— many of the same key employees have remained as has their illegal business practices.  (Well, of course, thorn is a thorn by any other name.)

Mann says, “CHSM has continued Church Street’s practices” and “Indeed, many of the personnel associated with Church Street continued to work for CSHM

He claims:

  • Dictated the hours that Dr. Mann and Small Smiles should be open for business.
  • Imposed pressure on Dr. Mann and Small Smiles to schedule more patients.
  • Decided which equipment Dr. Mann could purchase for Small Smiles
  • Insisted on certain dental procedures over others
  • Set. Dr. Mann’s compensation.

Here is a statement that raises HUGE red flags and give me great concern:

Monday, July 14, 2014

No Action taken against “Creepy” jury stalker, Attorney Scott Greenspan.

Somehow Greenspan thinks “no action” being taken translates to “complete exoneration”. Stop laughing!

Syracuse, NY -- A Manhattan lawyer accused of stalking an Onondaga County jury on behalf of insurance giant AIG won't face discipline by a court system panel, according to the New York Law Journal.

State Supreme Court Justice Deborah Karalunas threw out the verdict in a lawsuit against Small Smiles in November 2013 after ruling that lawyer Scott Greenspan had prejudiced the jury. The jury found no wrongdoing against the now-defunct dentistry accused of malpractice it its office on South Geddes Street.

Karalunas had described Greenspan's actions as 'creepy' and 'seedy' in her Nov. 18 decision.

But Greenspan called the decision by the court's disciplinary committee a "complete exoneration," the law journal reported. Greenspan said the accusations turned his professional career upside down. He's now looking for a new job.

Read entire article here

 

Related:

'Creepy' jury stalker hired by insurance giant AIG forces retrial in Syracuse dentistry malpractice case

Friday, July 04, 2014

Small Smiles guilty of abusing children, but jury awards nothing to injured children

By Douglass Dowty | ddowty@syracuse.com
Email the author | Follow on Twitter
on July 03, 2014 at 3:35 PM, updated July 03, 2014 at 3:44 PM

Syracuse, NY -- A Syracuse dentistry is guilty of malpractice and negligence in the care of four young patients, but will not have to pay the families for injuries, a state Supreme Court jury ruled.

That means that while Small Smiles mistreated patients at its South Geddes Street clinic, the injuries did not reach the threshold for compensation, said Richard Frankel, a Texas attorney who represented the patients' families.

The split verdict sets the tone for a huge backlog of lawsuits against Small Smiles. There are 30 other children statewide -- five more in Syracuse.

Complaints against Small Smiles date from 2005 to 2009. The Syracuse office closed in 2012 after the owner filed for bankruptcy.

Before the jury verdict, state Supreme Court Justice Deborah Karalunas ruled that Small Smiles violated state law as a dentistry by being owned by a corporation and not a dentist, Frankel said. …

Read Article Here

Monday, June 09, 2014

Settlement reached between “owner dentist” Jodi Kuhn and CSHM/Small Smiles Dental Centers

What that settlement is remains unknown. Here is the latest entry on the court docket, dated June 3, 2014.

ORDER: The court has been notified that this case has settled. It is hereby ORDERED that a stipulation of dismissal or other settlement document shall be filed within thirty (30) days of the entry of this Order.

The preliminary injunction hearing set for June 5, 2014, and the initial case management conference set for June 6, 2011, are CANCELLED.

Sunday, June 08, 2014

Revisiting 2009 MassHealth Independent Audit Report

Revisiting 2009 MassHealth Independent Audit Report; not much has changed.

  • Audit report for period July 2005 – May 2009
  • Dental Program claims processing system has resulted in millions of dollars in ineligible claims and potential fraudulent claims being paid.
  • Only 15.7% of radiograph claims met requirements.
  • 84.3% of radiographs (x-rays) by 10 providers (3 Small Smiles and 3 Kool Smiles) failed to meet requirements
  • Radiographs (X-rays) claims paid to 3 Small Smiles clinics and 3 Kool Smiles clinics totaling $3,09,172 were unallowable.
  • DentaQuest (f/k/a Doral Dental) Senior Dental Director stated providers “treat to the benefits allowed and not member’s need)
  • 3 Kool Smiles and 3 Small Smiles clinics routinely gave members bitewing radiographs contrary to FDA recommendations.
  • Small Smiles said in 2009 they implemented a new dental protocol that included the 2004 FDA recommendations.
  • DentaQuest contract required them to identify standards of care based on published recommendation of nationally recognized authorities such as the AAPD.
  • DentaQuest contract required it to monitor providers’ compliance with the AAPD guidelines.
  • MassHealth failure to adequately control orthodontic services resulting in $321,553 overpayment to just one provider.
  • DentaQuest failure to adequately monitor claims was widespread.
  • Many cases of double billing and double payments

MassHealth Dental Audit 2006-2009 by Dentist The Menace

Saturday, June 07, 2014

Remember Allcare Dental?

With corporate dentistry taking over the world, it’s good to remember Allcare who closed it’s doors overnight in January 2011 leaving patients without care or recourse, and dental boards scratching their..uh.…heads.

A class action lawsuit was filed and just like the Allcare’s doors, patients were left lock-jawed.

Allcare Dental Class Action Lawsuit

imageThe Allcare companies filed for bankruptcy in the Western District of New York (Buffalo), Bankruptcy Petition #: 1-11-13848-CLB.  Those proceedings terminated in 2013 with a report of no distribution.  As such, there are no available assets from these entities for unsecured creditors.

You may have individual claims.  Once the class action claims are dismissed, the statute of limitations for your claims will continue to run.  You should contact an individual attorney in your state if you desire individual representation.  Failure to file within the applicable statute of limitations will forever bar your claims.  We are not handling these claims given the no-distribution report.

http://www.allcaredentalclassaction.com/uploads/Allcare-Dental-Class-Action-Complaint-filed-2-7-2011.PDF

Allcare patient speaks about ordeal in 2012.

http://www.abc57.com/home/top-stories/ALLCARE-DENTAL--162156285.html

Saturday, May 31, 2014

Franchise or Ponzi Dental Scheme? — Comfort Dental

In an Affidavit filed this week in the Bahr brothers (CDMO & CDET) v. Rick Kushner and Comfort Dental lawsuit reveals the abuse and threats that reign down from Kushner and other Comfort Dental executives.

Louisville, Colorado Comfort Dental subfranchisees were berated, threatened and assessed $50,000 penalty for failing to use Budget Dental Lab dba Premier Dental Lab owned by Rick Kushner—owner of Comfort Dental, Inc.—and his brother, Barry Kushner, along with Roy Martin, C. Michael Bloss, Bruce Irick and Neil Norton.

“We would order an appliance from the non-Comfort Dental lab because quality was much higher and much more reliable.”

“In some cases costs were higher when using a non-Comfort Dental lab, but we felt it necessary to serve our patients’ best interest.”

“Comfort Dental assessed a $50,000b out-o-system lab referral penalty on us.”

“…after having been summoned by Rick Kushner, at a meeting at the Comfort Dental headquarters in Lakewood, CO… we (the partners of Louisville (CO) office were admonished by Rick Kushner and about the franchise violation, use of an outside lab. Immediately thereafter, Rick Kushner announced that a $50,000 fine was being imposed on our office/partnership. The entire sum due and payable in 2 weeks.”

Saturday, May 24, 2014

Florida Dentists, Dr. Miranda W. Smith-Smiles and Giggles Dentistry-Arrested Medicaid Fraud

One of Dr. Miranda Smith’s patient had perfect teeth, yet in Smith’s treatment plan she pulled every tooth and fit the patient with ill-fitting 140523 miranda smith-florida-medicaid frauddentures; a pattern said investigators.

Other’s were children, sedated, for dental treatment they didn’t need.

Her husband blames the whole mess on “two disgruntled and racist employees”. And says, “She’s been fighting this for three years, nine employees and their families are out of work because of this”.

 

Christopher Torres, her attorney, says many of the charges have been disproved on an “administrative level” and believes the criminal charges won’t hold up.

Apparently the Feds think otherwise and have a 21-page affidavit to back it up with $140,000 in Medicaid fraud charges.

It’s not the disgruntled employees that concern me, it’s the ones who are happy at their job working for dentists like these.

Smiles and Giggles Dentistry for Children and Adults is located in Spring Hill, Florida.

 

Florida AG Press Release:

imageAttorney General Pam Bondi News Release

May 23, 2014
Media Contact: Jenn Meale
Phone: (850) 245-0150

Attorney General Pam Bondi’s Medicaid Fraud Control Unit and the Pasco County Sheriff’s Office Arrest a Tampa Bay Dentist

TALLAHASSEE, Fla. –Attorney General Pam Bondi’s Medicaid Fraud Control Unit, with the assistance of the Pasco County Sheriff’s Office, arrested Pasco County Dentist Dr. Miranda Smith on charges of Medicaid Provider fraud.

Dr. Smith, owner of Smiles and Giggles Dentistry for Children and Adults in Pasco County, allegedly billed Florida’s Medicaid program more than $140,000 in dental services which were either unauthorized or not provided.

The Attorney General’s Medicaid Fraud Control Unit initiated its investigation of Smith and her dental practice after receiving complaints about suspicious billing from parents and patients. According to the investigation, Smith billed Medicaid for x-rays, anesthesia, and other dental procedures that were not performed. Additionally, former patients alleged that Smith’s employees provided dental care, even though these employees were not licensed dentists.

According to the investigation, at least one minor patient's parent was told her child had eight cavities and would need to be sedated to perform urgent dental work. The parent received a second opinion from a dentist with more than two decades of experience. The dentist performed her own examination and found that the child had no cavities.

Investigators also found that Dr. Smith and staff exhibited a pattern of pulling healthy teeth in an effort to sell patients dentures and make larger Medicaid claims.

Smith is being charged with two counts of Medicaid Fraud. If convicted, she could face up to 10 years in prison and up to $10,000 in fines. The Attorney General’s Office of Statewide Prosecution will prosecute this case.

The Florida Department of Health’s Board of Dentistry voted on May 16, 2014, to suspend the license of Miranda W. Smith, D.D.S., in case number 2011-12390. This suspension will become a Final Order of the board within the next few business days.

I couldn’t help but compare the two pictures above! LOL

Never mind…

Friday, May 23, 2014

Texas State Board of Dental Examiners take swift action!

For those who think the Texas State Board of Dental Examiners can’t take swift action, you are dead wrong.

Bryan, Texas creepy dentist and dental board member, Dr. William Reagan Birdwell was arrested Wednesday, May 21, 2014 after caught filming an employee changing in his office bathroom.

At  lightening speed the board took harsh action by removing any mention of him on their board member page.

So there!

Birdwell was appointed by Governor Rick Perry in 2009 for a term ending in 2015. I guess his term ended early.

Wednesday May 21, 2014 TSBDE Board Members

image

 

 

 

 

 

 

 

 

 

 

 

 

Two days later, poof, he’s gone!

image

Thursday, May 15, 2014

CSHM-Small Smiles Dental v. Jodi Kuhn: Kuhn Responds to Complaint

The Hearing scheduled for May 14, 2014 to hear arguments on the Temporary Restraining Order and Injunction was rescheduled until after June 5, 2014 apparently to allow time for discovery such as a deposition of Jodi Kuhn. (see Joint Motion to Reschedule)

(Waist high boots will not be nearly high enough; so I’m thinking a full diving getup will be needed.)

May 6, 2014 Kuhn filed her Response to CSHM’s Complaint, which I thought odd. Usually at least 2 extensions are asked for before those are ever filed.

Reading the Response will make your head spin, but don’t be alarmed. It’s suppose to make the judge’s head spin, and frankly after reading the Complaint and the Response my sympathy is with any judge who finds this mess on his docket.

I find the Complaint and Response something conjured up in a witch’s cauldron. Hardly a sentence in either has the actual truth of the matter at hand. I wonder how she squares up everything in her Response with the clinics she has her name slapped all over in Ohio and Kentucky. (you will see what I mean when you read it) .

If Kuhn’s lies hold, then every clinic is up for grabs in more than just Small Smiles!

She goes into great depth about how CSHM was the one Excluded from Medicaid and not her Colorado clinics. She even attaches the Joint Report by Senators Baucus and Grassley, talking about what terrible treatment children receive at Small Smiles clinics.

Since she contends HHS-OIG has serious problems with CSHM, and not Small Smiles clinics, I wonder why the clinics, staff and treatment received at the clinics were under such scrutiny; CSHM wasn’t treating these sweet children.

Anyone think HHS-OIG had problems with the way Kuhn’s paycheck was being printed or something? Further she didn’t mind one bit to hand over every dime “her” clinics made to CSHM until the Exclusion was announced.

Frankly, I would have been pissed long before now they were taking all the money I was making straight out of my bank account. Plus, I’d be pissed they were still taking it out of my Ohio and Kentucky clinics. She doesn’t mention those clinics. Hmmm…. 

Doc 24 CSHM v Kuhn Response

Related Documents:

CSHM v Jodi Kuhn Complaint, April 21, 2014
CSHM v Jodi Kuhn Response, May 6, 2014
Thornton Small Smiles Purchase Agreement, May 6, 2014
Thornton Small Smiles Stock Pledge Agreement, May 6, 2014
Joint Motion To Reschedule TRO Hearing, May 12, 2014

Tuesday, May 13, 2014

Dental Group Practice Association changing it’s name to Association of Dental Support Organizations

What’s in a name? A brand.

Anyone besides me think the DGPA has gotten such a bad reputation over recent years, it needed a name change? Does it matter? Not really. They are who they are, not matter what they call themselves.

“Association of Dental Support Organizations” Unveiled as New Trade Association Name

(May 13, 2014) – NAME CHANGE REFLECTS EVOLUTION IN THE DENTAL PROFESSION AND ASSOCIATION’S FOCUS

DENVER, May 13, 2014The Dental Group Practice Association (DGPA), a nonprofit industry association representing more than 30 dental support organizations (DSOs), announced today that the organization has changed its name to the Association of Dental Support Organizations (ADSO).

“It’s important that our organization’s name clearly reflects our mission to support DSOs and all they do to ensure the delivery of innovative, high quality and cost effective care,” said Dr. Quinn Dufurrena, Executive Director of ADSO. “Our mission is to provide world-class business and technology support services to dentists, a partnership that lets dentists focus on what they do best, which is serving their patients.”

Friday, May 09, 2014

Texas v. Xerox in connection with massive dental fraud in the state

 

FOR IMMEDIATE RELEASE
May 8, 2014
www.texasattorneygeneral.gov

State of Texas Files Legal Action to Recover Fraudulent Medicaid Payments from Xerox

State of Texas Files Legal Action to Recover Fraudulent Medicaid Payments from Xerox

AUSTIN – The Texas Attorney General’s Office today filed a civil lawsuit in state district court against Xerox Corporation and its wholly owned subsidiary, ACS State Healthcare LLC. The State’s legal action seeks to recover fraudulent Medicaid payments for orthodontic and dental services that were improperly approved by Xerox.

Since 2003, Xerox has served as the vendor responsible for reviewing dental and orthodontic claims submitted to the Medicaid program. Under state law, orthodontic services are not generally eligible for coverage under the Medicaid program. Only the most acute cases where orthodontic disfigurement poses a health risk to a patient are eligible for Medicaid coverage; the Medicaid program does not cover cosmetic orthodontics. The State’s lawsuit seeks to recover Medicaid payments that Xerox approved for orthodontic services that were not medically necessary and therefore not authorized by law.

Texas Attorney General's lawsuit against Xerox Corporation and ACS State Healthcare LLC

Today’s legal action reflects the culmination of a lengthy multi-agency investigation into orthodontic Medicaid fraud. In June of 2012, the Attorney General’s Office, together with the Texas Health & Human Services Commission (HHSC) and the HHSC-Office of Inspector General formed a dental and orthodontic fraud task force to investigate fraudulent overbilling by dental and orthodontic Medicaid providers. One of the results of the task force’s investigation was the discovery that Xerox had not been properly reviewing orthodontic claims as required by its contract with the State. Further, the task force uncovered evidence revealing that Xerox systemically approved orthodontic claims that were not authorized by state law.

The State’s law enforcement action is seeking injunctive relief, civil penalties and restitution of overpayments made by the Medicaid program as a result of Xerox’s unlawful conduct.

CONTACT
Press Office at
(512) 463-2050

Partners Uncomfortable at Comfort Dental; patients caught in the crossfire.

In an article on Dentaltown, dated October 2012 Comfort Dental founder, Rick Kushner said: -

“Corporate dentistry scares the hell out of me for two reasons: first, whether they get their money from the public or from private equity, corporate dentistry will always have only one priority: demonstrate more profit. (By the way, Comfort Dental has only one original money source: me. Oh and a couple of local banks. Of course, every single Comfort partner is equity invested in his/her own Comfort partnership.) And secondly, as a dental “chain” we are unfairly lumped together with corporate dentistry by ignorant dentists including DSIs (dental school instructors) and of course, some patients. Structurally and philosophically we at Comfort are as far from corporate dentistry as traditional private practice. Had the profession listened to me instead of attacked me over the past few decades, the professional landscape would be saturated with Lean & Mean group type practices so prosperous that there would have been neither need nor room for corporate dentistry. So again, how did corporate dentistry happen? It’s dentists’ fault. It’s DSIs (dental school instructors) fault. It’s not my fault; it’s their fault. Dental practices were so bad for so long with their 80 percent overheads and their hygiene-heavy practices that businessmen in business suits looked at them and instinctively knew they could do better and keep the difference in profits. And guess what? They were right. Businessmen in business suits looked at dental practice and knew they could handle our business better than dentists. So they did. Not my fault. I warned dentists but they were smarter than me. Graduates laden with debt and corporate dentistry are a match made in heaven. “

I would agree with 90% of that statement.

However a Complaint filed March 25, 2014 in Colorado US District Court accuses Comfort Dental of “exerting excessive and improper control over medical decisions and judgment of dentists practicing in Missouri, Kentucky and Indiana” appears to indicate Comfort Dental is more “corporate” than Mr. Kushner likes to think. 

A Brief filed with the Compliant, seeing an Injunction against Comfort Dental  states:

“Comfort Dental’s illegal conduct exposes Plaintiffs to immediate and irreparable harm. Comfort Dental’s demands that the Plaintiffs participate in the MLRP (Mandatory Lab Referral Program) and sell the Gold Plan (unregistered discount medical plan) force Plaintiffs to make an impossible choice: lose their 25 year franchise or violate the laws of multiple jurisdictions.…it impermissibly interferes with, and exerts control over, dentists’ independent medical judgment and forces Comfort Dental dentists to place the financial interests of Comfort Dental’ s owners over the best interest of their dental patients…threatens irreparable harm by threatening to terminate Plaintiff’s franchise, and by demanding that they engage in potently illegal conduct which could expose them to penalties, professional licensure actions and damage to their patients relationships and reputations. “

I read this to say, instead of dentists being fired, their Subfranchisee Agreement can be terminated without notice or opportunity to correct problems that may arise.This sounds a whole lot like more like “corporate dentistry” than independent franchise owners to me. As always I could be wrong.

However, before getting into what meticulously laid out in the Complaint and other pleadings, you need to know the players:

Thursday, May 08, 2014

Dr. Li Lou Skelton aka Dr. Li Lou, 7 pending malpractice suits in Texas

Dr. Li Lou Skelton, current dental license status is Active/Probation.

Agreed Settlement Order that began in June 2008; all related to Dr. Skelton’s dental treatment of 8 patients fell below the acceptable standard of care on  2004 and March 2008.

August 2010 Agreed Settlement Order dated August 2010, over substandard care of 17 additional patients. In addition to restitution to patients Skelton agreed to pay the Texas State Board of Dental Examiners $20,000 over the next 4 years in $5,000 installments.

Five Malpractices cases were filed against her in 2013 and between February and April of 2014, 3 additional cases have been filed.

This woman as 7 pending malpractice suits!!

Where is the Texas State Board of Dental Examiners?

 

  Case No. Date Filed Case Status
1 2011CI09803 06-14-2011 DISPOSED
2 2011CI15583 09-23-2011 DISPOSED
3 2013CI00047 01-02-2013 PENDING
4 2013CI05704 04-04-2013 DISPOSED
5 2013CI08156 05-14-2013 PENDING
6 2013CI08796 05-23-2013 PENDING
7 2013CI20502 12-18-2013 PENDING
8 2014CI02109 02-12-2014 PENDING
9 2014CI05424 04-03-2014 PENDING
10 2014CI05500 04-04-2014 PENDING
       
       
       
       
       

Saturday, May 03, 2014

Faulted in Medicaid Fraud, Company Keeps Contract

Faulted in Medicaid Fraud, Company Keeps Contract

The New York TimesFor nearly five years, a state contractor allowed workers with limited expertise to approve dental claims for Texas’ Medicaid program, the joint state-federal insurer. State spending on orthodontic services spiraled out of control; by 2012, federal and state auditors found that the contractor’s actions had opened the door for a “massive Medicaid fraud scheme” that cost taxpayers hundreds of millions of dollars.

More than two years later, Texas health officials have reeled in spending on Medicaid texas tribuneorthodontic services and pursued legal action against health care providers who billed for the services. But a Texas Tribune investigation found that while health officials have repeatedly raised concerns with the contractor, a Xerox subsidiary called the Texas Medicaid and Healthcare Partnership, they have not severed its multiyear contract worth hundreds of millions of dollars.

Critics accuse the state of dragging its feet because of the contractor’s political ties to Gov. Rick Perry, a claim the governor’s office says is not true.

Continue reading at New York Times

Read Texas Tribune Article Here - Company That OK's Unnecessary Braces Kept Its Contract


Related:

“Ho” Down in Texas – James W. Orr, DDS Testifies for Antoine Dental Center

Monday, April 28, 2014

Pop the corn, it’s show time! Let the battle of true ownership begin: CSHM sues one of their “owner dentists”

CSHM, LLC/Small Smiles Dental Centers/”fill in the blank” Youth Dental Center” was granted a Temporary Restraining Order against one of its fake “owner dentists” in US District Court last week.(April 25, 2014) The Order was granted after a Complaint was filed against Dr. Jodi Kuhn for allegedly breaching her various Management Service Agreements (MSA’s) with CSHM, LLC.

The Complaint states in January 2013 Dr. Jodi Kuhn Kuhn purchased 4 clinics in Colorado for $100 each from Randall W. Ellis, DDS—the prior fake owner dentist. Ellis purchased from Robert Andrus, DDS, the prior prior fake owner.

(That’s a damn good deal! But I don’t believe it to be true; not much of of anything in these documents is actually true. Kuhn’s name doesn’t’ appear until December 2013. If she purchased the clinics in January 2013, why is CSHM’s Linda Zoeller name still plaster all over the 2013 annual reports. After all Jodi did it herself in December of 2013.)

Thursday, April 17, 2014

How do the folks at Small Smiles-CSHM keep it all straight? A Rant.

How the people at CSHM keep it straight as to when they own the Small Smiles clinics and when they don’t is beyond me; since it always depends on who they are communicating as to whether they own them or not. Of course, the truth is they do own them, and Sen. Grassley’s report provided that evidence.

Church Street Health Management (CSHM) f/k/a FORBA had to divest in the Manassa, Virginia clinic in March of 2012. HHS-OIG sent them a Notice to Exclude. Here is the HHS-OIG agreement sent to Sheila Sawyer, General Counsel and Chief Administrative Officer of CSHM at the time.

On April 30, 2012, the sham owner of the Small Smiles of Manassas, Gillian Robinson-Warner supposedly signed a Termination Agreement with CSHM. The Termination Agreement states Small Smiles of Manassas, LLC, a Virginia limited liability company, “owns and operates a dental practice in a dental office at 9012 Mathis Avenue, Manassas, Virginia 20110”. Apparently the Manassas clinic was the worst of the worst of the Small Smiles clinics. However, all clinics have been under a Quality of Care Corporate Integrity Agreement since January 2010.

As the Manassas Termination Agreement reads one would assume Small Smiles of Manassas, LLC is a living breathing human-being. Gillian Robinson-Warner signed as President of Small Smiles of Manassas, LLC and agreed to pay CSHM $80,000 to CSHM if they would terminate the said MSA.

The very next day—May 1, 2012—two Motions were filed seeking the Bankruptcy Court’s approval to terminate the contracts.

Motions? Contracts? More than one, you ask? 

Yes, there were two!

The same day the Manassas Motion was filed in Tennessee Bankruptcy Court, so was a Motion seeking the courts approval to terminate the Management Services Agreement between CSHM and the Pueblo clinic. The Pueblo clinic is the flagship clinic of the DeRose-Padula family; the ones who created this monster. Isn’t that odd? The Pueblo clinic agreed to pay CSHM $300,000 to terminate their imaginary agreement. Dr. Randall W. Ellis supposed signed as president of the Pueblo clinic.

We know, the Small Smiles of Manassas, LLC is just a shell corporation, like all the others; each clinic has its own LLC or PC designation. Each controlled and operated by the people at CSHM and backers. Those are facts that have been proven over and over.

Despite that being common knowledge; CSHM will tell you the grass is purple while you are standing there looking at it and know its green; maybe they have lived in the fantasy world of “we only provide support services to dentist owned dental clinics land” for so long, they believe their own BS.

It is understandable where all of this might lead to an identity crisis for anyone working at CSHM or any of their Small Smiles clinics; particularly troublesome for Linda Zoeller. She isn’t even sure of her title at the various, LLC’s or PC’s. Here are 4 different titles she gave herself at just one of the Indiana clinics. Stop laughing!

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Reading over both Motions and Termination Agreements, I had to laugh out loud a couple of times. (Ok, I’ll be honest, it was more than a couple, and it was more like a couple in “I’ve only had a couple of drinks” kind of way.)

Besides all the stated facts in the document being anything but factual, I had to laugh at the language.

More than once “abundance of caution” was used. By my very favorite was “The Termination Agreement reflects the product of extensive arm’s length negotiations”. I’ll admit I blew coffee across the room when I read that one. I don’t know how a PC or LLC verbalizes its intent in negotiations; sign language?

Wednesday, April 16, 2014

Herbert Salisbury, III, DMD vs. Heartland Dental: Seller Beware

So you want to sell the dental practice you worked years to establish instead of just retiring and closing the doors? Were you offered, a “too good to be true” deal by Heartland Dental, or some other Dental Practice Management organization?

Do yourself and your patients a favor and decline. Take the lesson’s learned by Dr. Salisbury and don’t be swayed with visions of riches offered by Rick Workman. Otherwise be ready to become the slave of white collar suits sitting in a Canadian board room. Why? Because you will have to hit their production goals in order to receive the your final installment payments. (Read the lawsuit below).

Leaders in Dentistry: Kianor Shah, DMD

DrBicuspidLeaders in Dentistry: Kianor Shah, DMD

By Tony Edwards, Editor in Chief

DrBicuspid.com talked with Dr. Shah about what drove him to found Dental Equities, what he believes are the advantages of private practice, and where group practices may go wrong.

DrBicuspid.com: How did you go from a thriving private practice to founding a firm to help other dentists in private practice?

Dr. Kianor Shah

Kianor Shah, DMD.

Dr. Shah: Throughout dental school I was interested in the concept of delegating tasks within a practice to enable my colleagues to be more focused on the patient. I graduated from dental school, associated with a doctor, and learned so much from him. After six months, I purchased my first practice with the help of that other doctor and a conventional bank loan.

After you built your practice, you became a practice management consultant, working with group practices. But now you have founded an organization that works to strengthen private practices. Why is that?

Over the course of these last eight years, I have worked with a dozen members of the largest dental management services organizations and members of the Dental Group Practice Association and have observed their operations very thoroughly…

To Read more and comment, click here.

Wednesday, April 09, 2014

Praise for prosecutors: Ind. attorney general sets high standard

Praise for prosecutors: Ind. attorney general sets high standard

By Michael W. Davis, DDS, DrBicuspid.com contributing writer

April 9, 2014 -- On April 1, 2014, the Office of the Indiana Attorney General filed criminal charges against principles and employees of Anderson Dental Center. Defendants are alleged to have engaged in variety of criminal conduct, including dental Medicaid fraud, forgery of documents, money laundering, theft, corrupt business influence (racketeering), prescription drug fraud, and practicing dentistry without a license. All defendants are presumed innocent until or unless found guilty beyond a reasonable doubt by a court of law.

Several elements make this case very special. First, in the spirit of governmental full disclosure and transparency, the complete investigative report of Diane Hedges, the state investigator for the Indiana Medicaid Fraud Control Unit (MFCU), was posted on the Office of the Indiana Attorney General's website. This report and investigation, assisted by Sheila Green of the U.S. Health and Human Services Office of Inspector General (HHS-OIG) and Neal Freeman of the FBI, was exemplary in its thoroughness and detail. This type of evidence and report is the solid backbone of a criminal case for any state or federal criminal prosecutor. Good governmental investigators such as these are not paid nearly enough, nor appreciated enough by the public. Their work deserves great praise.

Too frequently, criminal charges are not brought forth in prosecution of dental Medicaid scams. Often, only civil charges are rendered, and cases are usually settled for pennies on the dollar, with no admission of guilt. Prosecutors are allowed to close a case. Nondentist owners who may be pulling all the criminal strings are rarely indicted. The crooks go back to business as usual, poor children are hurt, and taxpayers are ripped off once again. The cycle continues. Perhaps this time a chain was broken?

Read Complete Article At Dr. Bicuspid

Monday, April 07, 2014

Non-Dentist dental clinic owner arrested for Medicaid fraud in Indiana

Heads up all you others out there! Round of applause to Indiana AG, however, this is small peas, you have much bigger ones doing the same. Time to put some corporation executives in there with Ms. Metzner.

Anderson Dental Center Busted for Alleged Medicaid Fraud

By Mike Corbin - mcorbin@wibc.com | @WIBC_MikeCorbin

wibcAn Anderson-based dental group has been busted for alleged Medicaid fraud and corruption.

The Indiana Attorney General's office says the unlicensed owner of Anderson Dental Center, three dentists and four employees all face charges they bilked Medicaid of at least $300,000. Authorities say owner Sally Metzner and others submitted false and inflated claims to the Indiana Medicaid program for dental service payments. They say some of the documents were forged to get higher reimbursements than they were due.

The dentists 73-year-old Paul Pangallo, 69-year-old Jeffrey Rich and 46-year-old Thomas Dubois are also charged with money laundering, Medicaid fraud and theft. The four office workers are charged with corrupt business influence. A fifth worker is charged with prescription drug fraud. An affidavit alleges the fraudulent billing continued even after authorities executed search warrants at the office.

Sally Metzner

Thursday, April 03, 2014

CSHM and Small Smiles Dental Centers sign Exclusion Agreement

OIG Excludes Pediatric Dental Management Chain From Participation in Federal Health Care Programs

April 3, 2014

CaptureRelated Information

CSHM, LLC Exclusion Agreement

CSHM, LLC, formerly known as FORBA Holdings and Church Street Health Management (CSHM), signed an Exclusion Agreement that bars CSHM from participating in Medicare, Medicaid, and all other Federal health care programs for a period of 5 years, Daniel R. Levinson, Inspector General of the U.S. Department of Health and Human Services, announced today. The exclusion is based on CSHM's alleged material breaches of its Corporate Integrity Agreement (CIA) with the Office of Inspector General (OIG). CSHM manages and operates the national chain of Small Smiles Dental Centers, which provides services primarily to children on Medicaid. CSHM's corporate predecessor entered into the CIA in 2010, as part of the resolution of a False Claims Act case involving allegations that the company had provided dental services to children on Medicaid that were medically unnecessary or failed to meet professionally recognized standards of care.

To minimize immediate disruption of care to the hundreds of thousands of children treated at CSHM clinics and to enable an orderly, controlled shutdown of the company or divestiture of its assets, the exclusion will be effective on September 30, 2014. CSHM waived its right to appeal this exclusion in any judicial forum.

"CSHM has committed repeated and flagrant violations of its obligations under the CIA—violations that put quality of care and young patients' health and safety at risk," said Inspector General Levinson. "This exclusion underscores our commitment to enforcing our integrity agreements designed to promote quality of care and protect patients in Federal health care programs." Mr. Levinson said that this exclusion "makes clear to the provider community that OIG closely monitors our CIAs, critically evaluates providers' representations and certifications, and will pursue exclusion actions against providers that fail to abide by their integrity agreement obligations."

On March 7, 2014, OIG issued a Notice of Exclusion to CSHM based upon numerous material breaches of its obligations under the CIA. CSHM failed to report serious quality-of-care reportable events, take corrective action, or make appropriate notifications of those events to the State dental boards as required by the CIA, OIG found. CSHM also failed to implement and maintain key quality-related policies and procedures, comply with internal quality and compliance review requirements, properly maintain a log of compliance disclosures, and perform training as required by the CIA. Finally, CSHM submitted a false certification from its Compliance Officer regarding its compliance with CIA obligations.

This exclusion marks the culmination of a series of alleged failures by CSHM and its corporate predecessors to comply with its CIA. Under the CIA, an independent quality monitor conducted more than 90 site visits and reviews to monitor CSHM's compliance. Since the 2010 settlement, OIG repeatedly cited CSHM and took actions to address those violations, promote improved compliance, and maintain access to care for an underserved population. These actions included imposing financial penalties and forcing the divestiture of one of the company's clinics.

Despite these actions, CSHM remained in material breach of its CIA and OIG issued Notices of Intent to Exclude to the company in December 2013 and January 2014. In such cases, providers have the opportunity to demonstrate to OIG that they have cured, or are in the process of curing, the material breaches. CSHM represented to OIG that it would cure the material breaches. However, through meetings with CSHM and its Board of Directors and review of its written submissions, OIG determined that CSHM had failed to cure the material breaches and proceeded with the exclusion.

Until the exclusion goes into effect on September 30, 2014, an independent monitor will continue to monitor the quality of care being provided to patients at CSHM clinics. CSHM is required to inform patients at least 30 days before closing a clinic. CSHM is also required to keep State Medicaid agencies abreast of developments and provide monthly status reports to OIG. Any divestiture of assets by CSHM must be through bona fide, arms-length transactions to an entity that is not related to or affiliated with CSHM.

The Inspector General credited Special Agents from OIG's Office of Investigations, Miami Regional and Nashville Field Offices, with assisting in this investigation. OIG was represented in the investigation and litigation of this matter by Senior Counsel Felicia E. Heimer, Maame A. Gyamfi, Robert M. Penezic, and Tamara T. Forys, with assistance from Paralegal Mariel Filtz.

CSHM disputed OIG's determination that it was in material breach of the CIA.