Wednesday, July 20, 2011

Arizona–New laws go into effect July 20, 2011

Business Entities (ARS 32-1213(N))
The following language was added to Business Entities. No individual currently holding a surrendered or revoked license to practice dentistry or dental hygiene in any state or jurisdiction in the United States may have a majority ownership interest in the business entity registered pursuant to this subsection. Revocation and surrender of licensure shall be limited to disciplinary actions resulting in loss of license or surrender of license instead of disciplinary action.

Investigation/Complaints (Arizona Revised Statutes (ARS) 32-1263.02)
Investigative Interviews have been eliminated. All cases will be investigated through the chief investigator or an outside dental consultant. The Board will review the summaries of the investigations and if it appears that the licensee engaged in unprofessional conduct the dentist may be invited to attend a formal interview before the Board. Additionally, the Board may resolve more cases through consent agreements.

Powers and duties; executive director; immunity; fees; definition (ARS 32-1207(C))
Language was added to allow the Executive Director or the Executive Director’s Designee to issue and renew licenses, certificates and permits to applicants who meet the requirements; initiate an investigation if evidence appears to demonstrate a licensee may be engaged in unprofessional conduct or unable to safely practice; initiate an investigation if evidence appears to demonstrate that a business entity may be engaged in unethical conduct; subject to Board approval, enter into a consent agreement with a licensee if there is evidence of unprofessional conduct; and subject to Board approval, enter into a consent agreement with a business entity if there is evidence of unethical conduct.

To read all the new changes, click here

Tuesday, July 19, 2011

Cashing In by Cashing Out–Small Smiles and the Corporate Practice of Medicine

Listen up!  If you currently work for a dental mill in any capacity this is a must read for you.  If you work for a “chain” dental clinic, it’s for you too.   It lays it all out for the “fake” owners and exactly what can and may happen if you continue to cooperate filling the coffers of Private Equity firms, like Arcapita and FFL.


…Children are strapped down to a papoose board to eliminate the time it takes to calm and reassure them before a procedure. Parents are banned from the clinic rooms because they might want to slow the procedure if their child is fearful or in obvious discomfort.

     Unnecessary procedures are performed because the corporation gets paid by Medicaid for every procedure performed, not just the necessary ones. And children get rushed, inadequate, and botched dental work because it’s faster than taking the time to do each procedure properly.

      As the blurred face of the stricken ex-Small Smiles dental assistant explains, it’s all about “production, production, production.” It’s a good mantra for a widget factory. It’s a torture sentence in a dental clinic.

      How are such practices permitted in this day and age? The simple answer is they aren’t –and haven’t been for over a hundred years. Unfortunately, the laws that prevent such practices aren’t systematically enforced, and private equity firms with desires for outsized profits are taking advantage of that fact. They’ve discovered a veritable gold mine in the systematic bilking of Medicaid for their corrupted brand of dental “care”. By inflating the profit margins of these clinics with shoddy and abusive practices, private equity firms can sell the business at an extraordinary profit, with the only fallout being traumatized children who are often too poor to seek recourse – or know that any is due to them…

Click here to read the rest of this brilliant piece!

Dentists Warn of Risks Associated with Sports Drinks

Yes, Church Street Health Management has found a new subject matter to comment on, in order to get press I suppose.

Dentists Warn of Risks Associated with Sports Drinks

1.  One of the founders of the Small Smiles Dental Centers was instrumental in  putting soft drink machines in our schools.  Dan DeRose

2.  Since Church Street Health Management and their illegal Small Smiles Dental Centers target the “underserved” (preferably Medicaid children under 10)I doubt those same individuals are heavy into sports drinks.

“As children of all ages engage in outdoor activities during the summer, there is a growing tendency toward the consumption of sports and energy drinks instead of water,” said Dr. Steven Adair, Chief Dental Officer of Church Street Health Management, which manages more than 70 dental centers for low-income families in 22 states.

Choking on the above statement-They illegally own and operate, not manage, 73 clinics in 22 states and the District of Columbia.  It appears CSHM will do what they can to put their “two cents” out there on a subject matter, press is press I suppose.  :

 “Cashing In by Cashing Out" – It’s a must read!!!

Church Street Health Management’s New Members for 2011

Church Street Health Management finally filed their annual report July 17, 2011 with the Kentucky Secretary of State.

Noticeable changes are the “Managers”,  A Carlyle Group member finally emerges from the shadows.

Friday, July 15, 2011

Two family homes; each profit from taxpayer dollars-Medicaid.

When it comes to discussion of these illegal dental mills, I get so dang sick of all the remarks about “Medicaid moms” and blaming them for the pure existence of these disgusting places.

I have a question for you.

Which one of these homes leave the worst taste in your mouth?  They both live off your tax dollar.

Childhome  RichardMaloufHome

Thursday, July 14, 2011

Carlyle Group’s Susan Kasser, board member of Shari’s Management Corporation, joins the board of Church Street Health Management/Small Smiles Dental Centers

Kasser has been with the Caryle Group since 2004, prior to that she was at Goldman Sachs, surprise  surprise.

Here is her profile from the Carlyle Group website:
Susan Kasser is a Principal with Carlyle Mezzanine Partners, focusing on junior debt investments in support of leveraged buyouts, growth capital, and recapitalizations, primarily in North America and Europe.  Ms. Kasser is based in New York.

Since joining Carlyle in 2004, Ms. Kasser has been actively involved in current portfolio companies American Achievement Corporation, BioReliance Corporation, Church Street Health Management, Hudson Products Corporation, INC Research and Shari’s Restaurant Group.  Ms. Kasser was also actively involved in the investments in Applied Systems Inc, Sanitors, Inc, and US Investigations Services, which have been fully realized.

Wednesday, July 13, 2011

1-800-Dentist Patient Shopping for Kool Smiles? Sounds like it.

These criminal are so brazen.

Group Practice Leaders Accelerate Growth with Marketing Expertise From 1-800-DENTIST®

1-800-DENTIST’s Dental Marketing Summit will be held on July 18th & 19th at 1-800-DENTIST’s headquarters with two of the nation’s leading group dental practices, Midwest Dental and Kool Smiles.

Los Angeles, CA (PRWEB) July 12, 2011

Two of the nation’s leading group dental practices, Midwest Dental and Kool Smiles, will share proven marketing strategies that increase production and profitability at 1-800-DENTIST’s Dental Marketing Summit. The summit will be held on July 18th & 19th at 1-800-DENTIST’s Los Angeles headquarters.

The Dental Marketing Summit features key industry experts with 50+ years of combined experience in marketing: Fred Joyal, Co-Founder of 1-800-DENTIST®, Gregg Coccari, CEO of 1-800-DENTIST®, and including Ralf Tomandl, 1-800-DENTIST’s Director of Business Development.

Tuesday, July 12, 2011

Small Smiles Holding Company, LLC -Directors, Executives and Members

I've always wondered the names of the people who are hiding behind the "Mother Ship" of the Small Smiles Dental Centers and Church Street Heath Management.  Last week I was poked to dig deeper.  I was more curious than ever to find the names of those people who hide behind 100 or more corporations, public service companies, and limited liability companies. So I decided to send off for some information.

By looking at the names on this list it appears Small Smiles Holding Company, LLC is a mashup of every health "service" that bills Medicaid rooted in Nashville,Tennessee including, Ameris Health System, LLC; Children's Comprehensive Services (CCS);  the old Pricor; Corrections Medical Management; Ccs/Gulf Pines; Keystone Youth and Education; Ccs/Altacare  and more. Also the same bunch at Ameris Aviattion; Ameris Realty of Flordia, LLC;  Maderia Bay Marina, LLC; and Maderia Bay South, LLC.

Honestly, by the time I got to page 3 I expected to see my own name on the list.  (Just kidding)

Wednesday, July 06, 2011

Top 5 Ways Small Smiles Dental Centers has violated their Corporate Integrity Agreement

I knew they would disregard each and every word of the Corporate Integrity Agreement.  I said so right here, the very day it was announced.  As for the $24 million paid to the Federal government, and just over $2 million to the state of New York, to them it was going to be nothing more than the cost of doing business.  Pay to play-simply another business expense.  Hey, do they get to deduct that from their income tax return?

The current CSHM crew took over the operation of the Small Smiles dental clinics after they purchased all of them in the fall of 2006-actually they hired the old bunch to do it for a while. 

The arrogance shined like a beacon from the start. The investigation by the Justice Department started in the fall of 2007, just about the time Alberto Gonzales resigned.  All the while, thumbing their very long-and continually growing-nose directly at the entire United States Department of Justice, the US Attorney General and about 23 state Attorneys General and the public at large. No settlement was announced and signed until January 2010.   During which time, they didn’t slow down, skip a beat, miss a step-or any other idiom you want to use.  The child abuse and Medicaid fraud continued-business as usual. 
I originally planned to take all 65+ of the Corporate Integrity Agreement (CIA) that Church Street Health Management (CSHM)- formerly FORBA – signed in January 2010 and mark all the ways, I knew for sure, CSHM had violated said agreement.
I had not got past Section III before I was overwhelmed. No, that’s not right, I was pissed off! Why? Because of the continued arrogance.
So I decided to pick out my top five
1.  Continue with bonus program that is based on “production” or in CSHM speak, “Collections”  To this day, everyone gets bonus if they meet “collections” goals, and it gets bigger if they meet set intervals, no max they can make.  See below.  BTW the Lead Dentist gets 12.5 times the said amount.  Lead Dental Assistant gets 1.5 times set amount.
Munci bonus structure June 2011
2.  They are not supposed to base any compensation that would create an atmosphere for overtreatment and fraud, i.e. no % based pay.  Well, continuing with the bonus program didn’t thumb their nose to the CIA enough, no, they created a whole new contract for new and current dentists called “Collection Based Compensation”.   It’s all set out in a 30+ page contract that most CPA’s can’t figure out.
3.  Compliance Officer is not supposed to be the Chief Financial Officer – so they put the SVP of Financial Operations, Lorri Steiner in that position.  No, she’s not the CFO, but c’mon!
4. Appoint Compliance Liaisons at each center who are not afraid to report compliance breach to the board of directors, the compliance officer or anyone else.  So, what dose CSHM do, they make the Compliance Liaison the Office Manager!  Guess who gets a nice size bonus if all things go well at the center and they make their production goals, yep, the Office Manager!!!

5.  Hire an Independent Monitor to “monitor” their misbehaving.  So what does CSHM do, they have amazing made sure that N. Sue Seale, DDS, a great buddy and colleague of their Chief Financial Officer, Steven Adair, is the “pediatric dental professional” to check in on things with the Independent Monitor.   Reports to me are Sue and Steven come to some of the centers together and are quite cozy!

There you have it, my top five.  Well, the top five I picked out in the first few pages of the CIA anyway. 

Tuesday, July 05, 2011

Dental Care At Wal-Mart ? Coming soon!





Boston reporter investigates disciplined

The Boston Channel-See the video report here 
May 25, 2011
BOSTON -- A Team 5 investigation is raising questions about the state board in charge of disciplining dentists in Massachusetts. NewsCenter 5’s Sean Kelly reported Wednesday how difficult it is for the average patient to find out the details of why their dentist was disciplined.

“I just felt helpless,” said Sarah, a patient who admits she should have done research on her dentist first.

“I was livid, beyond furious,” said Sandra, another patient who was unsatisfied with her treatment and left her dentist’s chair complaining. She said she didn’t do research either, selecting her dentist from the phone book.

Sole Practitioner v. Corporate Dentistry

Calling a Spade a Spade! It’s amazing how few want to refer to the dental chain by what they really are-corporations practicing dentistry!  Instead they are referred to as “large dental practice groups”.  Huh? 


September 1, 2009
by Thomas A. Climo, PhD

For more on this topic, go to and search using the following key words: dental practice management company, dental service delivery, Thomas Climo.

The American Dental Association has published an annual “Survey of Dental Practice” since the 1950s. Not until the ADA's forthcoming 2009 publication “Survey of Large Dental Group Practices” will any alternative to a sole practitioner office have been subjected to ADA review.

In some respect, the ADA can be forgiven this oversight. After all, as of 2006, dentists using their dental degree in some fashion other than as an active private practitioner in the United States comprised only 8% of the dental population. It sounds comprehensive to account for 92% of the means for delivering dental services in the United States.

It is for that reason the forthcoming 2009 publication takes on greater significance. There must be a movement afoot, a trend if you will, that has led the ADA to consider an alternative to the usual means of delivering dental services, and that this alternative must be making the industry stand up and take notice.

This report will canvass the current market conditions of the dental service industry, highlighting why the sole practitioner office is now meeting a challenge from larger group, centralized managed dental centers.

• Sole practitioner office

It is extremely capital intensive to open a dental practice, and operating costs are high. If there is only 25% to 35% of revenues left to reward the sole practitioner from distributions ($18,000 per month) while holding working capital constant at $40,000 to $60,000, plus holding back a suitable 5% to 7% reserve for depreciation and replacement of old equipment with new, the sole practitioner is generating a little under $600,000 of revenue without showing much of a profit.

[Distributions to himself/herself in the form of salary cannot be considered “profit,” otherwise the sole practitioner is working for nothing. Distributions beyond salary would be considered “profit,” but, at $600,000 per annum of revenues, the typical sole practitioner office won't have a lot of that to go around, possibly enough to reward himself/herself and staff a modest holiday bonus.]

And don't think we are being conservative in this projection of sole practitioner revenue. For a dentist in a private practice, the ADA 2002 Survey of Dental Practice estimates adjusted net income of $183,050, practice expense of $295,890, and a total nominal income of $532,850. Let's lay this out and see what is left:

Total Nominal Income $ 532,850
Less Practice Expense $ 295,890 Total Disbursable Income $ 236,960
Less Owner Salary $ 183,050 Net Disbursable Income $ 53,910

Put $10,000 of the net disbursable income into topping off the working capital, set aside another $35,000 for capital replacement reserves (at 7%), and the sole practitioner has a whopping eight or nine grand to share with himself/herself and staff associates for a holiday bonus. Shake out these numbers any way you like, and you cannot turn around the salient fact that far too much capital goes into generating too little revenue for the sole practitioner dental office to be considered anything other than a means of income for the dentist.

At a 1.1% return on capital investment (of $500,000), the sole practitioner office is not set, nor framed to become, an investment vehicle that performs favorably when judged against other endeavors with similar capital costs that either drive down operating expenses or increase revenue in order to be competitive in their respective markets.

The sole practitioner dental office is a professional business with an outstanding record of debt servicing, but also one with an abysmally low return on capital investment. If it were up to an outside Board to determine how much to invest in a dental practice when judged against other available endeavors, capital to dentistry would go wanting. For that reason, dentists buy and sell from fellow dentists, and the merry–go–round of high capital and high operating costs with low margin of returns continues.

• Larger dental group practices

When faced with the kind of circumstances and results from above for any kind of business in any kind of industry, economists counsel the quick and immediate adoption of a competing business model rather than one of convenience for the practicing professional.

If capital costs are high, develop a scenario that reduces capital costs. If operating costs are high, develop a management model that reduces these costs. If profit margins are low, while keeping operating costs low, develop a marketing program that will increase revenues.

This is the business model behind larger dental group practices, or what is now being referred to as Dental Practice Management Companies. They are the new subject matter of the upcoming study from the ADA.

If raising $500,000 of capital that the sole practitioner would otherwise seek from the local bank competes with other investments, it might make more sense to combine general and specialty services and raise (instead) $2.5 million spread over both general and specialty practices. This is kind of a five–offices–in–one, economies of scale approach to dental practice.

In so doing, the operating costs of one practice are basically spread over five. Capital costs are shared between practitioners, and referrals from general dentist to specialist no longer take patient revenue away from the practice. Toss into this mix the allocation of accounting, other administrative tasks, marketing to a centralized management company, and staffing to accommodate up to 10 dental centers, and you've created a model that has systematically addressed high operating costs while spreading capital costs over a larger revenue base.

The return on capital moves from a low to a high margin basis. You might not be able to raise outside capital with a 1.1% return on investment, thereby limiting your options to a local bank, but you certainly can raise outside capital when you can show a 20% to 40% return on investment.

Repeating the Net Disbursable Income table we produced for the sole practitioner office, let's recast the ADA numbers as they might look for a large practice management dental center:

Total Nominal Income $ 4,000,000
Less Practice Expense $ 2,000,000
Total Disbursable Income $ 2,000,000
Less Professional Salaries $ 1,200,000
Net Disbursable Income $ 800,000

Whereas we used $500,000 as the capital base for the sole practitioner, in the larger dental practice management center we assume a capital base eight times this, or $4 million. It will include, in addition to top–of–the–line office and dental appurtenances, a suitably large budget for front–end management programs, and a sizable marketing campaign.

Indeed, in a dental practice management start–up, it is not unreasonable to spend $250,000 for installing and assuring sound management, and $750,000 for marketing. Even with this, the return on capital investment is 20%. This return will grow as the managerial and marketing investments are spread over more than one year.

The larger dental practice management center shows a drastically different result from the pittance left over for disbursement in the sole practitioner office.

The significantly improved size of the leftover net disbursable income confirms and substantiates the installation of a modern business model that basically remedies the weaknesses of the sole practitioner model. Although capital costs have grown in the larger dental practice management center, they have fallen with respect to each dental practitioner as well as with respect to revenue earned. Revenues have increased due to the increase in the size of the practice.

Combined, this means that for every dollar earned, the practice keeps more of it in a disbursable form. The ratio of operating costs to revenue has fallen from the sole practitioner's 65% to 75% to be more in the 50% to 55% range. The mission of reducing operating costs as they compare to capital costs and revenue has been accomplished. This will feed into a positive, healthy, and competitive return on capital. The return for our hypothetical large practice management dental center is almost 20 times greater than the hypothetical one demonstrated by the ADA for the sole practitioner.

The commotion surrounding the rise of a new dental service to the dental consumer has been solved. It goes by the name of capital and operating cost efficiency, and can be coupled with the advantage that marketing has for the larger practice management dental center. Competition is driven on many levels, but contrasting top–of–the–line dental offices with the compromised budget of a sole practitioner tells anyone aware of economics that a new form of delivery for dental services has arrived and will become the mainstream within five to 10 years.

The dominance of the sole practitioner circa 1919 to 2009 will give way to the era of the larger dental practice management company beginning in 2010. The ADA, in its forthcoming publication is wise for getting itself on track and ready to embrace this change.

• Capital markets

If there is truth to the inevitability of the takeover of large practice management companies in the future, then we would expect this to have evidence in the markets which provide funding to competitive endeavors. This leads to how large dental practice management companies are perceived by the two major forms of capital acquisition, private equity and public capital markets.

• Private equity market

The Committee on the Global Financial System in a July 2008 working paper, titled “Private Equity and Leveraged Finance Markets,” accurately describes the emergence and importance of private equity:

“Private equity, which was relatively unknown in the early 1980s, has become an important asset class in global financial markets. Private sector estimates indicate that, as of 2006, there were 2,700 private equity funds, which accounted for 25% of global mergers and acquisition activity, 50% of leveraged loan volume, and 33% of the high–yield bond market. These statistics demonstrate the close links between private equity and leveraged finance markets. A rationale for private equity transactions is better alignment of shareholder and management interests and improvement of the operational efficiency of firms. Private equity firms attempt to achieve this through a number of measures, including higher leverage and greater incentives for management through significant pay–for–performance packages.”

In other words, private investors who are represented by private equity firms are saying if it is money you want, provided you can give us the kind of performance package we require, then it is money we have.

Large dental practice management companies have put their hat in the private equity ring, as it were, and have found an accepting and willing avenue for funding their operations both as start–up or growing those operations through acquisition.

Here's an abridged list of current successful transactions:

  • Thoma Cressey Bravo Leads Recapitalization of Midwest Dental Holding Company
  • American Capital Invests in Dental Practice Management Company
  • RBC Centura Advises on Recapitalization of Dental Management Company: Investment Banking Group Offers Expertise in Healthcare Field
  • King & Spalding Represented Arcapita Inc. in its acquisition of FORBA, LLC, a dental practice management company, for $435 million
  • Freeman Spogli Acquires a Majority Interest in Bright Now! Dental, Inc.

• Public market

There have been no major inroads to date of dental practice management companies in the NYSE or NASDAQ. Public ownership is highly unusual for the medical or dental world. The data that we do have comes from a spurt of companies that went public in the 1990s but expanded too quickly, burdening themselves with debt that drove them into bankruptcy or into the arms of private equity buyers.

The sensitivity of dental practice management companies to market, and their corresponding decline in share prices that fall in line with market forces, is not an attractive forum for investment. Private equity appears to be the more common and superior form of investment for dental practice management companies.

Thomas A. Climo, PhD, is a former professor of accounting and finance at the University of Kent at Canterbury, England. He is currently assisting in the financial structuring for a large dental practice management group. He is also an expert witness in Las Vegas, Nev. E–mail him at


Dental Economics

Sentinel Capital Partners, LLC sells ReachOut mobile dental company to Morgan Stanley Private Equity–January 2011


Searching” Private Equity Dental” brings up a whole mess of trouble!  Here is just one.

rha_logo_75Sentinel Capital Partners, LLC invested $22 million dollars in ReachOut Healthcare America, Ltd in 2007, holding 80% of the company.  In August 2008 ReachOut Healthcare bought up Mobile Dentists,it’s closest competitor.  In 2010 they added “Help A Child Smile.”  ReachOut also offers vision services.

Based in Phoenix Arizona-ReachOut sends dentists-on-wheels to service low-income children in public schools under the government's Medicaid contracts. It has separate programs for the elderly and the military.  ReachOut operates in 21 states.

ReachOut Healthcare America (RHA) is amongst the nation’s leading administrative services organization for mobile dentistry and healthcare.

Founded in 1997 and headquartered in Phoenix, Arizona, RHA provides administrative support to dental PCs. RHA and its affiliate, Home Dental Group, has a  staff of  motivated professionals who will ensure their commitments are fulfilled to the highest standard. RHA works with PCs that possess a diverse patient base including children in our nation’s Headstart programs, foster programs and public schools.

At the time of Sentinel’s purchase of ReachOut, the company had less than $5 million in EBITDA.  At the time of the sale, the EBITDA had increased to $17 million.  Sentinel Capital Partners, LLC unloaded ReachOut Heathcare America, Ltd on Morgan Stanley Private Equity in January 2011. 

ReachOut Healthcare America, Ltd. (RHA) was formerly known as Health Kids Dental and Seniors Dental.

Co-Founders of ReachOut Healthcare America:
Michael Howell
Dan Goldsmith

From The
ReachOut Healthcare America Ltd. and Sirona Dental Systems Inc. -- Fixing teeth may not be the most glamorous of investment picks, but it has drawn in substantial private equity capital. Two niche providers stood out for the healthy returns that their sponsors extracted through timely exits. Phoenix-based ReachOut sends dentists-on-wheels to service low-income children in public schools under the government's Medicaid contracts. It has separate programs for the elderly and the military. Sentinel Capital Partners LLC invested $22 million in 2007 and held 80% of ReachOut. The company, with less than $5 million of EBITDA at the time, was Sentinel's third investment in a dental business but the first where government reimbursements accounted for nearly 100% of accounts. ReachOut added Mobile Dentists in August 2008 and Help A Child Smile in 2010. With organic growth, EBITDA had reached $17 million by the time Morgan Stanley Private Equity took over as new owner in January. The sale allowed Sentinel to book profits of between 6 and 7 times its cost.

Sentinel Capital Partners other dental company investments include:
Castle Dental Centers, Inc-sold in 2004
Metro Dentalcare-sold in 2007

Kool Smiles Dental owners purchased Midwest/Mountain Dental- April 2011

Mountain Dental and Midwest Dental operated by Dr. Jeff Moos is another dental chain owned by a Private Equity firm- the same one who owns Kool Smiles-Friedman, Fleischer & Lowe, out of San Francisco!  A “Mike Lindley” is on the board of Mountain Dental.
Friedman, Fleischer & Lowe, (FFL)the private investment firm who owns and operated NCDR, LLC – Kool Smiles Dental Centers purchased Midwest Dental from Cressley & Company April 2011.
Cressley & Co, along with CIT Group were leaders in the recapitalizaition of Midwest Dental in May 2007.  Cressley purchased MWD from Svoboda.

Here is the story from “The Middle Market
by Anthony Noto
April 7, 2011
San Francisco-based FFL is investing out of its 2007-vintage Friedman Fleischer & Lowe Capital Partners III fund, which targets companies with enterprise values within the $50 million to $500 million range.
Terms of the deal have not been disclosed. FFL is acquiring the Mondovi, Wisc.-based target out of Thoma Cressey Bravo Fund VIII LP.
Chicago-based Thoma Cressey led a recapitalization of Midwest Dental in May 2007 and purchased all of its interests from Svoboda Collins LLC. Terms were not disclosed.
Calls to Aaron Money, the FFL partner leading the latest acquisition, were not returned. A spokesperson at Midwest Dental could not be reached.
FFL already owns two companies in the dental space. Portfolio companies NCDR LLC and DPMS Inc. provide facilities and support staff to dental groups operating under the Kool Smiles brand, according to the PE shop’s website. FFL acquired Atlanta-based NCDR and San Ramon, Calif.-based DRMS in 2004 and 2006 respectively.
[ NCDR, LLC and DPMS, Inc were really just Kool Smiles whether it be Kool Smiles 2 or Kool Smiles 3 or whatever.  They merged a few months back and guess what, they are still NCDR, LLC - Kool Smiles]
Purchasing Midwest Dental would not serve as an add-on to NCDR or DRMS. 
Other midmarket PE firms have capitalized on M&A within the dental space as well. On Dec. 29, Sentinel Capital Partners sold Phoenix-based ReachOut Healthcare America Ltd., a provider of dental support service and care to underprivileged children, seniors, and military personnel. Terms were not disclosed.
A month earlier, dental services company Smile Brands Group Inc., backed by Freeman Spogli & Co., found a new private equity owner in Welsh, Carson, Anderson & Stowe. The price of that secondary buyout was not disclosed, but the Santa Ana, Calif. company said last April that it hoped to go public with an enterprise value of about $470 million.

Here is the story from LBO Wire
Cressey & Co. Passing Midwest Dental To Friedman Fleische Lowe
Shasha Dai
08 April 2011
Midwest Dental Holdings, a provider of management services to dental offices, may have its third private equity owner in four years if a pending sale to Friedman Fleischer & Lowe LLC proceeds as planned.
San Francisco firm Friedman Fleischer is buying the Mondovi, Wis., company from its current owner Cressey & Co., said a person familiar with the situation.
A spokesman for Friedman Fleischer declined to comment. David Schuppan, a Cressey principal; and Jim Myer, president and chief financial officer of Midwest, didn't return calls for comment.
Midwest provides management support for functions ranging from handling back-office work and marketing to finding medical assistants and dental hygienists.

Cressey's predecessor, Thoma Cressey Bravo, bought the company in 2007 from fellow buyout firm Svoboda Collins LLC for an undisclosed sum. LBO Wire reported then that Svoboda Collins saw more than three times its money, representing an internal rate of return of over 50%. Svoboda Collins acquired Midwest in 2004.
Midwest had about 450 employees, LBO Wire reported when Thoma Cressey Bravo bought the companyin 2007. More recent financial or staffing information wasn't available.

Thoma Bravo Cressey split in 2008 into two firms, Thoma Bravo and Cressey & Co., with the latter focusing on health-care investments.
Cressey & Co. closed its current fund, Cressey & Co. Fund IV LP, with $350 million in early 2010.
Reach Cressey & Co. at 312-945-5735.
The dental services provider may have its third private equity owner in four years if the sale goes through.

Cressey & Company
2525 West End Ave # 1175
Nashville, TN 37203-1793
(615) 369-8400

[Keystone Education and Youth Services, LLC has an office on West End Avenue in Nashville as well.  According to Bloomberg, Michael Lindley, Rodney Cawood and Tim Richter are still the top dogs over there.  They may have sold their interest to UHS, but I believe they really just did exactly what Jeff Moos did, recapitalized his income.]
Cressey & Company
233 South Wacker Dr.
Sears Tower, Ste 920
Chicago, IL  60606
[Another odd factoid here, there is a Mike Lindley on the board of Mountain Dental and Midwest Dental-Mountain Dental is of the same company, but the clinics in Colorado and New Mexico are operated under the name of Mountain Dental-you can check the company filings at the Secretary of State offices in New Mexico for Mountain Dental and Secretary of State office of Iowa for Midwest Dental]

Church Street Health Management-Small Smiles Dental Centers-Why I’m Here

Saturday, July 02, 2011

Aetna DMO only offers bottom of the barrel dental provider

This is a great example of an informed consumer.  “Jenny” sent me this just the other day.   Thanks “Jenny”!

From Lincoln Nebraska

My company gives a choice of Aetna PPO or Aetna DMO.  I was looking over the options and found the DMO sounded nice but after doing a search it turned up only one option for me, Blome Family Dentistry with Gregory and Sara Blome(father and daughter).  I hit one of the many "rate your doctor" websites and found that they both had sanctions against them.  Both of the sanctions had to deal with the Mother(Cindy Blome as stated on the staff page of their website).  She worked(maybe stills works) at the office and in 2008 the DEA looked into the large amount of hydrocodone being ordered by the office.  The father Gregory had gotten himself put on probation claiming he knew nothing about it and then in 2009 the daughter Sara was put on probation about the very same thing.  The mother was ordering these for her "migraines" but the sanctions states(Under Sara's) :

Poster recounts trauma of being strapped down

Dental Fear Central

Well, I've not been to the dentist in about 5 or so years. I don't remember the last time, to be honest.
I have always had a huge fear of dentists, but my biggest trauma was being held down for cleanings and fillings as a child every 6 months. Even though I was cooperative, I would be strapped down. Being an abuse victim, this scares me to death. My other fear is the pain, as I am on long-term opiate therapy for chronic pain (my spine is just totally obliterated) stemming from an accident and cancer.
I know I have many problems with my teeth, and it is humiliating to go to the dentist. I have a lot of decay at the gum line, I know I have periodontal/gum disease, and I have many cavities I can feel, esp along the molar gum line on the lower jaw. I also have one tooth that cracked off halfway but that never has hurt. I have been eating Motrin like candy for a month, putting this off. Just thinking about calling a dentist made me go into panic mode. But finally I cannot take this lower jaw pain anymore. I know I have impacted wisdom teeth and several huge cavities on that side that hurts. The Motrin doesn't help at all anymore, and although most would probably think that with my narcotics I wouldn't feel pain...I do. It doesn't touch the tooth pain whatsoever.
I don't even know what the cause of my jaw pain is...the whole right lower side hurts. I have TMJ problems from an accident in which I hit my lower jaw on the steering wheel as well. So many problems!!!
Besides the fear of the dentist, my "rationalization" for so long has been that I don't have the money to get these fixed. I know it truly doesn't make sense, was my excuse. For what little income I do manage to get, through selling things and whatnot, goes toward my two young kids. I avoided the dentist for so long because I had such a hard time finding a dentist that would accept payment plans, etc. My mom had to help me call places. Finally I found one yesterday, and I am hoping they will be able to help me. It is there that I will be going this morning.
Sorry for the length of this post. I have not slept all night, partly from the pain of my jaw, but mostly from sheer terror. I am also extremely worried about the pain, as I cannot just get narcotics from anybody. They all must come from my pain management doc, but he is not in the office until Monday. So that just adds one more level of fear on me. I hope and pray the dentist is kind and gentle, cause otherwise I may lose it!
I really appreciate finding that there is a forum out there for people who fear the dentist as much as I do. One of my friends goes to a sleep dentist, and gets knocked out for everything. She has a bad needle phobia as well. I don't' care about needles, I just fear the dentist in general! lol I wish I could afford the thousands of dollars it cost to see a sleep dentist. I will be happy just to be able to eat again and not suck down a bottle of Motrin like candy.
The worst part is, I feel like such a hypocrite for being so adamant about my kids brushing and flossing and seeing the dentist. When I haven't gone for ages. I had so much trouble as a child with teeth problems that I am always telling my kids "You don't want to have teeth like mine!".
I apologize for the long, rambling post. It sure feels good to know I will be understood here, though. My family thinks I'm crazy for avoiding the dentist. To them, quote "I should just get over it." That's their answer to everything. Suck it up and go.
Thanks for listening.

Dr. Kim Henry wanted to be heard, so here ya go, Kim


Saturday July 2, 2011
2:18 PM

Subject: You think you are valiant crusader

Came across your blog searching for info on Church Street Management, who sent me glossy brochures trying to hire me.

You are a prolific writer, but a real coward, as you have the comments disabled on all of your posts.

I am an enemy of corporate clinics also, but you don't know crap about dentistry, lady. You are just a pompous windbag.

Kim Henry, D.M.D.


Clearly Dr. Kim Henry hasn’t been here before it would be clear that comments are open, even anonymously, and I do not delete for filter any of them.

At one time, when I fist installed the Disgus comment software, it was set to cut comments off at 30 days, that was the default.  When I noticed this I immediately corrected this problem!

More of Dr. Kim Henry:  Ghana

I am a US citizen who sent quite a bit of money to a Ghanaian woman to start her in a tailoring business. This included money to buy land for the shop.
A good while later I was contacted by a man purporting to be an Interpol officer, with a record of my money transfers. He told me this woman and her accomplice was a scammer.
He suggested a Ghanaian attorney who would help with their prosecution for a fee. I paid him.
I supposedly won a $21,300 award in a Ghanaian court against these scammers. To pay it, the scammer's bank accounts were supposedly seized. I received a copy of the one-page court decree, but it looks suspiciously phony.
The attorney said Ghana levies a 7% tax on damage award. He said I must forward $1483 to pay the court before the check can be turned over the the Ghanaian Embassy in Washington for me to pick up. Frankly, the whole thing sounds like a scam.
Could anyone with any knowledge of the Ghanian legal system help me? Does this 7% tax exists? How can I verify the court award?
Thank you!
Dr. Kim Henry

I think we now know why she was sent a flier to come join the crew at CSHM.

Dr. Kim Henry Profile

…more on Dr. Kim Henry:

Dr. Kim Henry says:

August 17, 2009 at 1:26 am

I traveled to Ghana in 2006 for the first time. I was impressed by the friendliness of people there. I met a young girl in Aburi Garden who was gracious enough to show me around.

When I left, an e-mail correspondence ensued, in which she confessed romantic attraction to me.

Very soon, she wrote to tell me that she lost her job in a sewing factory. As I was grateful for her help as a tour guide one day, I sent her the money for a sewing machine, business cards, and a cell phone.

Later she said it was impossible to work in her house, so I sent her money to have a container converted to an office. She reportedly placed this on a street on Tema until the officials cleaned off the streets and forced her to move.

After that I sent her money to buy a piece of property adjacent to a busy road. The lawyer fees and land registration fees were enormous. And of course along the way, there were the usual illnesses of the girl and her family, them getting thrown out of their house, and countless other supposed difficulties.

When I finally said “no” to sending any more money, I got an e-mail from a supposed Interpol investigator saying they had been tracking these scammers for awhile and wanted to convict them. He had me send a lot of supporting documentation about my transactions.

The the policeman told me in Ghana courts of law, the victim of a scam crime must pay for the prosecution by a good attorney. I thought this was very weird, but I agreed to pay $1400 for the lawyer.

The case supposedly went to trial, and the scammers were convicted. I was awarded $21,300 in damages. But guess what? I was told the Ghana taxed court awards at 7%. When I sent this money, he guaranteed me that a check would be sent me by the Ghana embassy in Washington.

Now every day this attorney pesters me, saying I will lose the court award if I don’t pay the taxes soon. I wanted back-up evidence, and he sent me a scan of a court decree from the proceedings. Only trouble is, some words are not spelled correctly. It looks fishy to me. I remember that the phoney land deed was a very convincing piece of work.

Can anyone help me verify this policy of Ghana taxing victim compensation awards, and possibly verify the existence of the judge and the case number on this decree?

I hear it is common in Nigerian scams to offer “help” to a scam victim, in order to extract more money from them.

Kim Henry’

I suppose they lead a pretty boring life-4th of July weekend and this is where they spend their time… lol


Friday, July 01, 2011

Church Street Health Management, LLC Managers

Taken from the 2010 Annual Report to the Kentucky Secretary of State:
Rodney Cawood – 618 Church Street Suite 520, Nashville, TN  37219
Jack Draughon –2928 Habersham Road, Atlanta, Georgia 30305
Charles Griffith – 4209 South Bellaire Circle, Englewood, Colorado 80113
Charles H. Ogburn – 3807 Vermont Road, Atlanta, Georgia 30319
Bowen Diehl – 2945 Stanford Avenue, Dallas Texas 75225"
Michael Lindley – 857 Curtiswood Lane, Nashville, TN  37204
Alford J. Smith – 1652 Jacobs Drive, Gallatin, TN  37066
Scott A. Buschmann – 75 14th Street 24th Floor, Atlanta, Georgia 30309

Dental Associations receive nearly 50% of its monies from corporations

I’m sure this is quite normal, but there just seems like there is something wrong with it and I can’t lay my finger on exactly what it is.  Not right now anyway, if you could see my house you would understand.

Seems like receiving a discount for using particular companies is one thing, but if said companies actually contributes to nearly 50% of an organizations income that is whole other ball of wax.  I’m sure someone can enlighten me about this.

In the Tennessee Dental Associate 2010 Source Book it highly suggests it’s members use certain companies saying:

“When you use the services and products endorsed by the TDA, you not only obtain a good value but also assist in keeping TDA dues low. These companies provide the TDA with a royalty based on the amount of business generated by TDA members and their offices; non-dues revenue accounts for almost half of the TDA’s yearly income. When contacting these companies, tell them you are a TDA member”