Monday, August 29, 2016

TOXIC TROIKA FOR DENTAL PATIENTS: Collusion Between Corporations, Government and Organized Dentistry Maximizes Healthcare Profits

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



 
TOXIC TROIKA FOR DENTAL PATIENTS: Collusion Between Corporations, Government and Organized Dentistry Maximizes Healthcare Profits
 

Introduction
The US healthcare industry is corrupted by crony capitalism1 of government special treatment and favoritism, from big corporate healthcare political donors. A classic example is the McCarran-Ferguson Act of 19452, which exempts the healthcare insurance industry from federal antitrust regulation and statutes, which every other American industry must comply with. Insurance industry lobbyists have successfully defeated repeal attempts, throughout multiple decades of different political administrations. Money talks in Washington regardless of political party.

In the dental healthcare industry specifically, we’ve witnessed countless examples of government support for big business interests. The donor class3 of major political parties doesn’t care about labels such as Republican or Democratic. They expect special treatment and favoritism from government, for the moneys they pay in.


Examples of Dental Industry Crony Capitalism
 
In 2012, North Carolina attempted to establish statutes to protect the doctor/patient relationship, and a patient’s right to full disclosures within the dental informed consent process. The state was met with a heavy barrage of out-of-state big dollar opposition from the dental service organization (DSO) industry. (Author’s note: “Dental Service Organization” is an intentional misnomer created by this industry, which either beneficially owns dental clinics, or is subordinate to private equity investment groups which do. The allegation of support limited strictly to non-clinical services, and not patient care, is a bogus claim.4) Republican lobbyist old-boys Jeb Bush, Haley Barbour, Bill First, Tommy Thompson, Grover Norquist, and many others descended en masse into North Carolina, for this test case state legislation.5,6
 

The private equity investment industry, which controls most of corporate dentistry, pulled out all the stops. They funded a massive advertising campaign of misinformation relating to “access to care” and low-cost dental treatment. Through DSO industry lobbyists and private equity investment firms, “donation” dollars flowed to local state politicians. The initial legislation designed to protect the public interest from the unlicensed and unlawful practice of dentistry by a corporate third party, without the knowledge or consent of patients, was largely stifled. A watered down bill was eventually signed by the governor.

Crony capitalism of the federal government’s support for big business dentistry is well established. The Federal Trade Commission (FTC) stated the aforementioned North Carolina consumer protection legislation for dental patients risked reduction in trade competition.7 The FTC blindly accepted arguments of the DSO industry at face value, while totally ignoring the federal Fifth Circuit Court of Appeals ruling 07-30430.4
 
The FTC followed the same course of crony capitalism in support of the DSO industry in Texas.8 Absurd spin generated by the DSO industry became talking points of the FTC in an advisory letter to the Texas State Board of Dental Examiners’ legal counsel, “Proposed 22 TEX. ADMIN. CODE § 108.74 would make dentists who own, maintain, or operate a dental practice that employs a dentist “responsible for all administrative and operational” functions. Although the proposed rules do not expressly refer to Dental Service Organizations (“DSOs”), the rules seem likely to discourage dentists from affiliating with DSOs by mandating that dentists assume responsibility for the types of functions that DSOs typically provide, and by expanding the Board’s authority to take disciplinary action against dentists who enter into such prohibited agreements.”

The entire position of the FTC is based on a false premise of the doctor owning the dental practice and in full control of clinical decisions. Federal Fifth Circuit Court of Appeals ruling 07-30430, which is largely based on Texas state law, demonstrated the ridiculousness of that assumption. Dentists are employees, and are only nominee owners at best. They generally take orders from unlicensed managers. They can’t sell “their” asset of the dental practice without authority of the controlling party (beneficial owner), the DSO. Fee splitting of the doctor’s production billings are awarded to the DSO and are standard fare. Bonuses and quotas for clinical production are commonplace. Doctors retained for employment by a DSO rarely if ever have control over selection of clinical supplies or laboratories, in a patient’s best interest. Auxiliary clinical staff like hygienists and dental assistants is truly not under the direct control doctors, and too often freely engaged in unlicensed activities sanctioned by their employer, the DSO. Often the DSO, not the doctor, mandates which clinical specialists a doctor must give patient referrals to. Obviously, the DSO is intimately involved in the unlicensed and unlawful practice of dentistry. It’s in the interest of the DSO industry and the private equity investment industry to subvert government oversight and regulation, which they’ve been very successful in doing.

A master at the political and big business game of “pay to play” was former New Mexico Governor “Dollar” Bill Richardson (D-NM). His foray into the dental industry was through the New Mexico State Investment Counsel (SIC), which he chaired. The SIC was established to award low interest loans and grants, to New Mexico based businesses, in an effort to grow the state’s economy. $550,000 of state taxpayer money went to Small Smiles Dental (operated under the DSO title Forba). Forba was not headquartered in New Mexico, but Nashville, TN. Further at that time, the principle owner was Arcapita Bank (a today defunct Islamic Sharia compliant investment bank), in the Arabic Kingdom of Bahrain. To date, those taxpayer funds have never been accounted for.9
 

Nationally, numbers of DSOs have gone bankrupt, locked their doors to staff and patients, and abandoned patients in mid-treatment with citizen/patient funds on account. Examples include smaller DSOs in Texas10, but also larger corporate interstate chain dental clinics such as All Care Dental and Dentures.11 Prior warnings to government from concerned dentists did little to motivate state governments unwilling to take regulatory preventive action. State and federal authorities seem mired in the fantasy myth of doctors, and not corporate managers, as controlling corporate dentistry. With enough corporate money, reality gets distorted and government puppets dance to the tune, which they’ve been hired and paid for.


Blowback against Crony Capitalism in Dental Healthcare
 
Most states have statutes against fee splitting in healthcare professions, as it’s considered a highly unethical practice, and not in the interest of patients.12 (Author’s note: A doctor and most healthcare professionals have an ethical and fiduciary responsibility to place patient interests to the fore, because of their vastly superior expert knowledge and training.13 By contrast, a corporation has a primary ethical and fiduciary responsibility to generate profits for shareholders.14 The conflict-of-interest is self-evident. Neither doctors nor free market corporate managers can serve two masters. Healthcare isn’t the buying and selling of widgets.)
The North Carolina State Board of Dental Examiners (NCSBDE) filed suit against Dental One (a/k/a Dental Works), an interstate DSO, alleging the unlicensed and unlawful practice of dentistry by a non-dentist entity.15-6 This action filed by the NCSBDE has today been settled. Dental One has severe restrictions for alleged unlawful practice of dentistry, but only in North Carolina.

Washington State’s Department of Financial Institutions examined the dental franchise operation of Comfort Dental (chain of alleged dental franchises) and viewed them to be in violation of open disclosure laws of Washington, which largely mirror federal statutes.17A cease and desist order was agreed upon in the consent order of April, 2012. Yet, Comfort Dental continues to market so-called franchise opportunities in OH, IN, KY, MO, NE, KS, OK, TX, CO, NM, AZ, MT, as well as Washington, as of the date of this article.18 Seemingly, the cease and desist order within the consent agreement represents a meaningless “speedbump”, to the operation of Comfort Dental and its principles; Rick Kushner, Neil Norton and Graig Bears.
The Washington State insurance commissioner issued in August of 2015, a cease and desist order against the aforementioned Comfort Dental.19 This time the alleged violation was over the company’s “Gold Plan”. This is a discounted fee plan, which very closely resembles a duly registered and bonafide insurance vehicle, which it is not. Dentist franchise operators have expressed concerns in their individual states over potential misrepresentation to the public of Gold Plan as an insurance offering, specifically in MO, KY, and IN.20Unfortunately, franchise dentists are contractually obligated to honor Gold Plan regardless of possible violation to state law. Doctors are squeezed “between a rock and a hard place”.

More recently (February 1, 2016), the Hearing Unit Office of the Washington State Insurance Commissioner issued another cease and desist order against Comfort Dental Gold Plan, LLC.21 This order was required, as the previous order was allegedly disregarded by Comfort Dental. The insurance commissioner’s final order is well supported in detailed case law. The fines against Comfort Dental for non-compliance with the law are serious. Yet, one wonders if a few dollars placed in the “right” politician’s hand might not reverse this order? We’ll see.

One big complaint nationally by dentists working for Comfort Dental is their contract requirement to strictly use Budget Dental Lab for their patients. Serious concerns over dubious lab quality and negative patient outcomes have been expressed.20This problem isn’t restricted to Comfort Dental, but is a highly universal issue within the DSO industry negatively affecting patient care involving corporate unlicensed practice of dentistry.

Washington State hit Comfort Dental with yet another cease and desist order (July 5, 2016) for unlawful fee splitting via a “royalty” fee based on gross clinic collections, as well as the illegal practice of dentistry by a corporate entity.22 This action by Washington in many ways mirrors the earlier case by the NCSBDE against Dental One. The state’s brief is well structured, and again well supported in case law precedence.

One wonders how Comfort Dental and their directors; Rick Kushner, Neil Norton and Graig Bears will respond? Interestingly in the manner of organized crime Mafia figures, Rick Kushner (no longer a licensed dentist), is referenced as “the Godfather” on Facebook and by colleagues. One ponders how the DSO industry can continue the absurd myth, of not actively engaging in the unlicensed and unlawful practice of dentistry? How many palms need to be greased?


Corporate Dentistry Fights Back
The case was clearly made how corporate dentistry fought for their interests, over public interests, in North Carolina. That battle has been waged by the DSO industry nationally and on many fronts.23 Through media outlets and state and national legislatures, corporate dentistry has pounded home their self-serving messages. Money can purchase political favors, buy media attention, and even buy-off the dental profession itself (as the author will demonstrate later).
However, few in corporate dentistry have been so ham-fisted in squelching dissenting opinion, as Comfort Dental. Comfort Dental filed defamation suits again four individual University of Colorado dental professors, for alleged remarks made to students.24 That case has since been settled and parties aren’t talking, because of non-disclosure agreements in the settlements. Regardless, Comfort Dental has established corporate dentistry precedence, for shutting down opposition voices. The alleged slander was no worse than can routinely be found in online patient reviews of Comfort Dental, or most DSOs.

The DSO industry is currently fighting hard in Washington State, to put forth their misrepresentations, in spite of the disturbing activities of Comfort Dental and many others.25 Hired advocates place DSO myths and distortions in business publications such as Forbes.26 Money buys access, influence, and usually results.

The most visible lobbyist group for the DSO industry is the Association of Dental Service Organizations (ADSO).27 Corporate dentistry hired Dr. R. Quinn Dufurrena (January, 2011), former executive director of the Idaho State Dental Association, and then current executive director of the Colorado Dental Association, as executive director of the ADSO. (Author’s note: the connection to the CO Dental Association (CDA) isn’t happenstance, as some of the unethical activities of the CDA will be later highlighted. CO was the birthplace of the highly disturbing Small Smiles Dental, Perfect Teeth Dental, and Comfort Dental.) A primary focus for Dr. Dufurrena was to clean up the image of ADSO members, especially via the ADSO Code of Ethics.28 Some of the more troubling members of the ADSO quickly dropped out; Smile Smiles Dental and Kool Smiles Dental.29-31 Yet, these companies or their “progeny” dental companies are still doing business, especially with dental abuses to disadvantaged Medicaid children.

The heads of those companies still remaining in the ADSO couldn’t afford to have even a timid lightweight reformer serve as executive director of the ADSO. Their own companies’ histories and business models were far too checkered.32-38 The focus was to clean up an image, not the reality upon which corporate dentistry operated. On January, 2014, Dr. Dufurrena exited his role with the ADSO.





Organized Dentistry Joins Corporate Dentistry and Corrupt Government; Forming the Toxic Troika
It’s not unusual for organized dentistry to abandon service to doctors/members, as well as the public interest, in an effort to protect their fiscal backers. David Sohn is a San Francisco labor rights attorney. He recently prevailed in a California civil court action against Western Dental.39,40 The case set precedence, as Western Dental declined to appeal the judgement in favor of a dentist whose workplace rights were violated. These sorts of workplace violations are not unique to Western Dental, but common throughout the DSO industry.

After the ruling was established and the DSO (Western Dental) declined to appeal, Mr. Sohn approached the lead legal counsel for the California Dental Association, in an effort to publish the legal decision in the state dental journal. This judgement obviously holds case law importance not only to California dentists (employers and employees), but dentists nationally. The dental association’s attorney advised the dental association would not publish the public record court ruling, because it was adverse to the DSO industry generally and Western Dental specifically. Western Dental and the DSO industry are major financial sponsors of the California Dental Association.

The largest group in organized dentistry is the American Dental Association (ADA). This group as well has played favorites with the DSO industry, ignoring interests of member doctors and the public. Concerned Dentists of Texas, a dentist and public advocacy group, has exposed apparent collusion between the ADSO and the ADA, in 2015.41 Meetings were held in secret without notice to ADA House of Delegates members, or ADA membership at large. The ADA is well aware that clandestine meetings with a dubious organization like the ADSO will not be received well by membership, or other elements of the public. However, sponsorship money through advertising and support of the ADA Annual Meeting is always on the table.

One only needs to go to the Colorado Dental Association website, to see financial sponsorship by the DSO industry. Perfect Teeth Dental has an ad, in which they “proudly Sponsor the New Dentist Committee”.

Working conditions at Perfect Teeth Dental are problematic, and this DSO experiences a continual outflow of resigning employees. Many of their clinics are maintained with temporary agency employees, because dental professionals and auxiliaries are highly reluctant to become employed with this DSO. In fact, when doctors have attempted to resign from this DSO, Comfort Dental has attempted to enforce highly onerous restrictive non-compete contract clauses, in order to keep even highly unhappy and discouraged doctors.
It’s obvious why Perfect Teeth Dental would attempt to attract relatively na├»ve young doctors. It’s also disturbingly apparent why the CDA would run such an ad. Follow the money.


Colorado Dental Association Not Only Carries the Water for Corporate Dentistry, but Drinks the Kool Aid
 
One expects the CDA to be in the tank for corporate dentistry. The former executive director of the ADSO (Dr. R. Quinn Dufurrena) was also the former director of the CDA. Colorado (CO) was the former headquarters for the now defunct and disturbing Small Smiles Dental. It’s still the headquarters for Birner Dental Management, Inc. (d/b/a Perfect Teeth Dental) and Comfort Dental. It’s where the founders of such troubling DSOs as Adventure Dental (a/k/a Hero Dental) and Kool Smiles Dental got their starts, and learned their alarming “tradecraft”.

However, this year organized dentistry in CO sunk unethical collusion, to an entirely new nadir.
Not surprisingly for CO, bipartisan legislative support was given SB16-009, which Governor Hickenlooper (D-CO) signed into state law March 9, 2016.42 This unopposed bill legitimizes the unethical (and unlawful in most states) act of a dental professional fee splitting with an outside corporate entity. In essence, an unlicensed party becomes an owner to a dental practice. The bill’s language specifically utilizes the Comfort Dental franchise term of “royalty fees”, which is under challenge in other states like Washington. This is fully unlawful in North Carolina, which challenged a DSO collecting a percentage of a doctor’s clinical production in court, as an act of practice ownership.

The bill’s sponsors were CO State House Representative Dianne Primavera (D-CO) and State Senator Kevin Grantham (R-CO). This bill promotes crony capitalism of large corporate interests (corporate dentistry) over small business dentistry, which must be responsible to patient interests, not shareholder interests. Interestingly, on Sen. Grantham’s website he supports both “free market capitalism” and “small business owners”. Perhaps this politician may wish to change his website wording, to better reflect his reality?

At the hearing in support of the bill no party spoke in opposition.43 Speaking in favor of SB16-009 was General Counsel for Comfort Dental Graig Bears, and a representative from the CDA, Dr. Jason Ehtessabian. Dr. Ehtessabian is also affiliated with Comfort Dental in the company’s arranged franchise capacity. No one seemed concerned about Dr. Ehtessabian’s or Mr. Bear’s obvious conflict of interest. No representative of small business dentistry attended. No independent representative of the CDA attended, who wasn’t affiliated with corporate dentistry. Obviously, the fix was in against the public welfare in favor of corporate dentistry, corrupt government, and sold-out organized dentistry.

Added to this shameful situation was during the time of this bill’s proceedings, Dr. Claud Michael “Mike” Bloss was disciplined by the Colorado Dental Board on February 16, 2016.44-5 Dr. Mike Bloss, a prominent founding member of Comfort Dental, was issued a cease and desist order for using another doctor’s NPI number for his Medicaid billings.46 Dr. Bloss never in fact obtained an NTI number in Colorado. His Medicaid billings for Comfort Dental were a serious misrepresentation, and might be considered multiple counts of civil and criminal fraud. However, this Colorado case, nor any other states’ sanctions against Comfort Dental or directors, was ever a consideration in Colorado’s legislative process of SB16-009.
The CDA issued this statement on August 5, 2016:

“The Colorado Dental Board recently emailed Colorado dental licensees regarding SB16-009, a 2016 bill that made a technical fix to a longstanding state law on fee splitting by dentists. The Colorado Dental Association wants to make sure its dentists have the most up-to-date information on this new law. "

What SB16-009 DID NOT change:
Dental fee splitting laws aren't new. Fee splitting laws have been on the books for more than 30 years-primarily to address situations of patient referrals and kickbacks. The dental fee splitting law currently lives at CRS 12-35-129(1)(v), though the section numbering has changed a bit over the years. The fee splitting law has a longstanding exemption that allows dentists to pay marketing consultants, but other types of consulting services technically weren't addressed in the law. In addition to state laws on fee splitting, there are stringent federal laws regarding patient referrals and illegal kickbacks that continue and have not changed. No changes have been made to laws governing ownership of Colorado dental practices.

What SB16-009 DID change:
SB16-009 adds a straightforward, second technical exemption to the existing law in CRS 12-35-129(1)(v) to clearly allow payments for business consulting and practice management services. There have been some recent court cases that potentially would have restricted business consulting and practice management services based on CRS 12-35-129(1)(v). Comfort Dental drafted SB16-009 in response to these legal cases. The CDA worked with Comfort Dental to ensure the changes made to the law were written in a way that enhances current practice for all dentists and patients and to ensure any payments for services would protect and preserve the dentist's independent professional judgment. With these amendments, the CDA supported Comfort Dental in SB16-009. All types of dental practices use various business consulting and practice management services, which provide great benefit to practices so long as there is not interference with a dentist's independent professional judgment. In most cases, these changes will add a bit of flexibility for practices, rather than restricting existing practices.
Text of actual changes to the law (for reference):

§ 12-35-129. Grounds for disciplinary action
(1) The board may take disciplinary action against an applicant or licensee in accordance with section 12-35-129.1 for any of the following causes:
(v) Sharing any professional fees with anyone except those with whom the dentist or dental hygienist is lawfully associated in the practice of dentistry or dental hygiene; except that­:
(I) a licensed dentist or dental hygienist may pay an independent advertising or marketing agent compensation for advertising or marketing services rendered by the agent for the benefit of the licensed dentist or dental hygienist, including compensation that is based on the results or performance of the services on a per-patient basis; and
(II) nothing in this section prohibits a dentist or dental hygienist practice owned or operated by a proprietor authorized under section 12-35-116.5 from contracting with any person or entity for business management services or paying a royalty in accordance with a franchise agreement if the terms of the contract or franchise agreement do not affect the exercise of the independent professional judgment of the dentist or dental hygienist.”


Conclusion
 
The toxic troika of big business dentistry, government, and corrupt organized dentistry join together where allowed, to subvert the public interest of dental consumers. Powerful forces undermine the doctor/patient relationship, which is demeaned and degraded to that of high-pressure retail sales. They distort reality with terms like “access to care”, “free market capitalism”, and “economy of scale” resulting in lowered costs to consumers.
In truth, the healthcare accessed is generally of suspect quality. Crony capitalism is not free market capitalism. And, the alleged “economy of scale” comes down to creative accounting and unenforced tax codes on Wall Street tycoons.47-8
 

Editor’s Note: Dr. Jason Ehtessabian is no longer affiliated with Comfort Dental. He ended that business relationship several years ago.


References
1. https://en.wikipedia.org/wiki/Crony_capitalism
2. https://en.wikipedia.org/wiki/McCarran%E2%80%93Ferguson_Act
3. https://psmag.com/the-rise-of-the-political-donor-class-35fd8dac0986#.hlypopmrx
4. http://www.ca5.uscourts.gov/opinions%5Cpub%5C07/07-30430-CV0.wpd.pdf
5. http://www.bloomberg.com/news/articles/2012-05-31/republicans-target-dental-bill-that-private-equity-hates
6. http://blog.dentistthemenace.com/2015/12/astroturfing-by-dental-support.html
7. https://www.ftc.gov/sites/default/files/documents/advocacy_documents/ftc-staff-letter-nc-representative-stephen-laroque-concerning-nc-house-bill-698-and-regulation/1205ncdental.pdf
8. https://www.ftc.gov/system/files/documents/advocacy_documents/ftc-staff-comment-texas-state-board-dental-examiners/141006tsbdecomment1.pdf
9. http://riograndefoundation.org/small-smiles-a-case-study-in-state-investment-council-incompetence/
10. http://kxan.com/2014/10/24/austin-cosmetic-dentistry-suddenly-closes-its-doors/
11. http://www.dentistrytoday.com/todays-dental-news/4325-ny-based-allcare-dental-chain-closes-unexpectedly
12. https://en.wikipedia.org/wiki/Fee_splitting
13. http://www.ada.org/en/about-the-ada/principles-of-ethics-code-of-professional-conduct/beneficence
14. http://www.nytimes.com/roomfordebate/2015/04/16/what-are-corporations-obligations-to-shareholders/a-duty-to-shareholder-value
15.http://www.adea.org/uploadedFiles/ADEA/Content_Conversion_Final/policy_advocacy/Documents/emailDist/Press_Release.pdf
16. http://www.pbs.org/wgbh/frontline/article/dentalworks-chain-misdiagnosed-for-money-dentists-say/
17. http://www.dfi.wa.gov/documents/securities-orders/S-11-0766-12-CO01.pdf
18. http://comfortdental.com/comfortdentalpartnerships/
19. https://www.insurance.wa.gov/oicfiles/orders/2015orders/15-0184.pdf
20. https://www.scribd.com/document/223131741/Doc-6-CDMO-CDET-Craig-and-Carl-Bahr-v-Comfort-Dental-Crag-Bahr-Declaration-04-04-2014
21. https://www.insurance.wa.gov/laws-rules/administrative-hearings/judicial-proceedings/documents/15-0183-final-order.pdf
22. https://www.scribd.com/document/319922158/Washington-State-Notice-of-Intent-against-Comfort-Dental-for-illegal-practice-of-dentistry
23. http://blog.dentistthemenace.com/2015/12/astroturfing-by-dental-support.html
24. http://www.denverpost.com/2013/12/24/comfort-dental-plans-to-sue-cu-dental-school-professors-for-slander/
25. http://www.washingtonpolicy.org/publications/detail/legislative-memo-hb-1514-to-allow-the-use-of-dental-office-support-services
26. http://www.washingtonpolicy.org/publications/detail/legislative-memo-hb-1514-to-allow-the-use-of-dental-office-support-services
27. http://theadso.org/
28. http://theadso.org/wp-content/uploads/2015/09/ADSO-Code-of-Ethics.pdf
29. https://www.justice.gov/opa/pr/national-dental-management-company-pays-24-million-resolve-fraud-allegations
30. https://oig.hhs.gov/newsroom/news-releases/2014/cshm.asp
31. https://www.publicintegrity.org/news/Kool-Smiles
32. https://www1.eeoc.gov//eeoc/newsroom/release/6-2-10.cfm?renderforprint=1
33. http://www.pbs.org/wgbh/frontline/article/aspen-dental-facing-class-action-lawsuit/
33. http://www.ag.ny.gov/press-release/ag-schneiderman-announces-settlement-aspen-dental-management-bars-company-making
34. http://www.ada.org/en/publications/ada-news/2015-archive/october/indiana-attorney-general-takes-action-against-aspen-dental
35. http://www.mass.gov/ago/news-and-updates/press-releases/2014/2014-12-22-aspen-dental-aod.html
36. https://www.consumeraffairs.com/news04/2010/10/aspen-dental-settles-pennsylvania-complaints.html
37. https://www.justice.gov/archive/usao/ilc/press/2008/04April/0411.html
38. https://casetext.com/case/hoffmann-v-aspen-dental-management
39. http://www.plainsite.org/dockets/xwi4m7oo/superior-court-of-california-county-of-san-francisco/ashwin-nanda-dds-v-western-dental-services-inc/
40. http://blog.dentistthemenace.com/2015/10/dso-business-model-includes-violating.html
41. http://concerneddentistsoftexas.com/wp-content/uploads/2015/11/Full-page-photo-page-4-3-1.pdf
42.http://www.leg.state.co.us/clics/clics2016a/csl.nsf/fsbillcont3/0BC25CD7DF1E142687257F2400642C6F?Open&file=009_enr.pdf
43. http://coloradoga.granicus.com/MediaPlayer.php?view_id=46&clip_id=8637&meta_id=162219
44. https://www.scribd.com/document/322388950/160205-Order-to-Show-Cause-and-Notice-Dr-Claude-Bloss-co-Dental-Board
45. https://www.scribd.com/document/322388953/160226-Stipulated-Order-Dr-Michael-Bloss-co-Dental-Board
46. http://www.solutions-medical-billing.com/npinumber.html
47. http://blog.dentistthemenace.com/2015/06/basic-economic-models-of-large-scale.html
48. https://www.scribd.com/document/267615015/DSO-Organizational-Chart-By-Michael-W-Davis-DDS

Thursday, August 25, 2016

WHISTLEBLOWERS IN ACTION: Dr. Steven Pesis Discusses How Unethical Use of HIPAA Contribed to Patient Abuse at University of Pennsylvania

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




image
Dr. Steven S Pesis DDS
Email: Shimstock1@gmail.com
Dr. Steven S. Pesis studied psychology at Queens College before receiving his DDS at The University of Michigan School of Dentistry. He then received advanced training in general dentistry by attending the AEGD residency program at the Kornberg School of Dentistry at Temple University. During his residency he was educated in a variety of complex dental cases, including full mouth rehabilitations, implant dentistry, esthetic dentistry, Invisalign and dental anxiety. Following his residency, he worked in public health dentistry until he joined the Penn Dental Family Practice at the University of Pennsylvania. He also taught as Clinical Associate in the Department of Preventive and Restorative Sciences for the University of Pennsylvania School of Dental Medicine.
 
Born and raised outside of Detroit, Michigan, Dr. Pesis is a member of a family of dentists. His father and uncle share a practice in Michigan, while his brother practices in the public health sector for Philadelphia. He hopes to use his knowledge of dentistry and psychology to provide patients with the best possible care, educate future dentists and to further the advancements in the dental field.
 

INTRODUCTION

Dr. Steven Pesis is a public safety whistleblower, who acted in accord with his ethical and legal obligations to expose patient abuses under the American Dental Association Principles and Code, Pennsylvania Commonwealth administrative statutes under the dental practice act, as well as internal policy of the University of Pennsylvania (U/Penn). As a result, Dr. Pesis alleges he was wrongfully terminated from employment by U/Penn. Dr. Pesis filed a legal action against the Trustees of U/Penn and Peter K. Kauderwood, assistant dean at U/Penn School of Dental Medicine.

See: Suit Claims Penn Dentist Was Fired For Reporting Unneeded Treatment
 
INTERVIEW
Dr. Davis: Dr. Pesis, I sincerely thank you for taking the time and effort to address matters of this case. Our readers will fully appreciate you are unable to address certain specifics and details of this issue, because of ongoing litigation. However, could you give our readers an overview and outline of your case? 
 


Dr. Pesis:Thank you for taking the time to discuss these issues, Dr. Davis. You are a true dental professional, constantly advocating for patients and bringing these issues to the public. The importance of quality care for dental patients, honesty and integrity are the cornerstones of dentistry and should not be overlooked.
 
My situation began close to a year ago. The Penn Dental Faculty Practice also known as the Penn Dental Family Practice (PDFP) renovated a large portion of a new building at the University of Pennsylvania in order to relocate one of its three offices. The cost quickly began to increase and once completed, the project was rumored to be severely over budget. This office at 3737 Market, known as the University City location, was to be the crown jewel of the PDFP and many of the top producing dentists were transplanted from the other offices to this new location. After all of the commotion, I remained as the only full-time dentist at the PDFP Locust Walk location and I was designated by Dean Denis Kinane of the dental school as the Clinical Advisor for this location.
 
Shortly after the opening of the new office, the Locust Walk location hired a new dentist in order to fill the void left by the relocation of multiple dentists. During the new doctor’s first few days working at Locust Walk, I received reports from doctors and hygienists that he was extremely aggressive in his treatment plans, over-treating patients as well as billing incorrectly. The clinical advisor from another office also discussed similar concerns with me regarding the new dentist. We both investigated the information and determined that there were real concerns regarding the new dentist’s billing practices and treatments of patients. These findings were finally reported to the clinical director, Dr. Alisa Kauffman. Shortly after the reports were made, I was terminated from employment from the University of Pennsylvania. I was pulled into an office and told that I had violated HIPAA and that I was being terminated from my clinical and teaching positions. I spent nearly an hour explaining that these allegations were false and that everything I did followed HIPAA protocol and did not violate the university privacy policy. One of the last things I said was that regardless of what my fate is, PDFP owes it to the patients to investigate the new doctor’s practices. To my knowledge, no investigation was conducted into the claims that were made and to this day, individuals at the PDFP remain scared to report any wrongdoing by the new dentist for fear of retaliation.

Tuesday, August 09, 2016

When Dental Surgery Lands A Patient in a World of Everlasting Regret

Houston Press logoDon’t miss this entire in-depth article by Dianna Wray at the Houston Press by clicking here.

“…Before Hoover went to work on Noah’s mouth, the receptionist told Deel it would cost $300.”

“…A few minutes later, Hoover asks Deel to come take a look inside Noah’s mouth. As Deel stands by, Hoover opens Noah’s mouth and begins poking around with her fingers and silver instruments. The cavity is too deep, she tells Deel. They might have to put a crown on it. Hoover gestures to the teeth on either side. These teeth are weak too, she says, so they need crowns as well.”

“…Deel agrees the teeth need to be fixed and goes back to the front, where McGonagle, who also happens to be Hoover’s husband, offers Deel another margarita. A dental hygienist appears in the waiting room and informs Deel his son now needs five crowns. It will cost $6,000 out-of-pocket, she says.”

“…McGonagle doesn’t miss a beat. He can see Deel is a nice guy and he wants Noah to get what the boy needs, McGonagle says. Deel might qualify for a “special loan” from a lender that pays the office “right then and there,” says McGonagle. “I’ve had good luck with these guys,” McGonagle tells Deel. Hoover’s office also bills the Deels’ insurance for $6,000. Before Deel has even thought about it, he has applied for a “care card,” a health-care credit card with an extremely low initial interest rate that soars if the card isn’t paid off within the first six months.”

“…According to state district court records filed in Galveston County, Columbo stated that “every one of the crowns done just months ago have short margins or recurrent decay under them.” The documents also allege that “Columbo [told] Lisa and Noah that the crowns need to be replaced in the next few months and furthermore that there [wasn’t] any indication that Noah needed five to six crowns. Columbo also [gave] Lisa contact information for the Texas State Board of Dental Examiners and [encouraged] her to file a complaint.”

“…The Deels contacted Jim Moriarty, a Houston lawyer with years of experience in dental cases, and decided to sue. The case was filed on August 2 in Galveston County District Court.”

“…Moriarty has been representing people and their claims against dentists and dental corporations for about a half-dozen years. “It’s mainly about trust. We’re taught to trust these people in white coats and to believe what they tell us, so it gets very hard for people to ask if they’re trustworthy,” Moriarty says. “

“…Insurance companies have also helped shape dentistry because insurance adjusters have kept the annual coverage rate cap between $1,000 and $1,500 since the 1970s, without adjusting for inflation, according to the American Dental Association. “There are so many financial pressures on dentists today. It’s getting much harder to make a profit than it used to be,” James Quiggle, spokesman for the Coalition Against Insurance Fraud, says.”

“…Another Houston-area case — one that has become infamous — involved four-year-old Nevaeh Hall’s trip to the dentist. When Nevaeh went to Dr. Bethaniel Jefferson’s dental office in January 2016, she was giddy with excitement, her mother says. On a previous visit, she’d taken home a backpack full of dental care supplies, and she loved brushing her teeth with her SpongeBob SquarePants toothbrush. On this second visit, as her dental records show, the plan was to extract her damaged baby front teeth — she’d fallen down face first shortly after the teeth came in — and put crowns on the teeth on the right side of her mouth. “

“…according to a report from the Texas State Board of Dental Examiners. She was given “large doses of anesthetic and sedatives,” and there were “warning sounds and visual indications which showed that for a period of five hours Nevaeh’s brain suffered from a severe lack of oxygen.”

“…When Amanda Lightfoot got the bill for her dental work, she burst into tears right there in Hoover’s waiting room. It was fall 2014 and Lightfoot had come in just to get two crowns replaced….She went home with a hole in her mouth where the tooth had been, and says Hoover told her it would cost about $20,000 to finish the work. Lightfoot cried all night. “

“…This is how most of these cases go, Moriarty says. Dentists are regulated primarily by the state dental boards, the entities that have the power to investigate and discipline a dentist who has done wrong. Unless a board decides to reprimand a dentist publicly, the odds are good the public will never know there has even potentially been an issue, he says.”

“…“People assume dental boards are out there to protect the public and to make sure the dentist that comes out of school can treat you. People assume these boards will be there to protect you from any unscrupulous behavior in the industry, but that’s just not the case,” says Debbie Hagan, a Kentucky homemaker and grandmother turned dental patient rights activist who writes a blog detailing various issues with dentistry across the country. “

“… In March 2016, 14-month-old Daisy Lynn Torres was at Austin Children’s Dentistry to have two cavities filled. Shortly after Daisy was put under anesthesia, Dr. Michael Melanson told Daisy’s mother, Betty Squier, the child needed six cavities filled. Soon afterward, Squier was told there were problems during the procedure. Daisy was declared dead at a nearby hospital about two hours later…In July, Robert Williams, a forensic dental examiner, stated in a report commissioned by the Travis County Medical Examiner’s Office and first obtained by KXAN TV that Daisy may not have needed any of the dental work in the first place.”

“…For people like Moriarty and Hagan, the fight against bad dentistry is in many ways a personal battle, one that evokes longstanding memories.

“…As a child, Moriarty had cavities eating away his two front teeth and his family never had the money to fix them. “I often wonder how my life would have been different if I’d been able to get to a dentist,” he says. “I remember going to high school and being so embarrassed. I feel like it might have been a very different life for me.”

“…“I wouldn’t smile in the class pictures, because of all the metal. Standing up in front of the class was torture because I knew they saw me flashing a mouth full of silver every word I spoke,” Hagan says. “I don’t think most people realize how important it is, that you have to have your teeth in working order in order to thrive. You don’t want to be different, especially when you’re young and going to school. It changes kids. It changed me.”

 

http://www.houstonpress.com/news/when-dental-surgery-lands-a-patient-in-a-world-of-everlasting-regret-8647456

Related Documents:

Wednesday, August 03, 2016

Economic Turf Wars over Dental Sedation and Public Safety

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


Introduction
One can’t evaluate the different parties fighting over dental sedation privileges and the vast sums of money involved, without examination in the context of our toxic dental Medicaid program. Medicaid is a social safety net program jointly funded by the federal government and each individual state. However, administration of dental Medicaid is left to the particular state. Each state handles dental Medicaid very different with a complex variety of outcomes.

Florida
For example, the state of Florida refuses to authorize hospital-based sedation for dental Medicaid cases. Therefore, many of the most severe dental cases go untreated. Institutionalized patients for severe developmental disorders often go untreated. The potentials for ensuing major medical problems may go unaddressed, until the crisis stage for morbidity and mortality (illness and death).
As a result, numbers of Florida dental Medicaid providers deliver in-office sedation upon patients, who truly should only be seen in a hospital setting. Children, who have a much greater compromised airway than adults, are treated en masse with cocktails of different sedation medications, and in risky dose levels. In order to maximize dollar production under a flawed Medicaid fee schedule, these doctors are notorious for a dangerous lack of patient monitoring.

 https://appsmqa.doh.state.fl.us/DocServiceMngr/displayDocument.aspx
 
Authorities rarely deliver more than wrist-slap regulation upon these violators, as their removal from the Medicaid system could hasten the collapse of this broken government program. The poor and disadvantaged are left between a rock and a hard place. They can elect to eat a $hit sandwich or go hungry.

Other providers of Florida dental Medicaid pursue a different scheme. They simply place any “uncooperative” child in restraints (euphemistically called “protective stabilization”). Again because the dental Medicaid fee schedule is so abysmal, these doctors feel justified in maximization of dollar production regardless of a child’s stamina, understandings, and limited abilities. All treatment possible is completed in a single visit. In order not to overdose a child for local anesthesia (generically termed “Novocain”) for their diminutive body weight, these doctors frequently deliver inadequate anesthetic, which generates excruciating patient pain. However, with the child adequately restrained, dental services of extractions, steel crowns and pulpotomies (baby root canals) continue, regardless of a child’s discomfort. Obviously, many of these patients will be in need of extensive psychological counseling for posttraumatic stress. Unfortunately under our programs for the disadvantaged, it’s doubtful this brutal problem of which government bares great responsibility, will ever be addressed. Medicaid dentists too often choose between “juice ‘em (sedate) or papoose ’em (physical restraints)”.

https://appsmqa.doh.state.fl.us/DocServiceMngr/displayDocument.aspx
http://floridajustice.com/wp-content/uploads/2015/11/Schneider-arrest-warrant-affidavit.pdf
https://appsmqa.doh.state.fl.us/DocServiceMngr/displayDocument.aspx
 
Whistleblowers who step forward in Florida to expose these abuses to authorities are met with institutional roadblocks. These professionals with integrity are forced out of government service by superiors. The rationale is that if the crooks and abusers are severely disciplined and removed as Medicaid dental providers, there will be too few providers to keep the toxic program viable. Government enables the abuse of our most vulnerable citizens and assists in cheating taxpayers. http://media.news4jax.com/document_dev/2016/02/03/Dr.%20Mason_2048400_ver1.0.pdf
 
New Mexico
New Mexico (NM) allows for dental Medicaid hospitalization and sedation coverage, unlike Florida. On paper and in theory, Medicaid patients will be permitted access to hospital operating rooms and nurse anesthetists for necessary dental care. The reality is quite different. Further, the in-fighting between providers and hospitals is in anything but in the interests of patients.

Monday, August 01, 2016

Washington State Issues Notice on Comfort Dental

Washington state plans to enforce it’s laws against corporations practicing dentistry. Can we stand up and give Washington a round of applause, please.

Washington State Notice of Intent against Comfort Dental for illegal practice of dentistry