Showing posts with label Amerigroup. Show all posts
Showing posts with label Amerigroup. Show all posts

Monday, July 28, 2008

Another Small Smiles Business Partner Settles Medicaid Fraud Charges

I hardly know where to begin on this entry. What a mess we have here. It might help if you read the entry about the "Tangled Web" before reading this one.

Well, earlier this month we had Doral Dental implicated in the bribery charges of former Tennessee State Senator John Ford. During the trial FORBA/Small Smiles top dogs, Todd Cruse and Dan DeRose even had to take the stand.

Doral Dental execs were so guilty they admitted if they took the stand they would plead the 5th as not to implicate themselves.

Now we have Amerigroup settling the largest ever false claims Medicaid Fraud case in American history at a whopping $225 Million dollars. (somehow no jail time has been imposed)

After WJLA TV's investigation aired about the horrible treatments of children at Small Smiles clinics and the medicaid fraud in and around Washington DC, Amerigroup announced it was requesting Doral Dental to do a thorough investigation of these allegations. (aren't you just about choking right about now?)

Amerigroup contracts with the state

Doral Dental contracts with Amerigroup

Small Smiles contracts with Doral Dental provide dental care to children enrolled in medicaid in Maryland, District of Columbia, Ohio and Georgia.

Don't forget just a few short months ago Dr. Michael DeRose the co-founder of FORBA/Small Smiles paid a $10 million dollar settlement in North Carolina for medicaid fraud.

Something tells me that FORBA/Small Smiles was not exactly shaking in their boots when they were made aware Amerigroup was having Doral Dental look into their business practices, what do you think?

Friday, July 11, 2008

Oh What A Tangled Web

Doral Dental is a Third Party Administrator (TPA) of Government Medicaid Dental Programs according to

My first question is why in the world does any agency (Medicaid) need a THIRD party anything. Wouldn’t first party or second party at most be plenty?

Amerigroup is a Medicaid Managed Care Organization (MCO) but following along the thinking of Doral's designation, I guess Amerigroup would be considered a Second Party Administrator.

Your state Medicaid services would be the first tier I suppose.

So your state gets your hard earned, and taken away from you, tax dollars allocated to them to spend on the poor and those in need for medical treatment, called Medicaid. (In some states they give it a local name such as in Massachusetts it’s called MassHealth, in Tennessee it’s called TennCare, but it’s just Medicaid.)

Evidently the states don’t know what to do with the money, they need experts to distribute it so they hire companies like Amerigroup to spend your tax dollars for them.

In Maryland they have hired 7 of these companies, one isn’t enough I suppose. Amerigroup is one, AmeriChoice, Coventry Diamond Plan, Helix Family Choice, Jai Medical, Maryland Physicians Care, and Priority Partners are the others.

All of these companies then find it overwhelming to do the job so they hire Third Party Administrators such as Doral Dental. Doral Dental then goes out and gets contracts and hires the actual providers, your dentists and dental clinics such as Small Smiles.

Some of the Second Tier companies such as Jai Medical contract directly with the providers, Small Smiles, so I guess hats should be off to them for by passing those Third Party Administrators. Getting rid of the middle middle men I suppose. (more money for them to keep right)

However even the Third Tier companies like Doral find it overwhelming to spend all that money and will hire companies to help them decide where to spend it as they did in Tennessee by hiring Managed Care Services, a company who just happened to be owned by a state senator, John Ford, now on trial. (Amazing how many “consulting” firms are needed to decide where to spend all those Medicaid dollars isn’t it.)

Honestly, we have management companies managing management companies who hire consulting firms to help manage the management.

Well, evidently the rival firm of Doral, FORBA which just happens to own Small Smiles that are Doral Dental providers in other states wanted to sue Doral for Doral not letting them in on the TennCare Medicaid dental pie. This brought to light Senator Ford’s involvement and everything hit the fan and federal charges were filed but so far only against Senator John Ford, why no charges are being filed against FORBA and Doral for offering the bribe money is beyond me. I mean aren’t the ‘johns’ of hookers also charged?

Well anyway this brings me to Doral overseeing Small Smiles clinics in Virginia, Maryland, Ohio, Kentucky and a host of other states for those Second Tier Administrators like Amerigroup.

Doral says it’s conducting internal investigation of all the allegations on the mistreatment of children and fraudulent Medicaid billing, but what good is that exactly. I mean Doral sends it’s patients to Small Smiles in several states, yet is in competition with Small Smiles own management, FORBA in other states. (Head spinning yet? Mine sure is.) And the icing on the cake, Doral who is looking into these allegations is in deep doo doo in Tennessee for bribing a state senator! Don't think any kind of 'clean bill of health' Doral was to give Small Smiles would mean a whole lot, what do you think?

When pressed Doral will just throw the responsibility back to Amerigroup, saying they are the ones who push for all these children to be mistreated, (clearing throat) I mean money to be made, Amerigroup says it’s Small Smiles, and Small Smiles throws up it’s hands and says they don’t know anything about children being mistreated or Medicaid being ripped off.

And do you think the states know, well heck no. They don’t even seem to be smart enough to manage the Medicaid dollars in the first place and they have hired a umpteen packs of Foxes to watch one hen house.

But when all said and done there really is no competition or rivalry. They are all in the same bed, using the same horrible methods to steal millions and millions of your dollars and mistreating and abusing innocent children to get the job done and sending at least some of the huge profits to an Islamic bank is Bahrain that must not be making enough money of oil prices.

And let us not forget this same scenario is happening with United American Healthcare and it’s Third Tier Management group Omnicare. (As Doral Dental is to Amerigroup, Omnicare is to United American) FORBA/Small Smiles is also a dental provider for Medicaid enrollees of United American Healthcare in various states just like they are for Doral Dental and Jai Medical.

United American Healthcare, through it’s OmniCare company was paying Senator John Ford $8500 a month for his services in getting key legislation through the Tennessee assembly. Legislation that would greatly benefit FORBA/Small Smiles as well as it’s own interests. (You can read about this at various places on the net, so I’m not getting into all of those allegations here)

Point is United American Healthcare did nothing to curtail Small Smiles treatment of children in Maryland. Doral Dental terminated 4 individual dentists and is ‘investigating’ (chocking on that word) Small Smiles practices before it sends more of it’s enrollees to Small Smiles and in November Jai Medical Systems sent a letter directly to Todd Cruse putting Small Smiles on probation and requiring Small Smiles to allow parents to go back with their children, make sure all personnel are licensed BEFORE they treat children, not go to school while practicing, and were going to do surprise visits and random patient surveys.

In light of the recent allegations of United Healthcare and Doral Dental being in hot water up to their eyeballs for bribing a state senator, I don’t think either of these companies should be ‘overseeing’ or ‘investigating’ wrong doing of Small Smiles or any other company, do you?