CSHM, LLC (Small Smiles Dental Centers) Files for Chapter 7 Bankruptcy

February 17, 2015
Just 4 months after CSHM, LLC (Small Smiles Dental Centers) were Excluded from the Medicaid program, Michael F. Gries, the installed Chief Restructuring Officer, filed Chapter 7 Bankruptcy in Delaware Bankruptcy Court on February 5, 2015. (Case No. 15-bk-10206)

CSHM, LLC is the restructured company that emerged in June 2012 when Church Street Health Management (f/k/a FORBA) filed for Chapter 11 Bankruptcy February 20, 2012. (Case No. 12-bk-01573)

Church Street Health Management signed a 5 years Quality of Care Corporate Integrity Agreement in January 2010 (CIA) after a 3 year investigation by the feds that found billing fraud and gross mistreatment, overtreatment and failure to come close to meeting an acceptable standard of care treating the dental needs of children on Medicaid. They also agreed to pay $24 Million for their misdeeds; the Department of Justice was to received $14.2 Million and 21 states were to share $9.7 million and explained here on page 6.

In addition Church Street Health Management (f/k/a FORBA) signed a Corporate Integrity Agreement with the New York Office of Medicaid Inspector General. Agreeing to paying New York and additional $2.3 million.

After continued blatant disregard for the Quality of Care Corporate Integrity, consistent failures of inspections, a 1500 page bi-partisan 2012 Congressional Report  and various warnings by HHS-OIG, CSHM, LLC received notice they were Excluded from the Medicaid program in March 2014. However the government saw fit to allow CSHM, LLC to pilfer and plunder the Medicaid slush fund for an additional 6 months under an Exclusion Agreement.

“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.”

Despite the “Quality of Care” issues as indicated by the classification of the type of Corporate Integrity Agreement they were under, and results of the Monitor’s monitoring, when CSHM received their Exclusion letter they claimed none of the clinics they own were effected it was just the management division of the company and issued a press release stating the centers different entities therefore not effected. HUH?

Here we are in 2015, 8 years since Small Smiles dental centers and their so called management company, CSHM were first investigated—it started in mid 2007— and it just past the anniversary of the 5 year CIA. Heck it expired two weeks ago—January 15, 2015.
According to the 31 page, 3 columns, list of Creditors filed February 5, 2015 they still owe various states their portion of the $24 million dollars. (a breakdown is below)  

They owe several “owner dentists”, support staff, and other dentists, as well as whistleblowers, dental boards, ad agencies, law firms, TV stations, court reporters, (for the numerous lawsuits in which they are involved), storage facilities,(wonder what’s hidden there), utility bills for their clinics, dental labs and insurance companies (hope they kept the Malpractice premiums up for all those dentists!), and every dental supply company in the country, and various management companies. (yep, the management company hires management companies)

Other notables were, Garrison Loan Agency who ponied up the dough to keep this scumbag company alive and kicking from 2012-2015 and the IRS.

Those missing for the list are David R. Wilson, CEO and other top executives, and Waller Landsden Law Group.  Hmmm… Pleadings indicate Wilson was paid $1,194,432.85 the year preceding the filing of the bankruptcy.

Other points of Interest in the initial documents:
Doc 2 Schedules of Assets and Liabilities,
Page 2, Item 3
—In accordance with the Exclusion Agreement, the Company divested itself of substantially all of the CSHM Assets through a series of sales between April and September 2014.  Included among the sale of the CSHM Assets, the Company sold certain assets to First Quality Management, Inc. (FQMI), pursuant that certain Asset Purchase Agreement, dated as of September 30, 2014.  Separately, the Company also entered into that certain Assignment and Assumption Agreement with FQMI, dated September 30, 2014, in connection with the assumption of six (six) MSA’s.  A breakdown of the other clinics can be found here, beginning on page 9.  Missing from that list is all the Colorado clinics except the Colorado Springs clinic.  Interesting, indeed.

So I was right when I posted about FQMI and the continued operations of Small Smiles Dental Centers. Current pleadings say they paid Dr. Paul Elkin $401,574.00 in the year proceeding this bankruptcy filing.  He’s the new head at FQMI according to his LinkedIn page.

Page 2, Item 4
—Additional assets were sold to employees of the Debtor in September 2014…

Wait, I thought the “owner dentists” were already “owners”, not employees!” (sarcasm)

Page 11 & 12
—1st. Lien Holder: Garrison Loan Agency Services, LLC – $37,500,000.00 initial loan, still owed $28,764,918.60;
—2nd Lien Holder: Garrison Loan Agency Services, LLC – $17,500,000.00 initial loan, still owed $17,786,714.00.
——Grand Total for Secured Creditor Garrison Loan Agency $46,551,633.00
Under Creditors Holding Unsecured Nonpiority Claims (Schedule F, page 15, of Doc 2) are all Medicaid Fraud Control Units Creditors and the amount:

	State	Known 2010 Settlement Amounts	Due as of January 2015
1	MFCU of Alabama	$463,028.00	$79,595.63
2	MFCU of Arizona		$127,853.41
3	MFCU of Colorado	$1,200,00.00	$616,099.66
4	MFCU of  Georgia		$288,910.84
5	MFCU of Idaho		$46,687.18
6	MFCU of Indiana		$348,534.90
7	MFCU of Kansas	$517,959.60	$260,969.66
8	MFCU of Kentucky	$123,693.14	$22,484.43
9	MFCU of Maryland		$275,814.83
10	MFCU of Massachusetts		$726,035.97
11	MFCU of Nebraska	$270,000.00	$61,717.55
12	MFCU of Nevada		$83,402.83
13	MFCU of New Hampshire		$48,090.36
14	MFCU of New Mexico		$182,376.06
15	MFCU of New York $1.15M+ $2.3M	$3,450,000.00	$315,849.66
16	MFCU of DC		$78,057.19
17	MFCU of Ohio	$2,392,926.50	$502,185.04
18	MFCU of Oklahoma	$700,00.00	$355,411.82
19	MFCU of South Carolina		$471,779.92
20	MFCU of Texas	$546,000.00	$117,851.57
21	MFCU of Virginia		$228,616.76
22	Department of Justice	$14,200,000.00	$12,966,496.00
23	Department of Justice		$7,844,455.34
	Grand Total	$26,300,000.00	$26,049,276.61

According to the pleadings (Doc 8-1) Amended Schedule B Personal Property they have:
Assets:            $136,369.67
Liabilities:  $73,314,905.16

The 2010 Corporate Integrity Agreement
The DOJ said in 2010 “"We have zero tolerance for those who break the law to exploit needy children," said Tony West, Assistant Attorney General for the Civil Division of the Department of Justice. "Illegal conduct like this endangers a child’s well-being, distorts the judgments of health care professionals, and puts corporate profits ahead of patient safety."

(cough, choke and puke, they have complete tolerance, encourage it, and are accomplices to it!)

Drs. Michael and Rebecca Tarver: A Serious Threat to Children? I think so!

The latest report out of Ocala, Florida reveals some of the dangerous practices taking place inside Churchill Dentistry, formerly known as Polliwog Dentistry.  I can’t believe there haven’t been a host of dead children due to these two quacks.

Here are a few items pulled from the latest article:

• "…Churchill Dental billed Medicaid and the Medicaid recipient for the same service and also delegated their duties to dental assistants who sedated patients,"
• “…Tarver would tell parents that he had to apply the sealant to the patient's teeth and Medicaid doesn't reimburse him for the procedure.”
• “…Tarver would use a dental tool called a gold flame bur on the top of the child's teeth where natural grooves and cracks were present and would remove "pieces of healthy tooth…Tarver would then fill the space with a resin composite and bill Medicaid as if he had "filled a one- to two-surface cavity. Parents would later complain because they had received a bill from Medicaid, which charges recipients $25 per tooth for each resin filling, though Tarver had told them their children had no cavities.”
• “…both dentists would sedate every patient with hydroxyzine, which is used as a sedative to treat anxiety and tension, and with other medications for anesthesia..dental assistants would weigh patients and report the weight to one of the two dentists, and then one of them would say how many milligrams to administer…sometimes 12 to 15 children were being sedated. The average number, she said, was 10. For most kids, blood pressure and oxygen levels were not checked during sedation, the former office manager said, yet all their charts reflect blood pressure and oxygen readings that were "almost the same."
• “…Those who didn't respond to hydroxyzine were given Versed, a brand version of midazolam, used to "produce sleepiness or drowsiness and to relieve anxiety before surgery or certain procedures," the report states. Dr. Michael Tarver would inject it into the child's mouth.”
• “…the dental assistant — estimated that the office would treat 60 patients a day. It was open 9 a.m. to 5 p.m. Monday through Thursday with only the two dentists.”

Read the entire shocking story here.