Senators Bacus and Grassley Report on Corporate Dentistry and the Failures of HHS/OIG to Protect Children

Corporate dentistry criticized for unethical practices, unnecessary procedures

by Eddie Burkhalter
eburkhalter@annistonstar.com

Jul 28, 2013

When Quintoya Seawright’s 3-year-old daughter, Destiny, chipped a baby tooth in November 2010, the young mother took her to the Small Smiles clinic in Montgomery. Quintoya, 25, would end up taking her daughter to the clinic four times that month.

On the last visit on Nov. 9, her daughter was strapped to a board for an hour while the dentist struggled to place two stainless steel caps on baby teeth while her daughter screamed and struggled, saying she could still feel it, the family said.
But without much money, the young mother had to rely on Medicaid to pay for her daughter’s care. Small Smiles specializes in treating children eligible for Medicaid. The company operates another clinic in Dothan.

The large dental chain is owned by a private equity firm and is managed by Nashville-based CSHM LLC. A report released by the U.S. Senate Finance Committee last week claims Small Smiles and clinics like it are motivated by profit, often performing unnecessary procedures, and should be removed from the Medicaid program.

The report also says the clinics are operating in violation of laws in 22 states, including Alabama, that ban anyone other than a licensed dentist from owning a practice. The report states that CSHM actually owns and operates the clinics, and not the “owner” dentists the company enlists to skirt to get around those state laws.

Quintoya said she was never allowed to go back with her daughter to watch the procedures at Small Smiles, but the 3-year-old girl’s grandmother, Sophia, demanded she be allowed on the girl’s last trip.

Destiny began pulling at her mouth, so workers strapped her arms and legs to the board, then the dentist struggled for an hour to place the two caps on the tiny baby teeth while Destiny “kept saying she still felt it. He said, ‘No. She’s numb. It’s just the noise,’” said Sophia.

“Her heart was just beating so fast,” Sophia said. “The lady was holding her head down and was trying to get her to open her mouth by squeezing her nose.”
Destiny had a total of five stainless steel caps placed on baby teeth over four visits. One cap fell out along with the tooth a couple weeks later. Quintoya said she never heard the dentist say her daughter had cavities in those teeth, but he said the caps would help prevent them from forming.

“I’m not sure if it was a necessity to have all those silver things in her mouth,” Sophia said.

Read more: Anniston Star - Corporate dentistry criticized for unethical practices unnecessary procedures

Senators Max Baucus and Chuck Grassley issue 1,500 page joint report calling for corporate Medicaid dental clinics to be ousted from the program

Today, Senators Baucus and Grassley issued a 1,500 – 1517 pages to be exact — page report on claims I’ve been making here on Dentist The Menace for nearly 6 years. The report includes 66 exhibits.
The story accompanying the release of the Joint Staff Report On The Corporate Practice of Dentistry In The Medicaid Program can be found at The Center for Public Integrity, here.  In David Heath’s story, he reports the new owners Small Smiles Dental Centers state the following:

“only five of the 20 inspection reports mentioned in the Senate report fell under its watch.”

and

…"We've taken action to help CSHM improve its quality of care and management,"

and

…“The new team immediately initiated an aggressive turnaround effort premised on patient care, clinical excellence and regulatory compliance,” the company said.

Well, that’s nothing to be crowing about, since the “new management”  only legally acquired the company 13 months ago putting a guy by the name of David R. Wilson in charge. That was in June of 2012, (13 months ago) so 1/4 of the inspections mentioned in Bacus/Grassley report took place under their watch. This is not a good record in my opinion — heck it’s as bad if not worse than the Michael Lindley/Al Smith or DeRose Family regimes.  Nor it does it demonstrate anything close to “an aggressive turnaround effort on patient care”.  What it does demonstrate, however, is “business as usual”. 
CPI also reports twice last year the OIG threatened to shut Small Smiles out of the Medicaid program.

“Twice last year the HHS inspector general threatened to exclude Small Smiles from the Medicaid program. But in a letter to Grassley and Baucus, Inspector General Daniel R. Levinson said Small Smiles fixed the problems by selling the Manassas clinic, paying a $100,000 penalty and addressing other concerns.”

Now, did CSHM actually “sell” the Manassas, Virginia clinic?  That is highly suspect!  A guy out of Idaho left his own practice and moved his entire family to Virginia and slapped his name on the place, calling it Kids and Family Dentistry.  Coincidently, at the exact same time, the Small Smiles flagship clinic in Pueblo, Colorado changed it’s name to Family and Kids Dentistry, making the “owner” the same guy who was  the lead dentist working for Small Smiles at the time.  (Logos have a odd resemblance about them, don’t they?)  Anyone taking bets on whether the DeRose family — founders of Small Smiles —are somehow still involved with these two clinics?
As for the $100,000 penalty, that didn’t even cover 1/2 of the amount scammed in the x-ray scam in just one Colorado Small Smiles.  What would add insult to injury is it was probably on a payment plan, like the $24 million settlement in 2010.
The Bacus/Grassley report includes independent monitor reports on Small Smiles Phoenix, Arizona, Manassas, Virginia, Oxon Hill, Maryland and Youngstown, Ohio and others.  Small Smiles signed a Corporate Integrity Agreement with OIG in January 2010 agreeing to 63 pages of terms and conditions, including self-reporting.  Of course the “independent monitor” can only report on what they find.  But what about what they don’t find? 
I’ve not come close to reading the entire report just yet, but so far I’ve not read anything about the $200K x-ray scam in one of Colorado clinic that was NEVER self-reported, or the fact that a corporate staffer took the necessary Continuing Education courses to get the lead dentist in Mishawaka, Indiana credentialed in Indiana, making her effectively non-licensed to practice in Indiana to this very day or a host of other illegal activities going on behind the closed doors at Small Smiles Dental Centers and Church Street Health Management (CSHM). I doubt I find these things in the report, but you can find them here if you look.
It’s scary to think state dental boards and state Medicaid programs have not only turned a blind eye to the child abuse, but promoted and encouraged it.  Those of us following this industry also know this is just the tip of the iceberg. 
More on this eye opening report in the coming days.  In the meantime, I encourage everyone to read The Joint Staff Report On The Corporate Practice of Dentistry In The Medicaid Program and evidence attached by clicking here .

CSHM’s Small Smiles Dental Centers Up to Same Old Crap

No, this is not big surprise; it’s been around 18 years. This business has been hanging on since 1995 when Eddie DeRose, Michael DeRose, Adolph Padula and John Parrish open its second dental clinic in Colorado.  Then came the first phase expansion with the creation of DeRose Management in 1998, operation Children’s Medicaid Dental Centers in Colorado and New Mexico.  Becoming so highly lucrative in the business of abusing children and defrauding Medicaid under the guise of providing dental care to the “underserved”, FORBA was formed by the “family” and expansion across the country began.  In 2006 the “family” found a group of idiots, including a Bahraini banker, to buy it for $435 million dollars.  In 2012, this group filed bankruptcy after 10 years of reports of child abuse and fraud finally caught the attention of Health and Human Services and they were investigated and fined $10 million.  The first reports were around 2003.

Lately, I’ve received two emails from people who CSHM have tried to recruit. As you can see emails dentists have shared nothing has changed.

---

From: Scott Shue [mailto:sshue@cshm.com]
Sent: 
To: 
Subject: Lead Dentist Opening

Employment with guaranteed base salary and monthly bonus.  Benefits include medical, dental, vision, disability, etc.  Malpractice is covered.  We offer 2 days of CME and 401k with 5% match and a 4-year vesting schedule.  General dentistry with an emphasis on pediatrics.  Salary range of $150,000 to $180,000 for the Lead position.  Efficiency-based model utilizing DA’s with expanded functions, office manager and clinical coordinator.  The requirements for the Lead Dentist position is to establish conformity, a congenial work environment, development of other Associates, etc.

…Salary is determined by experience, clinical expertise and interview/leadership skill which would be part of a discovery effort throughout the interview process.  Monthly bonuses are a % of the location’s net profit.  Basically, the pool is 35% of the total profit would be split between the dentists.  The Lead would then get an additional 10% and the Owners get an additional 5% for each location.  We do not have production “quotas”, just daily/monthly expectations. 

Scott M. Shue | Recruiter | CSHM LLC |
618 Church Street, Suite 520
Nashville, TN 37219
C: 770.855.1877 | O: 615.750.0342 | F: 615.986.1705
email: sshue@cshm.com

 

 

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FYI – Dr. Jodi Kuhn, DDS the scam owner dentist for Small Smiles Dental Centers has now worked her way up to being called “owner of at least 11 clinics.  Five in Colorado, Five in Ohio and 1 in Kentucky. 

There are two types of management companies and below is a comprehensive comparison of the two.

Corporate DMSO	Dental Consultants and Managers
View Dentistry As A Business	View Dentistry As A Medical Profession
Employ The Dentist and Staff	Are Employed by The Dentist Who Owns The Practice
Own The Dental Offices	Manage Dental Offices As Needed by The Dentist
Are Backed By Wall Street Investors	Recommend Funding Solutions
Award Themselves with Dentist’s Earnings By Sweeping The Practice’s Bank Account	Invoice Dentist Practice and Take Payment Only For Services Rendered
Focus On Production Per Patient Agenda	Focus on Assisting Dentist With Quality Non-Medical Service.
Exploit Dentists’ Lack of Business Training	Teach, Mentor, and Assist Dentists With Business Needs
Have Fiduciary Duty To Financiers And Shareholders	Have Fiduciary Duty to the Dentist Who Hired Them
Convince Dentists They Don’t Need To Get Involved With Back-Office Operations	Encourage Dentists To Be Involved In All Management Decisions Of The Practice
Retreat and Hang Dentists Out To Dry In Times Of Trouble	Support Dentists And Offer Guidance Through Any Problem
Deploy Corporate Employed Office Managers To Reinforce Who’s In Control	Respect They Are Employed By The Dentists.
Understand High Profit Business Models	Understand Business Solutions For Dentists
Have an Master of Business Administration Degree	Have a Doctor of Dentistry Degree
Violate State Laws i.e. Dental Practice Acts To Hide True Ownership	Do Not Violate Laws When They Own A Dental Practice
Best Financial Gain Strategy With The Patient-Doctor Relationship	Do Not Come Between The Patient and The Doctor When Determining Treatment Options
View Dentists As Assembly Line Workers	Understand Dentists Are Medical Professionals Delivering Medical Care
Follow An Assembly Line Cookie-Cutter Business Models In Each Clinic	Provide Á la Carte Custom Services Per Owner Dentist Request
Set Quotas, Reward Top Producers With Bonuses and Dispose Of Non-Producers	Recommend Office Policies for Long Term Sustainability
Choose Suppliers And Vendors Offering Sub-Standard Materials	Recommend Trusted Suppliers and Vendors
Goal To Increase Profits Simply For Future Sale of Company	Goal To Promote Mom and Pop Practices
Control Every Aspect Of The Profession From Appointment To Patient Treatment Options	Provide Non-Medical Business Support Never Interfering With The Doctor Patient Relationship

Here is an example of a legitimate contract with a management service company looks like.

North Caroline DSO Management Services Agreement

Small Smiles Dental Centers Bankruptcy–It’s complicated

It’s complicated to liquidate a company operating illegal dental clinics.  As of February 21,2013 there have been 630 various pleadings filed in the bankruptcy case of Small Smiles Dental Centers. The Docket report is dang near 70 pages.  Even it is an interesting read.

If you currently work for Small Smiles Dental Centers or have EVER worked for Small Smiles Dental Centers you need to read this carefully. I realized they mass mailed a “Summary” of the Liquidation and Trust Agreement, as well as a “Ballot” but the key word is “summary”. 

This junk company is an albatross that will forever more hang around the neck of every executive, every regional or sub-regional manager and every dentist who ever worked there. You will constantly be looking over your shoulder for the next 10 years or longer. 

The last time I took the bar exam was…  uh… NEVER, so read it and draw your own conclusions.  

This the the current PROPOSED Plan of Reorganization and not approved by any means as of yet.  There are objections by their malpractice carrier on file, and that’s where the dentists come into play even more I suspect.

[Now, if I found myself in the middle of a malpractice lawsuit and being represented by an attorney assigned to me by a malpractice insurance company who didn’t want to cover claims because they got hoodwinked by some slick willy system scammers, I’m not sure I’d feel that particular attorney had my best interest in mind.  Think about it.]

Proposed Second Amended Joint Plan of Reorganization Doc 594 01-11-2013

I particularly enjoyed this section on page 17.

4.17(h) Claims Against Former Affiliates. Each holder of a Class 5(a) Claim will retain any and all claims and legal rights such holder may have against any of Danny DeRose, Edward DeRose, Michael DeRose, William Mueller, or Adolph Padula. All holder of Class 5(a) Claims will be entitled to initiate and prosecute any such claim against any or all of Danny DeRose, Edward DeRose, Michael DeRose, William Mueller, or Adolph Padula without restriction in the tort system. To the extent the automatic stay in these Chapter 11 Cases or any other limitation imposed by these Chapter 11 Cases would limit any such action, such automatic stay or limitation will be lifted thirty (30) days after the Effective Date of the Plan

Summary of Liquidation and Trust Agreement

Church Street Health Management Court Docket, February 21,2013

Oh where, oh where has Small Smiles gone, oh where, oh where can it be…

February is “National Children’s Oral Health Month”. Normally Small Smiles Dental Centers lead dentists (or fake owner dentists) slither from under their rock and hit local morning TV talk shows, claiming they are having free services that very morning for a couple of hours. So far, I’ve not seen hide nor hair of them in 2013. Kool Smiles Dental centers at least announced they gave away toothbrushes this year. (Geez, I hope they weren’t those chemical-laden ones from China that leave blisters in your mouth.)

Small Smiles “free services day” were a sneaky ploy. The dentists would appear on local talk shows about 6 AM announcing they were having free services that morning; from 9AM-11AM for example. They would invite the public, telling them they needed to call for an appointment; failing to mentioning the schedule was already packed tight as sardines – as they were everyday.

It was last year about this time they were preparing documents to file bankruptcy in Nashville’s Federal Court and closing several clinics (updates on that coming soon). By June the OIG forced them to divest in at least one clinic; personally I think it was more than one, Manassas, Virginia clinic for sure. (Let’s just say, whoever took over Manassas, also took the Pueblo, Colorado clinic as well. See: Violations of Corporate Integrity Agreement Triggers Divestiture Action by HHS OIG.

“It is clear that the defendants’ actions constituted more than just malpractice.” –Judge John Cherundo, Onondaga County Superior Court

By August 2012, Small Smiles Dental Centers were taking serious hits in the malpractice cases file against them. In 2011, families of at least 75 children had filed lawsuits in New York against the Small Smiles Dental Centers. Judge John C. Cherundo denied the companies request to dismiss the cases saying, “This intentional misconduct was part of the of the alleged scheme to generate revenue as quickly as possible”. 

The $700,000 cure for Church Street Health Management

This morning at 9:00 a hearing was to be held in Nashville Bankruptcy court whereby Church Street Health Management, LLC was asking the court to modify the final Debtors In Possession (DIP) Order and to reschedule the closing of the sale of Church Street Health Management ,LLC to CSHM, LLC. They want to set it for May 31, 2012 instead of May 30, 2012 and they want to remove a legal service agreement with King and Spalding. (lol…they are gonna miss that income!)
Church Street Health Management , LLC and CSHM, LLC are two completely different companies now, so keep that in mind from this point forward. Church Street Health Management, EEHC, LLC, FORBA NY, LLC and Small Smiles Holdings, LLC are now combined into one company, namely CSHM, LLC. At least that is what it will become when the sale closes with Garrision
In their “Assumption Notice” (Doc 301, 302, and 302 Schedule A) is listed all the contract and obligations the new buyer will assume and have possession of at closing of this Rule 363 sale. The first one filed May 1, 2012 had 14 pages of those phony Management Service Agreements with phony clinic owners and employment agreement contracts, intellectual property such as trademarks, non-compete contracts with the original founders-The DeRose-Padula family- and other miscellaneous agreement, contracts and business agreement. A new and amended Schedule A was filed the next day, May 2, 2012. Yes, there was a change, a tiny one; King and Spalding were removed as having a Legal Service Agreement with the new CSHM, LLC.
From reading the “Assumption Notice” , the new new CSHM, LLC will only “assume” a little over $700k ($707,399) (see assumptions and "cure" amounts here)of Church Street Health Management, LLC, EEHC, LLC, FORBA, NY, LLC and Small Smiles Holdings, LLC $23,607,147.40 of debt. (According to Form 1 Schedule F here-Doc 213, starting on page 51)
Suspiciously missing from the debt the new buyer would now assume is $4,911,378 listed as still being owed to several states on a March 23, 2012 report. (Here on page 51)
BTW, who were those $10,000 loans made to that were listed on the March 2012 expense report?! Who loans money when they are broke? (see here on page 6)

Bankrupt Small Smiles Holdings, LLC list of 1205 Creditors

• A. J. RIGGINS HEALTH SEARCH LLC
• AARON & SANDERS, PLLC
• ADIRONDACK CABLING INC.
• ADVENTURE 3 PROPERTIES LP
• ADVOCATE NETWORKS LLC
• ALABAMA ATTORNEY GENERAL
• ALFRED SMITH
• ALFRED SMITH
• ALFRED SMITH
• ALTAIR DATA RESOURCES INC.

• ALTAIR DATA RESOURCES, INC.
• ALVAREZ & MARSAL
• AMBULATORY SURGERY CENTER
• AMBULATORY SURGERY CENTER
• AMERI-FORCE MANAGEMENT SERVICES
• AMERICAN CAPITAL
• AMERICAN CAPITAL FINANCIAL SERVICES INC.
• AMERICAN CAPITAL FINANCIAL SERVICES INC.
• AMERICAN CAPITAL, LTD.
• ANGELA CRAWFORD
• APPLIANCE THERAPY GROUP
• APPLIANCE THERAPY GROUP
• ARAMARK UNIFORM - SYRACUSE 308
• ARCAPITA INC.
• ARCAPITA INC. AND AT&T SERVICE AGREEMENT
• ARES CAPITAL
• ARES CAPITAL
• ARIZONA ATTORNEY GENERAL
• ARIZONA DEPARTMENT OF REVENUE
• ASSOCIATED BANK, N.A.
• AT&T CORP
• AUTONOMY INC.
• AUTONOMY INC.
• AVERY CROSSWHITE
• AVERY CROSSWHITE
• AXIS DIRECT INC.

See the Rest of the list here

Church Street Health Management Files for Bankruptcy With Plan for Sale - Bloomberg

I’m not really a betting person, but I’m guessing, the Small Smiles at Church Street Health Management are now down to wee little bitty smiles.  No, I’m sure they are down right frowns and have been for a while now. 
Want to take a guess where there is a ‘Big Smile” ? 
Maybe Interstate corporate dentistry is NOT exactly the investment Private Equity firms think it is! 
Read on…  documents related to the case at the end.
Church Street Health Management Files for Bankruptcy With Plan for Sale – Bloomberg
Church Street Health Management LLC and four affiliates, providers of management services to 67 dental centers, filed for bankruptcy as part of a plan to sell the businesses.
The companies had assets valued at $895.3 million and debt of $303.4 million, according to Chapter 11 documents filed yesterday in U.S. Bankruptcy Court in Nashville, Tennessee, where Church Street is based.
A sale in bankruptcy is the “best option to maximize the value of the assets for stakeholders and to safeguard the welfare of the patients,” Martin McGahan, Church Street’s chief restructuring officer, said in court papers.
Affiliates Small Smiles Holding Co., Forba NY LLC, EEHC Inc. and Forba Services Inc. also sought court protection from creditors. Small Smiles is the parent of a group of companies that provide management services to dental centers serving low- income families in 22 states.

FORBA Holding, LLC Changes Name Once Again ; Now Church Street Health Management, LLC

Another name change for FORBA!

No Big Surprise, most companies who end up with a horrible reputation do a name change, but the leopard never changes it's spots.  They can change their name weekly if they want, but what they do and how they do it isn't changing.

Look for your "One Call Sees All" card in the mail, advertising they are accepting adult patients.

Wonder what happened to the sales pitch surrounding FORBA - For Better Access?
 

FORBA Holdings, LLC is now
Church Street Health Management, LLC  or CSHM

The name changed was filed today, in Colorado, December 23, 2010 at 2:24PM 

Look For Letter Head and Business Card To Be Ready To Go By January 1, 2011

Clinic

Big Smiles and Small Smiles, since they are treating adults now.