After WFAA investigation, company settles with State of Texas for record $235.9 million

Xerox Corporation and its former subsidiary, Conduent, agreed Tuesday to a record $235.9 million settlement with the State of Texas, according to the Texas Attorney General's Office. 
It was the largest single Medicaid fraud-related settlement in a case filed by the Texas Attorney General.

The settlement comes after a three-year WFAA investigation that uncovered millions of dollars in alleged overbilling by Texas dentists targeting low-income children for unnecessary and often harmful dental and orthodontic work.

Read entire story at WFAA website

Related:

 WFAA's Byron Harris reports 

Byron’s Lens: Dental Kickbacks The Story Behind The $8.45 Million Dentists’ Settlement

There’s a McDonald’s on Garland Road in Dallas near the old Lochwood Mall, almost across the street from what used to be Galaxy Dental.  Galaxy’s florescent green and yellow paint scheme made it stick out, even in the clutter of Garland Road.

I spent several mornings at that Mcdonald’s in the spring of 2012, nursing a coffee while everybody else was dining on McMuffins. I was there to try to overhear the conversation a group of women who often met there for business. They were “community outreach workers,” they said. But what they talked about were their plans to scour low income neighborhoods for children eligible for Medicaid.  Their mission: to recruit Medicaid eligible mothers to bring their children into Galaxy Dental. The outreach workers talked loud enough that I could tell they were pumped.  

A federal lawsuit unsealed in Dallas last week alleges why they were so excited.

See the entire story by Byron Harris at WFAA’

https://creatavist-g49brf5.atavist.com/byrons-lens-dental-kickbacks-?units=us

“Ho” Down in Texas – James W. Orr, DDS Testifies for Antoine Dental Center

Background
Who can forget the reports by WFAA’s Bryon Harris, which spurred investigations in to orthodontic Medicaid Fraud by the State of Texas?
In the fall of 2011 and continuing today, The Texas Health and Human Services Commission (HHSC) Inspector General put Credible Allegation of Fraud (CAF) payment holds on a covey of dental clinics; some general dentistry and some orthodontic clinics.  

Deciding not to take this sitting down, a few of these highly suspect dentists decided to take it to court; appealing to the State Office of Administrative Hearings (SOAH).

Dr. Juan Villarreal, owner of Harlingen Family Dentistry, a Scientologist  and a former  member of Texas State Board of Dental Examiners (TSBDE) appealed the HHSC decision for his CAF payment hold.  In a ruling by the SOAH in October of 2012, Villarreal/Harlingen Family Dental’s payment hold was reduced from 40% to down to 4%.  The ruling for Harlingen was further upheld by an HHSC Administrative judge in January of this year (2013).  Villarreal also heads up Texas Dentists for Medicaid Fraud Reform (TDMR). 

The judge’s ruling in the Villarreal case, by the most part, was based on the testimony of one Dr. James W. Orr.  This favorable ruling no doubt was the impetus to others, like Antoine Dental Centers and M & M Orthodontics in appealing their CAF payment holds. 

One last thing, before we move on — WHAT is the HDL scoring index? Well, it is much like scoring some jurisdiction do to determine if one gets bail or not. A point for this, a point for that and if it totals up to be high enough, bam! You’re outta there. For orthodontics (braces and other appliances) children over age 12 AND have lost all their baby teeth can received services if their HDL score is 26 or higher. Like anything else there are exceptions, but this is the simple explanation.

Antoine Dental Center-Dr. Behzad Nazari
First up, for this series, is Dr. Behzad Nazari and Antoine Dental Center (ADC) vs. Texas Health and Human Services (THHSC) (SOAH docket no. 529-0997).  ADC was represented by Jose A. (Tony) Canales and Oscar X. Garcia. Robert (Bob) M. Anderton.  Many of these clinic suspected of fraud have hired dentist/attorney, Dr. Robert (Bob) Anderton, former American Dental Association president.

Dr. Behzad Nazari/Antoine Dental Center has been under a 100% (that is HUGE) CAF pay hold since March 28, 2012 totaling over $550,000.  On March 29, 2012 the Texas Attorney General’s Medicaid Control Fraud Unit (MCFU) opened an investigation into ADC. 

Texas AG Greg Abbott disappointed in Dallas DA Craig Watkins’ “sweetheart deal” with Richard Malouf

Sweethearts?

A good example of why you can’t count on local DA’s to enforce the laws!

---

Bio | Email
WFAA
Posted on March 5, 2013 at 10:05 PM
Updated today at 9:54 PM

Dallas County District Attorney Craig Watkins accepted — then returned — a 2009 campaign donation from the wife of Medicaid dentist Dr. Richard Malouf, who was under investigation at the time by Watkins' office for allegations of Medicaid fraud.

The Texas Attorney General’s Office says Watkins’ settlement of the case was a "sweetheart deal."

Dallas dentist Dr. Richard Malouf is the founder and former owner of All Smiles Dental Centers in Dallas. From 2008 through 2010, All Smiles billed the state of Texas more than $20 million for putting braces on children under Medicaid.

For the past five years, federal, state and local officials have been investigating Malouf for Medicaid fraud.

The Dallas County DA's office was one of those doing the investigating. Watkins' office received a criminal referral from the AG about Malouf.

In 2009, Malouf's wife, Leanne, wrote Craig Watkins — who was running for re-election as Dallas County DA — a $10,000 campaign donation, News 8 has learned.

Soon after, Watkins was asked to attend a meeting at the office of one of Malouf's attorneys, according to Heath Harris, the first assistant in the DA's office. News 8 wanted to talk to Watkins himself about the sequence of events. His office said he was ill and unavailable. Heath Harris spoke on behalf of Watkins.

Dallas District Attorney Craig Watkins Letter to Stephanie Leanne Lott Malouf Jan 5 2010 Redacted

At the meeting at the attorney's office, Heath Harris said, Watkins was introduced to Malouf.

Malouf wanted to talk to Watkins about his criminal case, Heath Harris said.

"This Malouf person is trying to talk to him about a criminal matter," Heath Harris told News 8. "It's my understanding he [Watkins] immediately shuts him down. And he leaves."

Watkins returned $10,000 to Leanne Malouf with a cashier's check in January, 2010.

Texas Vows to crack down on dental Medicaid fraud

I’m guessing Texas is not exactly the best market anymore for the Medicaid dental mills and DSO’s in general.

by BYRON HARRIS
Bio | Email
WFAA
Posted on January 16, 2013 at 6:48 PM
Updated yesterday at 9:55 PM

NEWS 8 INVESTIGATES

AUSTIN — State Sen. Jane Nelson (R-Flower Mound) put it simply Wednesday, speaking to a group of reporters at a news conference in Austin:

"It is infuriating to hear of the kind of problems that are taking place... problems that are particularly serious in Medicaid dental, orthodontia and transportation for Medicaid patients," she said.

For the past two years, News 8 has been investigating the Texas Medicaid Dental program and hundreds of millions of dollars the state has spent on orthodontics under Medicaid.

Sen. Nelson specifically mentioned the parents of Medicaid children who had been solicited by "marketers" bearing free gifts and cash, the subject of several News 8 stories.

Senate Bill 8 is designed to cure some of those abuses.

• READ: Senate Bill 8

"It strengthens the prohibitions against solicitation of Medicaid clients," Nelson said. "We heard story after story about that. We are going to prohibit that and make sure it doesn't take place."

So far, the bill does not specifically prohibit handing out gifts and cash to parents to induce them to take their children to certain dentists. Nelson says hearings over the next two months will flesh the bill out.

The legislation also articulates the Inspector General's role in uncovering and reporting fraud, and bans a dentist from participating in Medicaid if found guilty of fraud.

The bill moves Medicaid Transportation into managed care, and directs the Department of Health and Human Services to reduce inappropriate ambulance use.

Even though the specifics of this bill haven't yet been hammered out, there's already huge opposition to it. That's a sign, Nelson says, that as it is, some dentists are making lot of money.

E-mail bharris@wfaa.com

After 18 months of reporting, WFAA’s Byron Harris reports; black market for Medicaid Dental patients is going strong

Thank you Phyllis Gonzales! You are one brave woman! We need more Phyllis Gonzales’ that’s for sure.

WFAA
Posted on December 18, 2012 at 10:13 PM
Updated today at 9:01 AM

NEWS 8 INVESTIGATES

The black market for Medicaid Dental patients is going strong, despite the state’s tightening of the payment system for providing dental care to poor children.

Phyllis Gonzales said she was paid more than $1,000 by 1-Stop Dental in Hurst over a two-month period. In exchange, she said she brought about 60 kids and their parents to the dentist’s office.

There, she said parents got between $20 and $35 for switching their children to the dentist working there.

It’s illegal to pay a parent to switch dentists under Medicaid, according to the Texas Department of Health and Human Services.

The 1-Stop story came to News 8’s attention because of flyers stuck under car windshield wipers at DART station parking lots.

“The policy was basically to bring as many patients as possible,” Gonzales said. “The payment [to Gonzales] was $10 per child, with bonuses of $100 once you reached ten children."

Thousands more children abused at private owned “chop shops” - 1-Stop Dental, First Impressions Dental, Gold Star Dental. Parents are paid $35 to bring their child for “treatment”!

These are just 3 of 30 or more operated by a very close knit group of criminals with DDS after their name in Texas. I’m sure we will be hearing more on this cartel.

Hey, Ms. Lisa Re, is this one ok with you as well? I assume it must be, it’s the same story we hear about Small Smiles of which you are such a big fan!!

Here is Byron Harris’ latest report:

by BYRON HARRIS

Bio | Email
WFAA
Posted on December 12, 2012 at 10:38 PM
Updated today at 9:35 AM

NEWS 8 INVESTIGATES

The darkest side of Medicaid dental

DALLAS -- In the eighteen months since News 8 began reporting on the Medicaid dental program, we’ve discovered hundreds of millions of dollars paid out by Texas that other states don’t pay for at all. We’ve discovered children being lured from their neighborhoods into dental chairs, just for the Medicaid dental fees they’d bring. And we’ve outlined how gift cards have been used to entice parents to bring their kids to certain dentists.

The State of Texas is now cracking down on those practices through enforcement and new systems for reimbursing dentists. But that’s only increased the competition for new, young Medicaid patients and the income they can bring to a dental office. In their worst forms, might be described as tempt and torture.

The Switch Bonus
In the parking lots of Dallas DART stations, crude flyers are being tucked under commuters’ windshield wipers.

“Get paid to take ur [sic] kids to the dentist. The dentist is giving $20.00-$35.00 per kid,” the flyer reads.

Texas expands Medicaid dental fraud estimates to $154 million

 

;

by BYRON HARRIS Bio | Email WFAA-TV Posted on October 17, 2012 at 10:03 PM Updated today at 12:01 PM Story

NEWS 8 INVESTIGATES

Texas Medicaid dental expenditures quadrupled in recent years, from $400 million in 2006 to $1.43 billion in 2011. The Office of Inspector General is now tracking more than $383 million of potential fraud and overpayment, it told a Texas House of Representatives committee.

In a House hearing on Monday, News 8's investigations of Medicaid dental fraud were praised by state representatives. "I have to tip my hat to WFAA in Dallas for doing what they've done," said Rep. Lois Kolkhorst (R-Brenham), chairwoman of the Public Health Committee.

The state has suspended payments to 26 orthodontic organizations under a policy called Credible Allegation of Fraud (CAF). The state can hold money back from Medicaid providers if it suspects it was billed fraudulently. Texas estimates that $229 million in Medicaid payments to put braces on kids' teeth may have been improper.

Audits show as many as nine out of 10 payments may have been fraudulent. For general dentistry, more than $154 million may have been overpaid. Expert analysis shows half the bills checked were erroneous. Eighty-nine dental providers have had payments withheld under CAF.

The OIG told a the public health committee of the Texas House that more manpower, more interest in fraud, and improved software are helping catch more fraud going forward. E-mail 

E-mail bharris@wfaa.com

Texas Stakeholder’s meeting cover a lot, offered no solutions.

In case anyone missed the Stakeholder’s webinar yesterday. Here is a link to it:  July 27, 2012 Texas Dental Stakeholder’s Meeting

They talked about patient recruiting. They talked about the criminal behavior and the $10k fines for each of the people who recruit each time they approach a person in one of their vans. But I didn’t hear anything about who was going to start stopping these vans and handing out those $10K “patient recruiting tickets”. They also mentioned how illegal it was to “hire” a company to recruit and it was illegal to work as a recruiter.

They talked about the horrors and trauma small children are experiencing at the massive number of low quality dental centers, like Kool Smiles, Small Smiles, All Smiles, The Smile Center. They even mentioned babies being tied down and traumatized by hundreds of Texas dentists who are committing Medicaid fraud. Needless to say they skimmed over that subject as fast as possible. Mentioned a couple of words about standards and tabled it for later discussion, as they have for the past 10 years! Hey guys, it’s still on the table, don’t you see it!

The attorney for the Texas Dental Board admitted they have the power to make the rules, but didn’t say a word about if they planned on enforcing the rules they already have in place or any news ones they might create.

They talked about the $63 thousand dollars the government is handing out to Medicaid providers, and stressed the dentists are in the category. Then they told how to apply, what criteria must be met and I believe someone gave a count of 461 dentists who have already signed up for their piece of the pie. I’m not sure but I thought I heard applause.

 

by BYRON HARRIS
Bio | Email
WFAA

Posted on July 27, 2012 at 7:42 PM

Updated yesterday at 7:42 PM

DALLAS - As Texas cracks down on questionable Medicaid dental payments, dentists' offices are going dark all over the state.

From 28th Street in Fort Worth, to Eureka Circle in Wichita Falls, to Amarillo, dentists who've already collected money from the state to treat Medicaid patients are now turning away those patients, because the dentists' Medicaid claims are being rejected. There are more than 4,300 Medicaid dentists in the state.

Tens of thousands of patients are affected. In 2010, Medicaid paid for braces on about 80,000 kids in Texas. Treatment commonly takes two years.

Since March, the Medicaid dental is managed by three Managed Care Organizations (MCO's)  which have stiffened standards. One MCO said 91 percent of new claims are being rejected.

Moms whose kids already have braces on their teeth are being told children's braces must come off halfway through treatment, that they must go to another clinic far from home, or that there will be no more treatment whatsoever.

Friday, Dr. John Roberts chaired his first stakeholder meeting as Texas HHS dental director. The old director left after News 8 discovered hundreds of millions of dollars of questionable payments under Medicaid orthodontics.

Dentists learned the three MCO's have different payment rates and differing standards. But the overall impression was that moving forward, the children with braces already on their teeth would receive treatment somehow.

"There are plans in place to continue treatment on patients, to re-evaluate patients, and to complete every patient's braces," said Dr. Robert Morgan of Children's Medical Center in Dallas, who attended the  meeting.
The meeting was also broadcast over the web for reporters and interested parties.

It was not clear how the process would exactly work.
If the state reassigns patients to new dentists, regardless of their original need for braces, it will cost millions for treatment which may have been unnecessary in the first place.

One example is All Smiles Dental Centers, which is being sued by the state for fraud. All Smiles told The Dallas Morning News it is eliminating orthodontic treatment at 13 clinics. One witness in the state's case against All Smiles said 95 percent of the dental chain's claims in a 300-patient sample were fraudulent.
All Smiles did not respond to News 8 efforts for clarification.

Related:

• Texas taxpayers pay big for straight teeth
• Questions surround lucrative Medicaid dental business
• Texas Medicaid problems may apply nationwide
• Crooked Teeth: Medicaid Millions
• Texas, feds take action on orthodontic fraud
• Outrage on Capitol Hill follows News 8 Medicaid probe
• Texas AG lawsuits spurred by WFAA dental investigation
• More stories about WFAA's Texas Medicaid orthodontics investigation

In all fairness Malouf did take his business model from the DeRose family in Pueblo, Colorado… and they have their own footballs stadium and city for that matter…

Who said you can’t make any money seeing to the oral health of our nations poor.

WFAA-TV Byron Harris reports:

WFAA

Posted on July 12, 2012 at 10:30 PM

Updated today at 9:37 AM

DALLAS - The Texas Medicaid dental scandal is moving into a new phase. A construction phase.

One of the dentists charged with fraud in billing Texas taxpayers tens of millions of dollars for unneeded braces on children is in a new spurt of expanding his mansion.

He's building a water park on the property.

It's happening out of public sight, among the high-dollar homes on Dallas' glitzy Strait Lane. All the homes are big here, but the home of dentist Richard Malouf, former majority owner of All Smiles Dental Centers, is even bigger.

Plans for the expansion are on file with the Dallas Planning Commission.
"There's going be a gymnasium, a rock climbing wall," said real estate columnist Candy Evans. "There's plans for a bowling alley upstairs. There's going to be exercise rooms."

The complex, which began taking shape six years ago, began with one chateau. Malouf's Medicaid dental empire was expanding, and he sold a major share to a private equity fund.

Now he's sinking his earnings into a new mansion next door, along with a private Schlitternbahn in the back acreage, along with a second swimming pool to match the one at the original mansion.

All this is happening as two suits charge Malouf with massive fraud, brought by the Texas Attorney General and private attorneys under the False Claims Act.
Attorney Jim Moriarty is one of a consortium of attorneys in the action, led by Waters & Craus in Dallas. They say samples of Malouf's records show that 100 percent of his Medicaid claims were false.

"Frankly, it borders on being obscene," Moriarty said of the mansion expansion. "The taxpayers of the State of Texas paid to build that house, and are paying to expand that house for a guy who claims to have made his money treating the people of Texas."

"I think the only other park I know of is in Jupiter, Florida," Candy Evans said.
That one belongs to singer Celine Dion. A comparison of photos of Dion's estate with those of Malouf's, obtained by News 8, show that Malouf's water park may be bigger.

In Texas, a family's home is immune from seizure. But the lawyers in the false claims action against Malouf say his home may be fair game.

"If that home is purchased with stolen money, or that home is based on money that has been earned by falsehood or deceit, then that home is not protected at all," Moriarty said.

Malouf has several groups of attorneys, since his former company, All Smiles, is in bankruptcy in addition to his pending false claims suit. His most recent criminal attorney did not get back to us.

Related:

• Candy's dirt real estate blog
• Texas AG lawsuits spurred by WFAA dental investigation
• All Smiles Dental Center files for bankruptcy following investigation
• Texas Medicaid dental program pays millions for crowns, fillings
• Texas doctor accused of Medicare, Medicaid fraud gives up license
• Medicaid recruiters scramble for Texas dental patients
• Outrage on Capitol Hill follows News 8 Medicaid probe

Texas Attorney General Lawsuit–Dr. Richard Malouf–All Smiles Dental Centers

Texas AG lawsuits spurred by WFAA dental investigation

 

Posted on June 26, 2012 at 12:38 PM

Updated today at 9:40 AM

Related:

• Dental Investigations

DALLAS - A year-long WFAA investigation into questionable Medicaid dental payments has resulted in the Texas Attorney General filing lawsuits this week.

Greg Abbott charges that a Dallas dentist and his corporate entities bilked taxpayers out of millions for fraudulent orthodontic work on poor families.

Dallas dentist Richard Malouf amassed a multi-million dollar mansion, corporate jets and luxury vehicles through his dentistry, News 8 has found.

He and his former firm, All Smiles, declared bankruptcy following a series of reports detailing how he and other dentists around Texas gamed the welfare system by billing for unnecessary dental work.
WFAA found that over the past few years, Texas has paid out more in Medicaid orthodontic claims than all other 49 states combined.
All Smiles billed Medicaid for at least $15 million over two years, which is twice as much as the entire state of Illinois. The Attorney General’s lawsuits, filed in Austin Monday, seek to recoup “two times the amount of the overpayments.”

WFAA’s findings have spurred outrage among lawmakers and hearings in Austin and Washington D.C.

Madelayne Castillo, a former All Smiles employee, and Dallas orthodontist Dr. Christine Ellis filed separate whistleblower lawsuits in April and May alleging fraud by Malouf and his corporations.
Both lawsuits remained sealed while the Attorney General’s office investigated the claims. On Monday, Abbott’s office joined those lawsuits by refiling them in the state's name.

In April, Dr. Ellis testified before the U.S. House Oversight and Government Reform subcommittee that Malouf and other dentists were responsible for “flagrancy of fraud that is truly unbelievable."
In May, WFAA reported that All Smiles bankruptcy documents showed that Malouf owns 28 percent of the company, and Valor Equity of Chicago had the remaining 72 percent.
A subsidiary of Valor is a named defendant in one of the Attorney General’s suits.

Abbott alleges Malouf and others violated of the Texas Medicaid Fraud Prevention Act.

“The defendants knowingly or intentionally submitted false information, and misrepresented material facts, when seeking prior approval for orthodontic services,” the lawsuit states.
“Defendants submitted claims for services which they did not provide, and misrepresented or concealed the true nature of the services which they provided,” it states.

“Defendants also knowingly paid or received consideration as a condition of the provision of dental/orthodontic services by unlawful recruiting and paying kickbacks for the recruiting of Medicaid clients,” it continues.

The suits allege that Malouf and the other defendants billed for work that was not medically necessary, and in some cases, performed it with unqualified dental workers. They also “upcoded,” or billed for orthodontics which were more expensive than what was actually provided, the suit states.

by BYRON HARRIS and JASON TRAHAN

Bio | Email

WFAA

Byron Harris update on dental Medicaid fraud in Texas

June 20, 2012

Read Byron’s complete report here at WFAA

In 1998, Texas spent $16.5 million on stainless steel crowns, in 2010, 12 years later, Texas taxpayers spent nearly $108 million, up 650% in 12 years!

In 1998, Texas spent $16.5 million on stainless steel crowns, paying for 250,000 thousand of them. In 2010, 12 years later, it spent nearly $108 million, on 700,000 crowns. Up 650% in 12 years! Byron Harris reports on why that could be. Hint: think body snatchers!

June 1, 2012
WFAA

Orthodontics Offices Closing in Texas

Looks like the spin has started in Texas. I’m hearing many Orthodontic clinics will  close up shop on July 1, 2012.

In the piece below, Dr. Michael Newman's says, "...about 5 percent of them would meet the requirements now."

Fact is, about 5% qualified EVER! Only thing that is changing is maybe, just maybe, stricter enforcement of standards already in place.

Surely Dr. Newman really meant to say, "about 5% is all we can bill for and not get nailed for Medicaid Fraud, now"

TIMES RECORD NEWS - Wichita Falls, Texas

Orthodontist office braces for closure
Practice was only one in area taking Medicaid

Wichita Falls, TX May 26, 2012 -The only orthodontic office accepting Medicaid payments in Wichita Falls has stopped seeing patients and has locked its doors.

Red River Orthodontics set up shop on Euerka Circle in mid-2010. A sign in the door of the vacated Wichita Falls practice directs patients to an office in Fort Worth.

Representatives of Red River Orthodontics declined to comment, and referred questions to an attorney who could not be reached Friday.

The business was registered in the Wichita County Clerk's office under the title John Gremmels, Grill Repair, PA. The address given was in the 3300 block of Monterra Crest Drive in Fort Worth.

Last year Texas paid out $184 million in Medicare for orthodontics. That's more than every other state combined.

Dr. Bill Hendrickson, of Hendrickson Heetland Orthodontics, said he suspects Red River Orthodontics bolted for the door when they realized the Medicaid money was drying up.

"Their words were, 'It's a good investment,'" said Hendrickson, who visited the office personally. "They said, 'This is a very lucrative business.'"

Hendrickson now is in talks with state officials. He said he's trying to take on the patients who were displaced when Red River Orthodontics jumped ship.

Technically, at least one dental office that offers orthodontic services still accepts Medicaid, but is actually kept from doing so because of more stringent, state-mandated requirements.

In 2005 about 80 percent of dentist Dr. Michael Newman's patients were on Medicare. Newman, who operates Texas Orthodontics in Wichita Falls with his wife Denise, practices orthodontics as well as other dental procedures. Until October 2011 he was able to treat most of the patients who needed Medicaid to pay for his services.

But stricter enforcement of Medicaid standards mean that most of them, even patients who have already been fitted with braces, won't receive his care.

"I would say about 5 percent of them would meet the requirements now," Newman said.

In fact, only one of his potential patients received the go-ahead from the state for treatment. Newman wasn't allowed to treat that patient because he isn't a specialist.

A few factors have contributed to this, he said.

One is that some orthodontists have been accused of taking advantage of Medicaid funds. One case, detailing taxpayer money given to All Smiles Dental Centers in Dallas, has drawn significant media attention.

Another factor is the splitting of the third-party entity that paid Medicaid funds to orthodontists, the Texas Medical and Healthcare Partnership. About a year ago, he said, the company was divided into three new agencies, DentaQuest, Delta Dental, and Managed Care of North America. Newman said it hasn't been the same since.

He said the companies have drawn up constricting new rules that makes it virtually impossible to get a patient approved for payment.

"They started cutting back so that we couldn't get the cases approved," he said.

One rule that's being more strictly enforced is that an orthodontist must prove that a procedure is "medically necessarily" to maintain a patient's health. Newman said this is laughable.

"There is no patient I have ever seen who is going to die because of their teeth," said Newman, an officer of the American Orthodontic Society.

Disgraced Texas “All Smiles Dental Centers” & Dr. Adrian Martin Codel

Has anyone wondered who Valor Investment’s front man dentist happens to be, since Malouf no longer owned more than 50% of the centers, Valor needed a pretend owner to be on the various PLLC documents.

The “pretend” owner is Dr. Adrian Martin Codel, of Chicago, Illinois, Valor’s headquarters.

Adrian Martin Codel
All Smiles Dental – Texas
AC Dental – Chicago

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Dr. Adrian Codel

After graduating from Northwestern University Dental School's last graduating class in 2001, I went on to complete a General Practice Residency at the Illinois Masonic Medical Center.

This hospital based dental experience included training in IV sedation and Special Needs patient care in a clinical and O.R. setting. The public health component involved providing dental care on a mobile dental unit.

I enjoyed this aspect of dentistry so much, I stayed on as an attending dentist primarily on the mobile unit. Specifically, providing free urgent care to the homeless Chicago population Friday nights. In addition, I was an associate dentist for a pediatric dentist my first 3 years after receiving my GPR certificate.

In 2005, I purchased an existing dental practice and have been a solo practitioner in this urban community based practice since then.

In October 2010, I was approached by a colleague interested in making an equity investment in the largest provider of dentistry in the state of Texas. I agreed to consult him in this purchase and am currently the president/owner of All Smiles Dental Centers which oversees 38 clinics and 5 mobile units providing dental care to the undeserved population in Dallas and surrounding areas.
http://www.sharecare.com/user/dr-adrian-codel/bio

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Now, unless Dr. Adrian Martin Codel is a complete imbecile, he knew he was breaking all kinds of Dental Practice Acts by doing this. I’ll give him kudos though; he at least admits he was approached to help with an “Equity Investment”.

I think he might have been approached before October 2010, his Texas dental license was issued in September 2010.

Now he’s linked up with the most outrageous, flamboyant criminal dental enterprise since Michael A., Eddie and Dan DeRose and their FORBA a/k/a Small Smiles. 

Hmm…All Smiles, Small Smiles, …. I’m thinking a nice jingle is in order!

Dr. Adrian M. Codel
Illinois Lic info:
Number-019025709
Status-Active
Date Issued-10/29/2001

Texas Lic info:
Number – 0025986
All Smiles Dental Ctr –Abrams
6780 Abrams Rd. #207
Dallas, Texas 75231
312-217-9630Status - Active
Date Issued –09-14-2010
Disciplinary Actions- No
Permits – Nitrous-issued 10-12-2010

Valor Private Equity-Richard Malouf All Smiles Dental Centers Top 20 Unsecured Creditors List

Amended 20 Largest Unsecured Creditors- Doc 8

Valor Investments –They lost their ass fast.

Other Filings Here

Byron Harris was in Washington for the hearing on Medicaid fraud. You don’t want to miss his report.

by BYRON HARRIS
Bio | Email

WFAA
Posted on April 25, 2012 at 10:11 PM
Updated today at 7:36 AM

WASHINGTON — "It took a reporter to unlock the mystery that Texas is spending more on braces than the rest of the country put together?"

That was the half-humorous question Rep. Trey Gowdy (R-South Carolina) asked his fellow members of the House Oversight and Government Reform subcommittee in Washington on Wednesday.

Looking at Medicaid fraud, the committee talked to whistle-blowers and lawyers from Minnesota and New York, all of whom discussed scandals in their home states.

But the witness at the heart of this hearing was from Texas.

Dr. Christine Ellis, a North Texas orthodontist, credited News 8 with revealing a "flagrancy of fraud that is truly unbelievable."

News 8 spent thousands of dollars to acquire Medicaid records from the State of Texas and discovered that the state paid out $424 million to put braces on poor kids' teeth from 2008 to 2010.

News 8 also obtained spending totals on orthodontics from other states individually, after the federal government said it did not compile them.

"As they say, everything is bigger in Texas," Dr. Ellis told the panel. "Thanks to the investigative reporting of WFAA's Byron Harris, we now know that orthodontic Medicaid fraud is no exception."

Texas Board of Dental Examiners–Drilled; the truth hurts

Well, it appears Wednesday-April 11, 2012-was an eventful day in Texas, at least when it comes to Corporate Dentistry practices that has invaded the state. The Texas state legislature is finally asking question why these places are in business and who is in charge of letting them do as much damage to the children as Mad Cow does to cattle.

The Texas State Board of Dental Examiners says it’s not them, just like the Georgia Dental Board. Below there are three articles from around the web on the happenings yesterday.

I just have so much to say about this, but I don’t have time today.

Wednesday April 11, 2012

Statesman. Com
Watchdog group, others doubt effectiveness of dental board
By Mary Ann Roser -AMERICAN-STATESMAN STAFF

Published: 9:19 p.m. Wednesday, April 11, 2012

Patients, dentists and lawyers told a Texas legislative committee Wednesday that the state agency that regulates dentists does a weak job of protecting the public from bad care.

But board officials said the Legislature hasn't provided enough money to better regulate 60,000 licensees in Texas.

The problems go beyond that, said members of Texans for Dental Reform, a Houston-based group that monitors the Texas State Board of Dental Examiners and has long sought to air its grievances before the House Public Health Committee.

The group, and other members of the public, came to the committee Wednesday with recommendations and complaints. Among them: The board protects dentists and lacks a standardized way of disciplining them; it defines standards of care on a case-by-case basis, rather than following established care guidelines when investigating dentists; and it allows dentists who have been in serious trouble to get a new license number, making it exceedingly difficult for the public to connect the dots to previous disciplinary actions.

They also said that board members should never act as expert witnesses in lawsuits involving dentists and asked for action against unregulated dental clinics that "overtreat" children to take advantage of increased payments from Medicaid, the state-federal program for the poor.

"Over the past three years, we have found the board resistant, abusive and arrogant towards the public and unwilling to make the changes needed to protect public safety and health," said Gwen Mitchell, president of Texans for Dental Reform.

Dr. Tammy Gough of McKinney, presiding officer of the 15-member dental board since December 2010, said the board has strengthened various rules and is developing a standard way to review complaints and discipline violators. She said she has no problems with a law banning board members from acting as expert witnesses because none do.

But the volunteer board is hamstrung in its work by too little staff, not enough money and a lack of authority over corporate-owned dental clinics accused of exploiting Medicaid, said Glenn Parker, acting executive director of the agency.

Medicaid fraud complaints are turned over to the attorney general, inspector general and law enforcement officials, Parker said.

"We understand there is room for improvement," said Gough, who won praise from various members of the public for her openness to change.

The board could do better if the Legislature allowed it to keep more of the $9.6 million it collects in license fees and other work, Parker said. Instead, its current budget is just $2.7 million, and although it is authorized to employ 36 people, it employs just 29 because it can't afford more, he said.

Board officials also said some changes Texans for Dental Reform and others are pressing for would require legislation.

Houston lawyer Jim Moriarty disagreed that the board lacks authority to go after the corporate-owned clinics that are abusing Medicaid. He has filed suits in New York and Colorado against a network of clinics with operations in Texas and said the board should discipline the dentists in those practices, he said.

Lawyer Charlie Gustin of Houston has sued the Smile Center in San Antonio and told the committee of one case involving a 5-year-old boy who received 20 "baby" root canals and 20 steel crowns in 48 minutes. The boy left the clinic with cement in his mouth, and 14 of the crowns have since popped off, Gustin said.

Smile Center spokeswoman Debbie Clarke said the owner of the practice was unavailable to comment Wednesday "due to his professional responsibilities."

At the hearing, committee Chairwoman Lois Kolkhorst, R-Brenham, said that she wasn't interested in revisiting past problems but that the panel recognizes that the board needs lawmakers' help to get the tools it needs to do a better job.

Dentist Douglas Terry, a Houston-area member of the reform group, said he was encouraged.

"Things are going to change," he said.

Contact Mary Ann Roser at 445-3619

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The Texas Tribune
Texas Dental Board is Accused of Ineptitude

by Becca Aaronson

April 12, 2012

Texas toddlers being held in restraints as dentists at corporate-run clinics performed unnecessary root canals were among the dental horror stories told Wednesday at a House Public Health Committee hearing at the state Capitol. 

The Texas State Board of Dental Examiners, which regulates dental licensing in Texas, was the subject of criticism by members of Texans for Dental Reform and unaffiliated residents, who called for legislative reform while levying accusations of ineptitude, a pattern of withholding or obscuring negative information about dentists, and failure to act against corporate-run dental clinics committing Medicaid fraud and harming patients.

But others came to the board’s defense, saying that the new leadership is trying to fix mistakes from the past and that the board lacks the resources to do its job well. 

“We have an underfunded and understaffed state board that is not able to accomplish all that we’d like them to accomplish,” said Richard Black, the legislative chairman for the Texas Dental Association and an El Paso dentist. Although it is taking time, the leadership of the board has made “substantial progress,” he said. 

Both Black and members of the dental board expressed concerns about the recent outcrop of corporate-run dental clinics — and the board’s limited ability to protect the public when unlicensed operators at such clinics interfere with patients’ treatment.

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The clinics in question often serve only Medicaid patients and pay one dentist to act as a prop by claiming ownership. The real owners of the clinics — usually private equity firms — are in the dental business for profit, and encourage overutilization of Medicaid services by dictating a “one-size-fits-all treatment plan” or setting quotas for the number of procedures that dentists should perform, said Black.

Dentists drilling for Medicaid gold is a national issue, as one Washington TV station documented, and more corporate-run dental clinics popped up in Texas after lawmakers raised reimbursement rates for dental procedures in 2009 to motivate dentists to accept Medicaid patients. Joyce Sparks, general counsel to the dental board, said the board has also seen an increase in complaints of dentists violating standards of care since then, which could be linked to the rise in reimbursement rates.

Jim Moriarty, a Houston lawyer, detailed reports of torturous procedures at corporate-run clinics, in which children as young as 2 are immobilized, sometimes with a restraining device called a papoose, while the dentist inserts multiple stainless steel caps or performs root canals rapidly.

“They won’t let the parents be present because the parents would be tempted in Texas to pistol-whip them if they knew what they were going to do,” Moriarty said. He’s currently suing one company that operates six dental clinics under various names in Texas and said the dentist who claims to operate those clinics — but actually works and treats patients in Oklahoma — bills Texas $12 million a year to treat Medicaid patients.

“We want to be part of the solution, but right now we have no tools with which to combat this,” said Glenn Parker, the dental board’s acting executive director. The board only has the authority to license and sanction individual practitioners, which inhibits its ability to monitor or regulate clinics owned by private equity firms or corporations. The only recourse for the dental board is to notify the Office of the Inspector General and other state and law enforcement agencies when they’ve received an accusation of Medicaid fraud.  

Unless someone comes forward “willing to testify they’re a cover for the private equity fund, so sanction me because I’ve been defrauding you,” the board can’t do anything, Sparks said. “It just doesn’t happen.”

The board has identified the corporate practice of dentistry as an issue for lawmakers to address in the next legislative session, Parker said, adding that the board wants to get legal authority to regulate those clinics. The board also wants adequate funding to resolve the complaints it receives.

Unlike the Texas Medical Board, which pays consultants and doctors to investigate allegations of medical misconduct, the dental board relies on volunteers to investigate complaints. There are usually 15 to 20 active consultants — dentists who apply to the board, undergo background checks and training, and then receive approval from at least two board members — to review complaints about standard of care. 

Parker estimates the dental board receives 500 to 600 standard-of-care complaints a year. At least two of the volunteer dentists must review a complaint and agree on whether a standard of care violation occurred before the case is closed. 

Board members said they've opened communication with Texans for Dental Reform to address their complaints, but ultimately, the agency needs more investigators and staff. Parker admitted the volunteers often "cherry pick" the easier complaints. “When you have staff turning over, some people do what’s easiest to do, not what’s best to do." 

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The Dallas Morning News

Texas board says it’s falling short in regulating bad dentists

SOMMER INGRAM
Austin Bureau
singram@dallasnews.com
Published: 11 April 2012 11:19 PM

AUSTIN — The agency that polices Texas dentists told lawmakers Wednesday that it doesn’t have enough resources or legal authority to crack down on careless and abusive dentists.

An advocacy group led the charge against the Texas State Board of Dental Examiners, telling a legislative panel that the regulatory board doesn’t do enough to discipline bad dentists or alert the public which dentists have been sanctioned.

“We’ve found [the] board to be resistant, abusive, arrogant toward the public and unwilling to make changes needed to protect public safety and health,” said Gwen

Mitchell, president of Houston-based Texans for Dental Reform. “The consensus is that it only has one agenda, and that is to protect its own.”

The board, which oversees 15,000 dentists, 32,000 dental assistants and 12,000 hygienists, has long been dogged by complaints of shoddy oversight that leaves patients suffering and dentists unaccountable.

In response at the House Public Health Committee hearing, board leaders said the agency needs more funding and staff to keep up with the demands of approving licenses and reviewing the 500 to 600 cases it gets each year.

They can range from pulling the wrong teeth to injuring a patient, from abusing drugs to sexually assaulting a patient.

Mitchell’s group and others want the board to disclose all complaints filed against dentists and to get rid of those providing dental care without a license.

But board officials said the Legislature wrote the law so that it can’t disclose complaints lodged against dentists if they are dismissed.
They said they’ve been limited in enforcement tools and largely depend on the attorney general’s or inspector general’s office to pursue and remedy cases of fraud, especially in Medicaid.

“It’s not the charge of the board itself to be the lead agency in investigating Medicaid fraud,” said Glenn Parker, the acting executive director. He said that if disciplinary action is taken by the attorney general’s or inspector general’s office, the board takes action.

He said the dental board collects $9 million annually in fees, but the Legislature allots it about $2 million for its total budget. “We could use a lot more funding,” he said, although he did not give a specific figure.

Licensing actions The board’s sanctioning method is to revoke or suspend dentist licenses, so board leaders say that leaves them without a way to punish those practicing without a license to begin with.

Dr. Tamela Gough, presiding officer of the board, said the board regulates individual practitioners but has no authority over clinics or owners of clinics. “We regulate the licensed dentist who is performing dentistry in these clinics — they’re not running willy-nilly as far as patient care,” Gough said. “But in order for us to regulate the actual corporate entity, it would require legislation.”

Jim Moriarty, a Houston lawyer who prosecutes Medicaid fraud cases, argued that the board is taking the easy way out by saying it doesn’t have the power to punish private entities and those practicing without a license.

“I’m appalled when I hear the board say they have no control over these people. Texas has some of the best regulations in the country, but the law is just not being enforced,” Moriarty said. “The board sits like an ostrich with its head in the sand saying, ‘If they don’t have a license, we can’t do anything.’”

Charlie Gustin, a San Antonio lawyer who works with children on Medicaid, told lawmakers about a boy he represented who went in for dental work and ended up worse off than he started.

He was given double the amount of local anesthetic required for a child his body weight and received 20 baby root canals and 20 stainless steel crowns in less than
an hour.

When he went to another dentist for remedial work, 14 of the 20 crowns popped out and the dentist noticed excess cement left in his mouth that can cause infection.

The dentist filed a complaint with the board and found that the first dentist’s license had been suspended in New York before he came to Texas.

“But the state board online lists no disciplinary actions,” Gustin said. “We need more disclosure to the public when you have a dentist that’s been kicked out of another state. But according to our state board of dental examiners, he’s clean. And that’s a problem.”

More fraud complaints
Joy Sparks, the board’s general counsel, said that over the last two years, Medicaid fraud complaints have increased, probably because reimbursement rates have gone up.

“The state increased the reimbursement rate to make it more lucrative for dentists to take Medicaid patients. … Once that occurred, there were those who took advantage of the system because it became more profitable to participate in Medicaid.”The House panel said it would consider efforts in the next legislative session to overhaul the dental regulations.

Texas, feds take action on orthodontic fraud | wfaa.com Dallas - Fort Worth

 

NEWS 8 INVESTIGATES

DALLAS — A Dallas dentist has agreed to pay the state and federal government $1.2 million to resolve allegations that he submitted false orthodontic claims under Medicaid.

Dr. Richard Malouf, former majority owner of All Smiles Dental Center, allegedly submitted false Medicaid claims between 2004 and 2007.

News 8 reported on Malouf's lavish homes and two multimillion dollar corporate jets. Malouf did not admit any wrongdoing or liability in his settlement.

He is one of several orthodontists highlighted for multimillion dollar billings under Medicaid.

Eleven dental operations statewide have had their state funds suspended for credible allegations of fraud in billing the Texas Medicaid Orthodontics program. This follows a 10-month News 8 investigation of medicaid orthodontics in Texas, which found the state spends more on braces for poor children than the rest of the nation combined.

"Something's wrong and I want my money back," said Texas Sen. Jane Nelson (R-Flower Mound). Nelson called a hearing to look into how Texas spent $424 million on orthodontics under Medicaid between 2008 and 2010.

Medicaid does not cover cosmetic orthodontics, but a News 8 investigation found that tens of thousands of children received procedures at taxpayer expense.

"What we really want is, we don't want people to do it," said Texas Sen. Bob Duell (R-Rockwall).

Dental Braces: Once Again Texas Makes News with Braces

 

Dental Braces: Once Again Texas Makes News with Braces

March 20, 2012 By Jim Du Molin Leave a Comment

What is it with Medicaid dental care and braces in Texas?

The Texas Health and Human Services Commission, which administers Medicaid in Texas for dental braces, has filed a request to be reimbursed for $7.5 million in alleged fraudulent claims it paid to Amarillo orthodontist Dr. Michael Goodwin.

Federal authorities also moved to seize the commercial and personal bank accounts of Dr. Goodwin and his wife as part of a probe linked to a Medicaid fraud scheme, according to the Amarillo Globe-News.

In 2008, Dr. Goodwin became an individual Medicaid provider, which allowed him to bill Medicaid only for services personally provided by the orthodontist.

Soon after the change, the Amarillo orthodontist was reported as scheduling up to 400 Medicaid patients a day and allegedly billing the government for orthodontic treatment he did not perform. The Globe-News further reports that patients and former employees likened the Amarillo Medicaid fraud scheme to “herding cattle.”