(Clip taken from interview on why they hired ADP to help them with the UnAffordable Care Act.)
(Clip taken from interview on why they hired ADP to help them with the UnAffordable Care Act.)
This same study could be done in any state these private equity owned dental clinics operate and the results would be the same, if not worse. All of this has been reported right here since 2007, it’s 2014! Just saying…
BY Glenn Blain NEW YORK DAILY NEWS ALBANY BUREAU|Wednesday, March 26, 2014, 12:20 AM
The state’s Medicaid program paid through the teeth for questionable billings by shady dentists and orthodontists, a new federal report charges.
One dentist claimed to have provided one child 42 tooth fillings in a single visit.
Another dentist averaged 16 procedures per child, compared with a statewide average of five, according to the report, which is being released Wednesday.
They were among 23 pediatric dentists and six orthodontists in the state who pocketed $13.2 million in Medicaid payments in 2012 for services that appeared unnecessary or may not have been performed at all, according to the report by the Department of Health and Human Services inspector general.
“We found one orthodontist who treated almost 5,000 children in a single year,” said Lucia Fort, an analyst in the inspector general’s office.
“That’s about 10 times higher than the state average for orthodontists.”
CSHM/Small Smiles Dental has been changing the business entity names on file with the Secretary of State in Kentucky and Ohio. Small Smiles of Akron, LLC – Michael Crites, DDS has been changed to Akron Smiles Youth Dentistry, LLC – Michael Crites, DDS. (if you would like a look at the many name changes in Ohio, search the Secretary of State site here using “Prior Business Name”)
Small Smiles of Louisville, PSC was changed to Louisville Smiles Youth Dentistry, PCS on November 27, 2013. Since at least June of 2013,
CSHM has also been changing information contained in their dentists National Provider Identifier (NPI) records on file with the Federal government. The mailing address has also been changed in the individual clinic records. The business mailing address has been changed to a US Postal Service sub-station post office box:16 Arcade Unit 198747, Nashville, TN 37219-1994.
The “manager of licensing and credentialing, Ms. Jenell Stringer is making the changes. I’m sure at the direction of someone at CSHM headquarters.
For instance, on June 11, 2013, Ms. Jenell Stringer, Manager of Licensing and Credentialing changed the mailing address in the NPI record of Small Smiles of Worcester, LLC d/b/a Straight Smiles of Worcester-(NPI number 1487943635) to:
16 Arcade Unit 198747
Nashville, TN 37219-1994
You can see for yourself by searching the NPI number here.
They did the same thing in May of 2010, just 4 months after the Corporate Integrity Agreement was put into place. At that time I believe they used a US Postal Service sub-station at 208 W. 8th Street, Ste 810,Pueblo, Colorado, 81003-3038
If you would like to check out the dentist records, click here. Below are a few names and NPI numbers:
Interview with Gary Iocco, President,
National Association of Dental Laboratories
By: Michael W Davis, DDS
Dr. Michael W. Davis maintains a private general practice in Santa Fe, NM. He chairs the Santa Fe District Dental Society Peer-Review Committee. Dr. Davis is active in dental care for disadvantaged citizens. His publications are on ethical issues within the dental profession, as well as numbers of clinical research papers.
Gary Iocco is the current president of the National Association of Dental Laboratories (NADL). The NADL promotes the highest standards in the dental laboratory industry through education of its members, advancing technology, raising standards, and serving the public interest. Communication with dentists and the public is also an important role of the NADL.
NADL Website http://www.nadl.org/home-page.cfm
National Board of Certification in Dental Laboratory Technology http:///www.nbccert.org
The Foundation for Dental Laboratory Technology http://www.dentallabfoundation.org
NADL What’s in Your Mouth http://www.whatsinyourmouth.us
Dr. Davis: Many in the general public may not know the vital role of the dental technician, within the dental team. From my perspective as a restorative dentist, a dental technician can make me look like a superstar, or a nitwit. What exactly does a dental technician do, and why is that so critical in successful clinical results for patients?
Mr. Iocco: As dental laboratory technology professionals we transform the dentist’s directions from the prescription or work order and create the actual treatment option that the dentist has chosen to provide their patient. Quality dental laboratory professionals employ knowledge of modern materials and available technologies to provide our dentist clients with a restoration that is consistent with the high standard of care and esthetics that our dentists expect to provide for their patients.
This is only possible if there is sufficient communication and understanding and a mutual knowledge of and commitment to what is required for a quality outcome.
While good communication is always important, the more complex or involved a case is the earlier in the planning process a dentist should bring their dental laboratory technology professional into the conversation.
Highly skilled and experienced dentists will tell you that to provide the standard of care and esthetics that they seek for their patients restorations, they work closely with a quality dental laboratory.
If anyone is looking for CSHM and Small Smiles press release after the media exposed the fact they will be excluded from Medicaid in 30 days, you won’t find it on their website any longer. No need to put out an “All Points Bulletin”, it can be found below.
President and CEO David R. Wilson, released a memo to payors on March 12, it has since disappeared from their website as well. But never fear,it’s still here.
The whole media statement, from start to finish, basically gave the finger to HHS-OIG and every person who has investigated them since 2007; in addition to making highly misleading—if not down right lying—to staff and employees.
Seems their Facebook page has disappeared as well. I imagine they don’t want any comments or questions, don’t you?
Below is the press release.
CSHM, LLC & OIG NOTICE OF EXCLUSION
In a letter dated March 7, 2014, CSHM, LLC (“CSHM”) received a notice of exclusion from federal health care programs from the Office of Inspector General of the Department of Health and Human Services (OIG). The notice of exclusion does not apply to any individual employee or the Dental Centers and Practice Owners, but to the CSHM, LLC corporate entity only. If the exclusion should go into effect, it means that CSHM may not continue with some or all of its current responsibilities under its Management Service Agreement (MSA) and this may affect administrative services related to Center operations.
The exclusion notice is based on the OIG’s determination that CSHM has violated some terms of the Corporate Integrity Agreement (CIA) that has been in place for the management company and its predecessors since January 2010. CSHM assumed the CIA in June 2012 and it is well known that it has implemented the CIA provisions within the Centers and generally since that time. Many Center owners and employees have met the Independent Quality Monitor (IQM) and CSHM’s compliance staff over the last 18 months as the company was implementing the CIA’s provisions. Generally, the alleged violations related to certain delayed reporting of a few adverse clinical events, failure to undertake certain training in 2012 before CSHM assumed the CIA, and the omission of two adverse events on the CIA disclosure log, though over 1,200 events were successfully place on the disclosure log for processing.
CSHM believes strongly that it has substantially and in good faith implemented the CIA at a great cost in resources and with the important cooperation of the Centers and its health care professionals, particularly on the enhancing dental clinical standards. The OIG’s proposed determination to exclude CSHM for some non-compliance with its CIA is an unduly harsh and an unprecedented response to expected and common difficulties in implementing a very complex CIA that has a novel and innovative administrative, process and clinical requirements.
CSHM intends to appeal the notice of exclusion and file a request for hearing with the Department Appeals Board. During the appeals process, the exclusion will be stayed and we will continue to provide business, administrative and support services to 53 associated dental centers in 19 states and the District of Columbia, pursuant to our management services agreements. The legal process will take an indeterminate period of time. In the interim, CSHM will continue to perform normal operations and will continue to provide our internal and external constituents with up-to-date information. Should you have questions regarding this matter, please contact a member of our communications team at Lovell Communications:
You have to check out CSHM-Small Smiles “Quality and Compliance” webpage. Past the list of the overseers, you will find a link that says“For more information, please visit: www.smallsmiles.com/compliance.
Go ahead, click it.
MARCH 12, 2014 - A company that manages a chain of dental clinics once accused of subjecting children to painful and unnecessary procedures and bilking the government for millions of dollars has been notified it will no longer be eligible for reimbursement from federal health care programs like Medicaid, its principal source of revenue.
The company, CSHM, manages 53 clinics nationwide, most of which operate under the name Small Smiles. The clinics treat mostly low-income children in areas where access to dental care is limited.
The Office of the Inspector General of the Department Health and Human Services sent a letter to CSHM on Friday citing multiple breaches to a compliance agreement, which mandates quality of care measures. The breaches included failing to report incidents involving patients at Small Smiles clinics in Tulsa, Okla., and Mattapan, Mass.
The OIG declined to provide further detail on the specific breaches that led to the exclusion.
Sen. Chuck Grassley, R-Iowa, who last year published a report on corporate dental management companies along with former Sen. Max Baucus, D-Mont., said Monday that the CSHM exclusion notice “will protect both taxpayers and vulnerable children receiving dental care in the Medicaid program.”
Check out the uptick in legal, conference and lobbying expenses. I’m not sure how you can spend that much in a year and not work more than 8 hours a week.
Management fees have also skyrocketed.
CSHM and Small Smiles have been dodging media phone calls for days. They have finally issued a statement; begrudgingly I'm sure.
They say they will appeal. I hear they won't. Hell, they have been appealing since 2010; dang near quarterly.
They have received at least 2 earlier threats to be excluded; maybe three. The report issued last year by Senator Grassley's office basically asked, "how bad do these folks have to be before excluding them. They may appeal just to keep the revenue flowing. But I would think they should be on a Credible Allegation of Fraud pay hold.
In a letter (see below) to Inspector General Daniel R. Levinson, Rep. Michael Burgess (R-TX) and Rep. Diana DeGette (D-CO) express their continued concerns about “deceptive practices of dental management service companies (DMSOs)”.
They further call on HHS OIG to exclude any corporate dental companies from participating in the Medicaid program, saying, “Based on the report by the Senate Committees and the prior findings of HHS OIG, we concur with our Senate colleagues and recommend that HHS OIG should consider excluding any corporate entity that employs deceptive business practices that result in substandard care, from the Medicaid program.”
Burgess and DeGette are also concerned about the length of time it has taken to bring one of these companies—Small Smiles Dental Centers—to justice.
The letter recounts the history of the Small Smiles investigation, starting with the “2008 investigative news report” by WJLA in Washington. That report actually aired in November 2007; so it’s even worse, right?
The 3 page letter also states:
March 10, 2014
WASHINGTON – Senator Chuck Grassley, senior member and former Chairman of the Senate Committee on Finance, said the decision of the Inspector General for the Department of Health and Human Services to disqualify CSHM, LLC from the Medicaid program “will protect both taxpayers and vulnerable children receiving dental care in the Medicaid program.”
The Inspector General delivered a Notice of Exclusion (click here to read the Notice) following a year-long investigation by Grassley and then-Chairman Max Baucus of Montana into allegations of abusive treatment of children in clinics controlled by corporate investors rather than dentists. The senators issued a report and recommendations last July and urged the administration to ban dental clinics from participating in the Medicaid program if the dental clinics circumvent state laws designed to ensure only licensed dentists own dental practices to prevent substandard care.
“Our oversight found that when states can’t hold owners accountable, then clinics are more likely to fail to meet standards that protect the children who should be helped,” Grassley said. “The actions of some dental practices strained the Medicaid program and put low-income children in traumatic, highly questionable situations.”
OMG! OMG! OMG!
After 7 long years of persistence, it’s finally happened! Small Smiles Dental Centers are excluded from participation in Medicare, Medicaid and all Federal Health Care Programs!
Let us not forget, the dental centers Quality and Compliance was overseen by:
Dr. Paul Casamassimo
Dr. Arthur Nowak
Dr. Joe Bernat
Dr. Anupama Tate
Dr. Steve Adair
I can’t woo hoo and OMG enough—I’m shaking from head to toe with glee!!!!!
Now, where can I locate a bottle of the “good stuff” Champaign!
Since the Antoine Dental Center's favorable ruling was overturned last week, TDMR, is calling for a Federal investigation into the judge. (God, I hate linking to these people! I think this is a ploy to get me to send them web traffic! LOL Don’t enter a password, it’s a phishing expedition.)
Yes, they want a Federal Investigation into the judge! Talk about cry babies! These guys simply can’t stand defeat. I bet they all got trophies for participation when they were kids.
However, to read about their game plan, you need a password. That’s right, a password. They have this big headline, then tell you to read it, you need their permission. Maybe it’s only a headline? Think?
I'd say an investigation should look at the previous decision of the administrative judges, but I try to give them a break that they just didn’t know what they didn’t know.
Frankly, the more Federal investigations into this the better. What's really odd, is this particular case is over some $400,000. Who spends $2-5 million in attorney fees to recoup that amount? Yeah, this is much bigger than Antoine Dental Centers.
One thing that crosses my mind, is how Dr. James Orr and Bob Anderton trained these dentists how to cheat the system—in Anderton’s own private law office—and now Orr is the “expert” witness for the dentists and Anderton is their attorney. Talk about conflict of interest! Geez! This seems to be more about Orr and Anderton covering their own butts, than it is about Antoine Dental Center’s pay hold.
Currently Orr and Anderton are touring, teaching dentists about—of all things—record keeping!
There is just no way that this is sliced where the attorneys representing Antoine Dental Center and Dr. Nazari have their clients best interest ahead of their own. I almost feel sorry for Nazari. He could have, reached some settlement, taken his slap on the wrist, paid a little fine, and gone on about his business. At worse, a few months jail time; he would have gotten more sleep there than I bet he’s getting these days. I believe he is being coerced. Pure craziness.
Where’s the popcorn?
Analysis of ADC vs. Texas Health and Human Services Commission
March 6, 2014 -- Why should anyone care about a dental Medicaid ruling from an administrative law court in Travis County in Texas? One reason is that this case involves several millions of taxpayer dollars. Other similar cases brought before this court of alleged dental Medicaid fraud and abuses have and will involve taxpayer money, in excess of $100 million.
The vast majority of dental Medicaid fraud cases are generally resolved in settlement agreements. Alleged violators usually pay some amount of restitution to the government in exchange for no admission of wrongdoing. Often, the alleged violators return to "business as usual." We, the public and dental profession, receive little or no data on case specifics. Records of investigations are sealed upon settlement.
Public record disclosure of this particular case exposed some of the dark underbelly of the dental Medicaid industry, along with some of its nefarious inner workings.
In the Welcome Letter from Dr. R. Quinn Dufurrena as posted on the Dental Group Practice Association (DGPA) and the DGPA’s press release, I think it’s clear what the plan is for the group; more “creative” dentistry —i.e. teledentistry (whatever the hell that is)—and changing state dental practice acts to be more revenue generating friendly, despite any loss in patient quality of care. After reading excerpts of several articles and interviews with Dufurrena published over the years, it appears he’s wishy washy on many issues, other than teledentistry. Other than that, he will be whatever they need him to me. Of course, I could be wrong.
From Dufurrena’s Welcome Letter at the DGPA:
From the March 3, 2014 DGPA Press Release:
Doug Brown is president of Affordable Care, Inc. Steve Thorne is president of Pacific Dental Services. Neither are dentists.
Dr. Richard Quinn Dufurrena hasn’t been interested in the actual practice of dentistry in years; if ever. But he has been interested in the business of dentistry. So he is going to fit right in the DGPA and the DSO business modeling they promote.
From the June 2008 article about Dr. Dufurrena’s Hillibrand Fellowship and him taking the position as Executive Director of the Idaho State Dental Association:
Judge finds credible evidence of Medicaid fraud by Texas clinic
March 5, 2014 -- A Texas judge has upheld payment holds on Medicaid payments for Houston dental clinic Antoine Dental Care (ADC), citing credible evidence of Medicaid fraud. The clinics billed about $8.1 million for orthodontic services in less than three years.
The 36-page ruling was issued February 28 by Judge Rick Gilpin, an administrative law judge for the Texas Health and Human Services Commission (HHSC).
Reimbursements for Medicaid claims by ADC, which has two clinics in Houston, have been on hold since 2012, pending an investigation by the HHSC and the Texas Office of Inspector General (OIG) for Medicaid fraud involving orthodontic care. ADC ranked in the top 25 providers for Medicaid payments; about 70% of ADC's patients were Medicaid recipients, the ruling stated.
In February 2013, Dr. Richard Malouf of All Smiles and home waterpark fame started his own website, richardmalouf.com. Below is his press release about all the issues he was addressing.
New Website Released for Dr. Richard Malouf of Dallas
Successful Dallas dentist and entrepreneur sets up own news portal at http://www.richardmalouf.com.
Amazingly, it’s gone poof!
His facebook page is barebones, so is his youtube channel.
But no Richardmalouf.com.
The scammers running the Texas Dentists for Medicaid
Fraud Reform (TDMR) website have boasted time and time again, over rulings made against Texas taxpayers and for Antoine Dental. Heck, they have a whole section of their website devoted to their “wins”. They have also had their cronies on this website, commenting about how they are winning their cause; which appears to be “Let us continue to defraud taxpayers.” Frankly, I think their name should be “Friends of Dental Medicaid Fraud”. I’m not sure what they consider a “win”. Apparently, it’s not what you and I call a “win”. Their headlines over there are outright false! So imagine the bullshit contained within! I especially love their comment section, entitled “Speak Your Mind”, amazingly what is on my mind doesn’t seem to make it, maybe yours will. Click here.
On November 5, 2013 their headline read, “OIG Loses Another Medicaid Fraud Court Battle” an article they were happy to assist with in the Texas Tribune.
(Battle, yes, WAR, NO!)
Then on November 6, 2013 their headline read – Antoine Dental Center Innocent of All OIG Allegations of Fraud and Misrepresentation.
(This is especially galling, since it is an outright lie! Lie!!! Lie!!)
Again, on January 17, 2014—SOAH Judges Again Reject OIG Arguments in Antoine Dental Case
Today, what’s missing from their website is the headline of this blog post;or something close to it.
It appears the Applet Court and Judge Rick Gilpin disagreed 100% with all other rulings in the Antoine defraud Texas taxpayers case. He issued a “Final Order” on Friday (February 28,2014) that walked through this case and all the hearings and ruling step by step and ruled completely opposite of all other rulings—Antoine Dental to remain on 100% pay hold.
You don’t want to miss reading the Final Order. He all but called them all, Antoine owner, Dr. Nazari—including the Administrative Law Judges—criminals and at the best—imbeciles. You read it and decide.