Dental billing fraud is more common than you think

Everybody knows going to the dentist is important, yet half of American adults skip out on regular dental care.

Some avoid dentistry out of fear of pain or sheer busyness, but a large portion of Americans can’t afford it without financial assistance.

Unfortunately, it’s Americans on government assistance programs for dental care who are being taken advantage of. Worse, their children are suffering for it.

It started as a solution

Many low-income children don’t receive dental care until they’re brought to the emergency room with a toothache, simply because their parents can’t afford it. Nearly half of American children are on some form of government-funded health insurance, either Medicaid or the Children’s Health Insurance Program (CHIP).

…As a result, corporate dental chains started accepting Medicaid and CHIP, and even opening new offices specializing in Medicaid…

…most of the charges were coming from one dental chain, Kool Smiles, and that the x-rays didn’t justify their treatments. Kool Smiles was investigated, and state officials found that the crowns were not only unnecessary but that the dental work was shoddy….

…Kool Smiles isn’t the only dental chain implicated by government officials in fraudulent billing practices. Dental chain Small Smiles settled with the United States in 2010 for $24 million to resolve allegations of fraudulent charges. In April 2014, the company that owns Small Smiles, CSHM, Inc., was excluded from participating in federal health care programs like Medicaid for five years…

Read the entire story at Fox.com

What the story fails to mention:

Small Smiles/CSHM is still operating Small Smiles clinics.  They are simply using a different corporate name—First Quality Management, Inc.  Many of the original corporate level employees still in place. Some clinics are under the control of Hero Management who operates Adventure Dental and Vision and others have been taken over by Sarrell Dental based in Alabama.

Small Smiles now under direction of former Small Smiles Employee gone rogue: Ron Montano, Hero Dental Management and Adventure Dental and Vision.

If you are seeing more commercials for Adventure Dental and Vision lately it’s not an accident.  Check the phone number, it’s actually Small Smiles clinics.

Hero Dental Management is the new FORBA/Church Street Dental Management/CSHM and many Small Smiles clinics are now under the umbrella of Hero taking the name Adventure Dental and Vision.

Ron Montano broke out on his own and created Hero Dental Management and clinics operating as Adventure Dental just like Drs. Pham and Tran broke away and created NCDR and Kool Smiles.

Where Was The Colorado Dental Board?

It took the Colorado Dental Board until June 2009 to finally order Michael A. DeRose ‘retire’ his license to practice dentistry and tell  him he is never to apply for a new license anytime in the future.

In the Order from the board it cites the two disciplinary actions taken against DeRose in North Carolina.  In December 2005 his license was suspended for 180 days for doing more than 6 pulpotomies in one visit on children at his Medicaid Dental Centers, now called Smile Starters in North Carolina.

I’m thinking 6 is still outrageous!  Think you could have 6 teeth worked on in one session?  How about being tied down, and given 6 root canals??!!  The level of lidocaine alone to keep a patient pain free seems to me would be at a dangerous level.  But they don’t worry about that, since they could care less if they even have a supply of lidocaine on hand it appears.

Then in April 2007 settled with the government for $10 million with Dr. Tish Ballance, and still every state where he was licensed let him keep his licenses.

Michael’s dad, Dr. Eddie let his licenses just expire.

William Mueller, one of the original cast of characters was forced to ‘surrender’ his licenses, but not until 2009!

Over the years these three had ‘actions’ taken against them on a few occasions in more than one state, but only the latest is currently on file at DORA, Colorado’s records search.

Some of the documents mention referring problems to the state Attorney General’s office for further review.  But I can’t find one time any of them were ever seriously considered for prosecution.

The laws in Colorado were changed at least twice to curtail these guys from abusing children for profit, but the Dental Board never revoked their licenses as they should have.  They allowed Dr. Michael DeRose continue with this abuse from 1982 until 2009!  That’s 27 years!!!!!!

Now look where we are.

Had the Colorado Dental Board done their job, there would be no Small Smiles, Kool Smiles or Adventure Dental out there tying up children and drilling out perfectly good teeth, causing horrific trauma to small children, devastating the trust children have in their parents and adults and scamming Medicaid (you tax dollars) out of 100’s of millions of dollars.

Somehow through all of this the uncle, Dr. Adolph Ralph Padula came away unscathed.  His license is as pure as the white driven snow.

Dr. William Mueller (UPIN# 64458) was finally locked out of the medicaid program March 18, 2010.

Forba Holding, LLC Sues Adventure Dental and Vision (Hero Management, Ron Montano)

I reported a month or so ago about Ron Montano, his dental management company, Hero Management and his string of clinics called Adventure Dental and Vision.  I reported that he used to work for Small Smiles.  His separation from the company is conflicting, I've heard he quit, I've heard he was fired...not that it really matters.

Well, in April 2007 Forba Holding file a lawsuit again Ron Montano and Hero Management and the cause in question is the "Economic Espionage Act of 1996, section 18:1831.  Forba was demanding $350,000 in damages according to the suit.  Cause Number 2007cv00675.  This particular case was dismissed on September 21, 2007 with both parties agreeing not to pursue this any further.  I suspect Forba really didn't want ALL their trade secrets being aired in open court don't you?

According to Wikipedia the Economic Espionage Act of 1996 is as follows:

The Economic Espionage Act of 1996 (see RFD 18 U.S.C. § 1831) makes the theft or misappropriation of a trade secret a federal crime.

This law contains two sections criminalizing two sorts of activity. The first, 18 U.S.C. § 1831(a), criminalizes the misappropriation of trade secrets (including conspiracy to misappropriate trade secrets and the subsequent acquisition of such misappropriated trade secrets) with the knowledge or intent that the theft will benefit a foreign power. Penalties for violation are fines of up to US$500,000 per offense and imprisonment of up to 15 years for individuals, and fines of up to US$10 million for organizations,

The second section, 18 U.S.C. § 1832, criminalizes the misappropriation of trade secrets related to or included in a product that is produced for or placed in interstate (including international) commerce, with the knowledge or intent that the misappropriation will injure the owner of the trade secret. Penalties for violation of section 1832 are imprisonment for up to 10 years for individuals (no fines) and fines of up to US$5 million for organizations.

In addition to these specific penalties, section 1834 of the EEA also requires criminal forfeiture of (1) any proceeds of the crime and property derived from proceeds of the crime and (2) any property used, or intended to be used, in commission of the crime.

The Act authorizes civil proceedings by the Department of Justice to enjoin violations of the Act, but does not create a private cause of action. Thus, victims or putative victims must work with the U.S. Attorney in order to obtain an injunction.

I don't really understand exactly why it was Forba vs Hero since this is a criminal act and Forba would have to file a criminal complaint with the US Attorney to get this suit filed and according to the filings this is a civil suit. 

Anyway, evidently Forba says Ron Montano took some 'trade' secrets with him when he left Small Smiles and is using them to profit from his Adventure Dental and Vision clinics.

The attorney for Forba was William T. Slamkowski of Hensley, Kim and Holzer in Denver.  The attorney for Ron Montano  was Brett Painter of Davis, Graham and & Stubbs in Denver.

Update:

Ok, I finally got my hands of the law suit and Forba was ticked off because two of their employees, besides Ron himself went over to Adventure Dental at the time it was called Captain Smiles.  The two others that jumped Forba's ship was Joseph Lee and Adam Ditto.  Lee and Ditto supposed took all this sensitive info over to Montano....

Adventure Dental and Vision, yep vision too

Before going any further, I want to warn you that the owner of these clinics worked for and was trained by FORBA and Drs. Michael and Ed DeRose and Dan DeRose as well as Michael Roump of the infamous Small Smiles clinics that mistreat and abuse children and have been accused of medicaid fraud.

Looks like there's yet another dental clinic on the rise catering to low income Medicaid children only this one is going to take care of eye care as well. (I bet FORBA hates they hadn't thought about this new cash cow!)

Adventure Kids Dental and Vision (yes vision is being added I suppose unless there is something about seeing with ones teeth that I'm not aware of).

This place started out in Colorado Springs, CO (yep, Colorado again) as Academy Kids Dental and is the brain child of Ronald (Dr. Ron) Brandon Montano once again another former Small Smiles dentist, like Dr. Tran and Dr. Pham of Kool Smiles being former Small Smiles (Ed and Michael DeRose trained) dentists.

As of right now there is a clinic in Colorado Springs, Colorado another in Greenley, Colorado and one on the east coast in Brockton, Massachusetts and two in the DC area.

This clinics theme is cartoon action hero with the main character being "Captain Smiles". see captainsmiles.com

And the 'management company' for Adventure Kids Dental, sometimes referred to as Adventure Dental, is Hero Management. (an email address on one of the websites is cathy@hero-management.com)

So what's the deal with every dental clinic needing it's own personal management company anyway?

Another of it's websites is: adventuredentalandvision.com

The staff at the Colorado Springs clinics includes Drs. Ron Mantano, Mario Montanez, Melissa Montano and Steven Gould.

The Greenley dentist is Dr. Amy Jorgensen

No one is listed in the Brockton office so it might not be open yet, who knows.

Anyway there are two now opening in the Washington, DC hotbed:

1253 West Pratt Street
Baltimore, MD
410-727-4746

and

1305 Rhode Island Avenue NE
Washington, DC 20018
202-269-4746

..both 4746 wonder what special meaning those numbers have to Dr. Ron?

We can only hope that complaints don't come flying in for Adventure Dental. Hopefully Dr. Ron learned what NOT to do while working at Small Smiles in Colorado Springs. I heard he was let go, so that's a good sign since Small Smiles/FORBA doesn't keep dentists who are patient and nice to children.

Time will tell.

Anyway it's looking like the Washington DC, Maryland, Virginia area of the country needs it's own fully staffed task force, complete with a SWAT team to keep a close eye on all the dental clinics for the poor.