CSHM, LLC (Small Smiles Dental Centers) Files for Chapter 7 Bankruptcy

February 17, 2015
Just 4 months after CSHM, LLC (Small Smiles Dental Centers) were Excluded from the Medicaid program, Michael F. Gries, the installed Chief Restructuring Officer, filed Chapter 7 Bankruptcy in Delaware Bankruptcy Court on February 5, 2015. (Case No. 15-bk-10206)

CSHM, LLC is the restructured company that emerged in June 2012 when Church Street Health Management (f/k/a FORBA) filed for Chapter 11 Bankruptcy February 20, 2012. (Case No. 12-bk-01573)

Church Street Health Management signed a 5 years Quality of Care Corporate Integrity Agreement in January 2010 (CIA) after a 3 year investigation by the feds that found billing fraud and gross mistreatment, overtreatment and failure to come close to meeting an acceptable standard of care treating the dental needs of children on Medicaid. They also agreed to pay $24 Million for their misdeeds; the Department of Justice was to received $14.2 Million and 21 states were to share $9.7 million and explained here on page 6.

In addition Church Street Health Management (f/k/a FORBA) signed a Corporate Integrity Agreement with the New York Office of Medicaid Inspector General. Agreeing to paying New York and additional $2.3 million.

After continued blatant disregard for the Quality of Care Corporate Integrity, consistent failures of inspections, a 1500 page bi-partisan 2012 Congressional Report  and various warnings by HHS-OIG, CSHM, LLC received notice they were Excluded from the Medicaid program in March 2014. However the government saw fit to allow CSHM, LLC to pilfer and plunder the Medicaid slush fund for an additional 6 months under an Exclusion Agreement.

“This exclusion marks the culmination of a series of alleged failures by CSHM and its corporate predecessors to comply with its CIA. Under the CIA, an independent quality monitor conducted more than 90 site visits and reviews to monitor CSHM's compliance. Since the 2010 settlement, OIG repeatedly cited CSHM and took actions to address those violations, promote improved compliance, and maintain access to care for an underserved population. These actions included imposing financial penalties and forcing the divestiture of one of the company's clinics.

Despite these actions, CSHM remained in material breach of its CIA and OIG issued Notices of Intent to Exclude to the company in December 2013 and January 2014. In such cases, providers have the opportunity to demonstrate to OIG that they have cured, or are in the process of curing, the material breaches. CSHM represented to OIG that it would cure the material breaches. However, through meetings with CSHM and its Board of Directors and review of its written submissions, OIG determined that CSHM had failed to cure the material breaches and proceeded with the exclusion.

Until the exclusion goes into effect on September 30, 2014, an independent monitor will continue to monitor the quality of care being provided to patients at CSHM clinics. CSHM is required to inform patients at least 30 days before closing a clinic. CSHM is also required to keep State Medicaid agencies abreast of developments and provide monthly status reports to OIG. Any divestiture of assets by CSHM must be through bona fide, arms-length transactions to an entity that is not related to or affiliated with CSHM.”

Despite the “Quality of Care” issues as indicated by the classification of the type of Corporate Integrity Agreement they were under, and results of the Monitor’s monitoring, when CSHM received their Exclusion letter they claimed none of the clinics they own were effected it was just the management division of the company and issued a press release stating the centers different entities therefore not effected. HUH?

Here we are in 2015, 8 years since Small Smiles dental centers and their so called management company, CSHM were first investigated—it started in mid 2007— and it just past the anniversary of the 5 year CIA. Heck it expired two weeks ago—January 15, 2015.
According to the 31 page, 3 columns, list of Creditors filed February 5, 2015 they still owe various states their portion of the $24 million dollars. (a breakdown is below)  

They owe several “owner dentists”, support staff, and other dentists, as well as whistleblowers, dental boards, ad agencies, law firms, TV stations, court reporters, (for the numerous lawsuits in which they are involved), storage facilities,(wonder what’s hidden there), utility bills for their clinics, dental labs and insurance companies (hope they kept the Malpractice premiums up for all those dentists!), and every dental supply company in the country, and various management companies. (yep, the management company hires management companies)

Other notables were, Garrison Loan Agency who ponied up the dough to keep this scumbag company alive and kicking from 2012-2015 and the IRS.

Those missing for the list are David R. Wilson, CEO and other top executives, and Waller Landsden Law Group.  Hmmm… Pleadings indicate Wilson was paid $1,194,432.85 the year preceding the filing of the bankruptcy.

Other points of Interest in the initial documents:
Doc 2 Schedules of Assets and Liabilities,
Page 2, Item 3
—In accordance with the Exclusion Agreement, the Company divested itself of substantially all of the CSHM Assets through a series of sales between April and September 2014.  Included among the sale of the CSHM Assets, the Company sold certain assets to First Quality Management, Inc. (FQMI), pursuant that certain Asset Purchase Agreement, dated as of September 30, 2014.  Separately, the Company also entered into that certain Assignment and Assumption Agreement with FQMI, dated September 30, 2014, in connection with the assumption of six (six) MSA’s.  A breakdown of the other clinics can be found here, beginning on page 9.  Missing from that list is all the Colorado clinics except the Colorado Springs clinic.  Interesting, indeed.

So I was right when I posted about FQMI and the continued operations of Small Smiles Dental Centers. Current pleadings say they paid Dr. Paul Elkin $401,574.00 in the year proceeding this bankruptcy filing.  He’s the new head at FQMI according to his LinkedIn page.

Page 2, Item 4
—Additional assets were sold to employees of the Debtor in September 2014…

Wait, I thought the “owner dentists” were already “owners”, not employees!” (sarcasm)

Page 11 & 12
—1st. Lien Holder: Garrison Loan Agency Services, LLC – $37,500,000.00 initial loan, still owed $28,764,918.60;
—2nd Lien Holder: Garrison Loan Agency Services, LLC – $17,500,000.00 initial loan, still owed $17,786,714.00.
——Grand Total for Secured Creditor Garrison Loan Agency $46,551,633.00
Under Creditors Holding Unsecured Nonpiority Claims (Schedule F, page 15, of Doc 2) are all Medicaid Fraud Control Units Creditors and the amount:

	State	Known 2010 Settlement Amounts	Due as of January 2015
1	MFCU of Alabama	$463,028.00	$79,595.63
2	MFCU of Arizona		$127,853.41
3	MFCU of Colorado	$1,200,00.00	$616,099.66
4	MFCU of  Georgia		$288,910.84
5	MFCU of Idaho		$46,687.18
6	MFCU of Indiana		$348,534.90
7	MFCU of Kansas	$517,959.60	$260,969.66
8	MFCU of Kentucky	$123,693.14	$22,484.43
9	MFCU of Maryland		$275,814.83
10	MFCU of Massachusetts		$726,035.97
11	MFCU of Nebraska	$270,000.00	$61,717.55
12	MFCU of Nevada		$83,402.83
13	MFCU of New Hampshire		$48,090.36
14	MFCU of New Mexico		$182,376.06
15	MFCU of New York $1.15M+ $2.3M	$3,450,000.00	$315,849.66
16	MFCU of DC		$78,057.19
17	MFCU of Ohio	$2,392,926.50	$502,185.04
18	MFCU of Oklahoma	$700,00.00	$355,411.82
19	MFCU of South Carolina		$471,779.92
20	MFCU of Texas	$546,000.00	$117,851.57
21	MFCU of Virginia		$228,616.76
22	Department of Justice	$14,200,000.00	$12,966,496.00
23	Department of Justice		$7,844,455.34
	Grand Total	$26,300,000.00	$26,049,276.61

According to the pleadings (Doc 8-1) Amended Schedule B Personal Property they have:
Assets:            $136,369.67
Liabilities:  $73,314,905.16

The 2010 Corporate Integrity Agreement
The DOJ said in 2010 “"We have zero tolerance for those who break the law to exploit needy children," said Tony West, Assistant Attorney General for the Civil Division of the Department of Justice. "Illegal conduct like this endangers a child’s well-being, distorts the judgments of health care professionals, and puts corporate profits ahead of patient safety."

(cough, choke and puke, they have complete tolerance, encourage it, and are accomplices to it!)

Is CSHM, LLC taking full responsibility for all future legal actions against Small Smiles Dental Centers? You decide.

Update: 10-24-2013 10:58AM

On October 9, 2013 the so-called “new company” who owns and operates all the Small Smiles Dental Centers that have managed to remain open denounced its association with the so-called former owners and management company.  (see statement below)

In making this claim, they must also be taking full responsibility for any and all illegal activities and/or malpractice issues that could arise in the future, right?  As the below email suggests, those will be coming.

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Hi - I have kept up with your site for a while now because honestly it was the only way to find out the "real" news on Small Smiles. I am former employee of Small Smiles in South Carolina. When I took the position I had NO clue what I was getting into. I resigned from my position due to the horrible reputation Small Smiles has and it was mentally exhausting to even go to work.

Small Smiles Dental Centers Release Statement RE: New York Malpractice Case #1

 

 

 

 

 

 

 

 

 

 

 

Sorry, there is no mistake or confusion. It's the one and the same.  Creative financing and a few (very few) corporate heads rolling does not a completely different company make. Good try.

I suspect in the future we will see New FORBA and NEW NEW FORBA side by side in court just as we have Old FORBA and New FORBA today.

A dead fish by any other name still stinks.

PS. there is issue with jury being "stalked" so verdict is not set in stone.

How many lawsuits have been filed against Small Smiles Dental Centers and the dentists who have worked there?

March 4, 2013
The answer can be found in court documents filed during their bankruptcy proceedings over the last year.  According to Affidavit of Chief Restructuring Officer of Martin McGahan, 100 were on file in February 2012.  More recent documents filed by their malpractice insurance carrier states 1100 are "working” so to speak and more lawsuit likely to come.

 

Affidavit of Martin McGahan - Doc 11 - February 20, 2012 – page 14 paragraph 38

“Since January 2010, approximately 11 lawsuits on behalf of over one hundred plaintiffs have been filed against the Company and certain of the Dental Centers, in primarily three states, Ohio, New York and Oklahoma.”

NUFI Objection Doc 568 - December 28, 2012 – page 4 paragraph 3:

“Subsequent to the Debtors’ settlement with the DOJ and the various states, a number of lawsuits were filed throughout the country by or on behalf of the Dental Center patients against certain of the Debtors, Dental Centers and Dentists, alleging claims for damages based upon treatment received at the Dental Centers. In addition to the Patient Litigation, the Debtors contend that “at least approximately 1100 additional patients or former patients” have retained counsel to assert similar claims against the Debtors, the Dental Centers and the Dentists.”

Dentists and auxiliary employee of Small Smiles Dental Centers (current or former) are not likely to be able to exhale for a very long time.

For a list of the 600 plus pleadings and filing of this case see in United States Bankruptcy Court – Middle District of Tennessee, see:
Church Street Health Management Docket Report

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In other Small Smiles Dental Centers news.  I’m told the morning huddles continue and production numbers remain a major topic of discussion. 

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

Health and Human Services or Health and Hedge-fund Services? When it comes to Medicaid dental mills, it’s the latter.

December 11, 2012
On Tuesday, December 11, 2012, The Today Show aired an investigative report about the on going troubles at the Small Smiles Dental Centers. Interviews included one with Health and Human Services (HHS) officials in charge of overseeing the compliance of the notoriously troubled clinics.

If you’ve not seen the report, please take time to do that here.

The segment included an interview with a HHS-OIG Branch spokesperson. However, if not for the HHS-OIG seal displayed one would presume it came out of the the PR department at CSHM headquarters.

NBS News Senior Investigative Correspondent, Lisa Myers asks HHS-OIG spokesperson, “They’ve had 4 bites at the apple, when is enough, enough?”  

HHS-OIG responded with this check list:

1. “Dentists have been fired” – Well, dentists are fired there every day!! They are fired every day because they don’t meet the production numbers set by the corporate office. Their turn over had been setting at 48% since the beginning!

What about the Chief Dental Officer – Steven Adair, DDS?  He actually got a promotion. Dr. Adair is the author of the news letter for CSHM in which he suggests instead of the papoose board, try the “superman cape” method.

What is the Superman Cape Technique? Here, read this!

Compliance officers? – Yes, a few. They have burned through 3 in 2.5 years. CSHM will not hesitate to been throw one under the bus, blaming them for falsified reports to the OIG.

2. “Clinics have been closed” – Yes, they have filed bankruptcy! The started closing clinics in early 2011! HHS only forced 1 clinic in actually close – Manassas Virginia.

3. “This is not the same company” – True, it simply filed for bankruptcy, reorganized with some of the same investors in the background, and changed it’s name, replaced the CEO and President. But that was in 2011!

3. “The Independent Monitor is telling us that Quality of Care is consistently improving” – The same independent monitor in place for 3 years! The one CSHM pays. The one whose head dental investigator is buddies with the company’s Chief Dental Officer. So exactly when did that “improvement” begin? June of 2012? Certainly not in April 2012? The new people in charge actually  stepped in October 2011. It just wasn’t on paper with the bankruptcy court until June 2012.

The company has been in the news, how many times since 2007?
Countless!!!

Report on Small Smiles Dental Centers to air

 

	Tomorrow morning, Tuesday December 11, 2012 the Today Show will air a piece on Small Smiles Dental Centers – scheduled to air between 7:30 – 8:00 AM Eastern Time.

Waller law firm seeking payments from Church Street Heath Management–Small Smiles Dental for its April–June 2012 expenses

Going over Waller’s timesheets, it appears sumpin’ BIG happened at the Indy 1 Small Smiles in April 2012. I believe there are a lot of “adverse events” attributed to the Indy1 clinic, but this was clearly bigger than they could handle in house, even with Sheila Sawyer overseeing things.

Indy1 is:

Small Smiles Dental Center
5430 E Washington Street
Indianapolis, IN  46219
317-322-1840
Fake owner - Helen Katherine Peterson, DDS

Doc 494-1 CSHM Waller Time Sheet 08152012

Small Smiles Dental Centers Bankruptcy Document Collection

Church Street Health Management bankruptcy operating report–June 2012

CSHM June Operating Report June 2012

CSHM–Small Smiles Dental May 2012 Operations Report as filed in Middle Tennessee Bankruptcy court.

Church Street Health Management May 2012 Expense/Operation Report Doc 435

Closing Day for Church Street Health Management-Small Smiles Dental Centers

No, not closing the doors, but I expect that soon.

Today was supposed to be the closing day for the sale of Church Street Health Management.

Yes, Church Street Health Management, LLC will now become CSHM, LLC with basically the same Private Equity Investors as before, CIT Corporation and others. The Carlyle Group swears they are out of it, I’m not sure. They say the “exited” in the last year. It must have been in the last 6 months!

Sales and Credit Agreement

The investors basically sunk another $25 million dollars into the company in February to keep it afloat while it “reorganized”. Whatever that means. No one else wanted to jump on the sinking ship so …. it became the property of the same folks.  If they aren’t pissed, they should be.

Since then they have ended up the subject of at least two Bloomberg reports. As usual they never come out looking good. But, honestly, how could they? They whole bunch are dirty rotten scoundrels. 

Abusing children and raping taxpayers is NOT exactly the best way to prosperity. These folks are so bad, even Don Meyer, who is notorious for selling snake oil to American’s can spin this one. All he can say is “we are providing care to the underserved”. He says it over and over and over…  If you listened to them, there would be no sex at all, unless you’re raped.

Still doesn’t it make it so. The once “underserved” are the most “overserved” in America when it comes to dental care these days.

I think things may be getting worse for the CSHM, LLC. I know, it’s hard to believe things could get worse-Bankrupt, Congressional Investigations, Corporate Integrity Agreement, and so forth-but they can.

The first few days of the new ownership is probably gonna suck!

According to sources, Met Life and United Concordia/Tricare are canceling their contracts with Small Smiles Dental Centers. 

If true, revenues just went to hell, again. If they couldn’t make it before, they certainly can’t make it now.

PS – If asked to sign some kind of Transition, Separation, Confidential, Severance and General Agreement, in exchange for a week’s pay, I would have an attorney look it over. Personally, unless they removed sections 4, 7, 8, 13 and clarified in writing why it says it’s governed by the state of Tennessee, and why Church Street Health Management is a “Released Party”, I wouldn’t sign it, no way, no how… Just saying…

FINALLY, someone asking Church Street Health Management to “prove it”, “fork it over”, “show us from where the money comes” and more.

Bankruptcy Watchdog Protests Wind-Down Process Of Small Smiles

Katy Stech May 11, 2012 (c) 2012 Dow Jones & Company, Inc.

A federal court watchdog wants to put a hold on the $25 million sale of the operator of Small Smiles Dental Centers to a private equity firm--a deal that a bankruptcy judge has yet to approve--until the Tennessee-based chain sheds light on its post-closing moves.

U.S. Trustee Samuel Crocker, who monitors bankruptcy court pleadings for the Department of Justice, wants company executives to be clearer about the financial professional who would take over the bankruptcy estate once distressed investor Garrison Investment Group purchases its operations on May 31, according to papers filed in U.S. Bankruptcy Court in Nashville, Tenn.

I heard the the infamous Doug Brown and Kirk Huntsman might be involved before it ends. if so, Doug Brown would be involved in more Private Equity “Medicaid dental mills” and “pull every tooth in your mouth and slap in some cheap denture” operations in the world.

The Order

Upon the motion of The Official Committee of Unsecured Creditors, by and through counsel, it is ORDERED that individuals designated by Fireman’s Fund Insurance Company shall appear for examination pursuant to Fed. R. Bankr. P. 2004 on May 16, 2012 at 9:00 a.m. C.S.T. at the offices of Baker,Donelson, Bearman, Caldwell & Berkowitz, P.C., 211 Commerce Street, Suite 800,Nashville, Tennessee 37201. 

IT IS FURTHER ORDERED that individuals designated by Fireman’s Fund Insurance Company shall produce the documents as specified in Exhibit 1 to the Committee’s counsel at the above address not later than May 15, 2012 at 4:00 p.m. C.S.T.

IT IS FURTHER ORDERED that the attorney for the movant shall serve a copy of this order on the party or counsel for the party required to appear and to the U.S. Trustee.

The attendance of an entity for examination and the production of documentary evidence are compelled in the manner provided in Fed. R. Bankr. Proc. 9016 for the attendance of witnesses at a hearing or trial.
Dated: May 4, 2012

Who wants to bet they do all they can to postpone this one?!!  LOL

Appears just about anyone can motion for a Rule 2004 Examination.

Exhibit A of Exhibit 1 – List of Small Smiles Dentist Names
I’d bet a whole crap load of these 916 dentists are on Santa’s Naughty list. No wonder I was told some of the folks in the below list are spinning in their shoes and support employees are afraid some are going to have a heart attack.

 Church Street Health Management Rule 2004 Examination and Document Request - Names of 916 Dentists Doc 319-2

Church Street Health Management/Small Smiles Dental; See from where the money flows and to where it goes.

Church Street Health Management-Small Smiles Dental Centers Monthly Operating Report March 2012

If you have trouble reading, you can open and read it the PDF here

Creditors Checking the Validity of Actual Property and Liens of Church Street Health Management’s held by its Collateral Agents - SSO FUNDING CORP.; SSH FUNDING CORP.;CIT HEALTHCARE LLC; AMERICAN CAPITAL, LTD.

Church Street Health Management Unsecured Creditors

vs.

SSO Funding Corp. is a special purpose entity acting as a conduit for the
provision of financing between Debtors and the entities providing financing to the Debtors and may be served in care of Global Securitization Services, LLC, 68 South Service Road, Suite 120, Melville, New York, 11747.

SSH Funding Corp. is a special purpose entity acting as a conduit for the
provision of financing between Debtors and the entities providing financing to the Debtors and may be served in care of Global Securitization Services, LLC, 68 South Service Road, Suite 120, Melville, New York, 11747

CIT Healthcare LLC, is the Collateral Agent and Administrative Agent for
the Prepetition First Lien Facility Lenders and the Prepetition Second Lien Facility Lenders. CIT Healthcare, LLC, may be served at 11 West 42nd Street, Floor 7, New York, New York, 10036.

American Capital Ltd. is the Collateral Agent under the Subordinated
Murabaha Facility Agreement and maybe served at 505 Fifth Avenue, 26th Floor, New York, New York, 10017.

Complaint by Unsecured Creditors to Determine Validity of Property and Liens-Doc 299

Small Smiles Dental - Church Street Health Management Auction Postponed Until May 11-May 22 Hearing to Approve Any Offers.

Small Smiles Dental - Church Street Health Management Auction Postponed Until May 11

Church Street Health Management LLC will auction the business on May 11, rather than April 20. The provider of management services for 67 dental practices in 22 states reported a $2.1 million net loss in March on total revenue of $11.6 million.

Unless outbid, existing first-lien lenders are to buy the business in exchange for $25 million in debt. Other bids are now due May 4, rather than April 16. The hearing to approve the sale will take place May 22.

Isn’t this a nice way of saying it’s being “repo’d”?

The official creditors’ committee was given the right by the bankruptcy judge to require the company to turn over copies of insurance policies. The committee says that the largest unsecured claims are held by patients who say they were given services unnecessarily. Seeing the policies will help, the committee says, in deciding if the insurance company was entitled to deny coverage of the claims.

Church Street said in a monthly operating report filed with bankruptcy court that earnings before interest, taxes, depreciation and amortization in March were $867,000. Depreciation in the month was $986,000 and interest expense was $120,000.

Church Street specializes in providing dental care to children whose medical expenses are covered by government- sponsored programs. Bankruptcy resulted from a $24 million settlement in January 2010 with state and federal authorities that led to negative publicity and lawsuits.

The company’s debt is structured in compliance with Islamic Shariah financing regulations. There is about $131.5 million owing on first-lien obligations, plus a $25.6 million second- lien. There is an additional $152 million on three subordinated debts.

It’s only Shariah compliant because they created several companies between it and the First Islamic Bank a/k/a Arcapita.

Assets are on the books for $895 million, with debt totaling $303 million, a court filing says.

The case is In re Church Street Health Management LLC, 12- 01573, U.S. Bankruptcy Court, Middle District of Tennessee (Nashville).

Selection of Bankruptcy Documents

Dental X-Rays causing tumors? Highly likely, but Medicaid Dental mills don’t care, it’s part of their bread and butter or it is?

I’m highly suspicious about articles like the one below or the latest sedation dentistry media blitz. I have to wonder if these are meant to drive home the request the ADA and the AAPD made to Centers for Medicare and Medicaid dated July 12, 2011 where they were crying and whining about the audits being “too aggressive”.  Evidently they made a home run in NY since it was recently announced NY relaxing it’s audit.

• ADA letter to CMS whining about audits of children Medicaid programs.
• NY OIG forces out due to recovering too much of taxpayers money from fraud.
• New York eases Audits
• FDA Dental X-Ray Guide

 

Are Dental X-Rays Causing Brain Tumors?

 

(NEW YORK) -- “It’s time for your annual X-rays.”  This is what millions of Americans are told when they visit the dentist.  But new research out of Yale finds dental X-rays may be linked to increased rates of brain tumors.

Meningioma is the most common type of brain tumors that originate in the brain and spinal cord, making up one third of these.  People who were diagnosed with meningioma were compared with healthy individuals.  They were asked how often they had the most common type of dental X-ray, called a bitewing, which involves placing an X-ray film between the teeth and shooting the film from outside of your cheek.  In those who reported having this type of X-ray once a year or more the risk for meningioma was 1.4-1.9 times increased depending on their age.

Another type of dental X-ray, called the Panorex, that rotates around your head taking a picture of all of your teeth from outside your mouth was associated with an almost five-fold increase in rates of meningioma when the X-ray was performed before age 10.  For those older than 10 there was a 2.7 to 3 fold increased risk when this X-ray was performed once a year or more.

Current recommendations by the American Dental Association do admit that there is little use for dental X-rays in healthy people without any symptoms, but still recommends X-rays of healthy children be taken every 1-2 years and every 2-3 years for healthy adults.  The authors think these guidelines may need to be reevaluated in the wake of their findings.

Reactions to the study have been mixed. For critics, the design of the study has some serious flaws. The main weakness is the failure of the researchers to obtain any of the patient’s dental records to verify that the number of X-rays they reported having was true, says Dr. Richard Besser, ABC News' chief health and medical editor.

“People with cancer are more likely to remember having dental X-rays,” explains Besser. “They are searching for some cause of their cancer and may incorrectly attribute it to any number of factors.”  Dr. Besser also points out that the study failed to find any connection between having braces and risk for meningioma.  “When you have braces you remember that clearly, and people who have braces on average undergo more x-rays than people without braces,” says Besser.

Dr. Alan G. Lurie, a Ph.D. radiation biologist who specializes in cancer induction and is president of the American Academy of Oral and Maxillofacial Radiology, agrees with Dr. Besser that the study has a serious flaw.

“They’re asking people to remember (in some cases) a couple of radiographs they had 30 years earlier when they were kids. They’re not going to be able to tell you what kind of X-ray machine was used…what kind of film, were there any retakes?" Lurie says.

Other doctors see this as a strong study and think that it raises valid concerns.  “The current study is well-done and confirms that even in the ‘modern era’ radiation exposure from repeated dental X-rays conveys an increased risk of these tumors,” says Dr. David Schiff of the Neuro-Oncology Center at the University of Virginia.

Overall, doctors are not surprised that dental X-rays could cause this type of tumor because the type of radiation that X-rays give off is known to be associated with brain tumors. “Ionizing radiation is the only well-accepted environmental risk factor for development of meningiomas," says Dr. Schiff.

However they warn that this study cannot prove that dental X-rays cause brain tumors.  It can only reveal a possible association between dental X-rays and tumors.

Still, there are some important things people can do to minimize their exposure to dental X-rays.  For example, patients can ask their doctors whether X-rays are completely necessary, or how much radiation will be delivered by the various options available.

“All health professionals should be thinking that for our patients, each exposure must be beneficial and we should be of a mindset to do the fewest exposures possible to obtain needed diagnostic information," explains Paul Casamassimo DDS, professor and chair of pediatric dentistry at the Ohio State University College of Dentistry and chief of dentistry at Nationwide Children's.

Overall, experts hope that as a result of this study the public gains new awareness of a potential risk and will take their concerns to their dentist.  

Dr. Paul Casamassimo is on the Advisory board of one of the nations worst offenders- Small Smiles Dental Centers, owned and operated by the bankrupt Church Street Health Management.  Dr. Casamassimo should heed his own warnings!

He should be asking his colleague, Dr. Steven Adair about the unnecessary x-rays taken at the Small Smiles Dental centers, and the fraud involved in said unnecessary x-rays, especially at the Denver dental centers with Dr. Minh Tia and his office manager! I believe that amounted to some $200k between June 2010 and June 2011! Just saying….

 

In an article about “Dental Therapist” dated April 10, 2012, it mentions Dr. Paul Casamassimo is the AAPD Pediatric Oral Health Research and Policy Center Director.

American Academy of Pediatric Dentistry Responds to Kellogg Foundation Report on Dental Therapists

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Academy of General Dentistry  Responds to Dental X-Ray Warning:
Thursday April 12, 2012

CHICAGO, April 12, 2012 /PRNewswire-USNewswire/ -- On Tuesday, April 10, 2012, in the journal Cancer, the American Cancer Society published an article entitled "Dental X-Rays and Risk of Meningioma," which summarized a study that sought to develop a correlation between dental radiographs and brain cancer.

According to the Academy of General Dentistry (AGD), a professional association of more than 37,000 general dentists dedicated to providing quality dental care and oral health information to the public, the study's findings are not applicable to modern dentistry because the study was based upon an examination of outdated radiographic techniques, which produced considerably more radiation than patients would be exposed to today.

"Modern radiographic techniques and equipment provide the narrowest beam and shortest exposure, thereby limiting the area and time of exposure and reducing any possible risks while providing the highest level of diagnostic benefits," said AGD President Howard Gamble, DMD, FAGD. "Today, patient safety is always maintained with the recommended use of thyroid collars and aprons."

The article from the American Cancer Society, which received attention from many reputable news outlets, could cause the public to decide to limit or even refuse X-rays in an effort to keep their families safe.

"It is regrettable to think that an article based on outdated technology could scare the public and cause them to avoid needed treatment," said Dr. Gamble. "With the radiography techniques in use today, the amount of radiation exposure is reduced and more controlled than it was in years past."

The AGD supports radiographic guidelines provided by the American Dental Association (ADA) and the U.S. Food & Drug Administration, and concurs with the ADA that dentists should order dental radiographs for patients only when necessary for diagnosis and treatment.

The AGD encourages patients to discuss their concerns with their dentists in order to determine what's best for them. The AGD also encourages dentists to communicate with their patients and address any unexpressed concerns of radiographic risks in order to reduce fear and promote a better understanding of the benefits and the risks associated with the specific needs of each patient.

"Neglecting one's oral health has serious oral and systemic risks," said Dr. Gamble. "Radiographs play an important role in improving the oral health of the public, and patients should not be deterred from seeking oral health care due to misperceptions from this study."

The Cancer study contained many inconsistencies and possibilities for error, including the fact that its findings were based upon a population-based case-control study. This means that it relied upon the patients themselves to recall and self-report past events, many of which were from decades earlier.

The AGD supports ongoing scientific research on any correlations between dental radiographs and incidents of disease in an effort to provide the most accurate information to the public and to correct any misperceptions created by the Cancer study.

About the Academy of General Dentistry
The Academy of General Dentistry (AGD) is a professional association of more than 37,000 general dentists dedicated to providing quality dental care and oral health education to the public. AGD members stay up-to-date in their profession through a commitment to continuing education. Founded in 1952, the AGD is the second largest dental association in the United States, and it is the only association that exclusively represents the needs and interests of general dentists. A general dentist is the primary care provider for patients of all ages and is responsible for the diagnosis, treatment, management, and overall coordination of services related to patients' oral health needs. For more information about the AGD, visit www.agd.org.

SOURCE Academy of General Dentistry

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All I have to say here is that the AGD or any other of the D’s are not to quick to come out against reports that are loaded to the brim with “old” and “outdated” studies if it could possibly generate revenue.

Catching up on Church Street and Small Smiles bankruptcy this Easter weekend finds whistleblowers still waiting on their good citizen reward.

I decided to read over some more of the thousands of pages filed on the Church Street Health Management/Small Smiles dental bankruptcy filings as we did our family travels this weekend. What caught my eye was a 140 page Affidavit of Service. The list was very interesting, and what,or should I say who, was on this listed was what really made an impression.

First, in my loose estimate there are some 800 to 1000 minor children who have lawsuits pending against this criminal enterprise for abuse, mistreatment or overtreatment and blatant malpractice.

Second, you know those whistleblowers who blew the lid off this particular criminal enterprise back in 2007 The one that finally reached a settlement in January 2010. Well, they are on the “notify” list, meaning they are to be “served” copies of all these documents, or most of them anyway.

Now, that means not only did Church Street Health Management and their host of Small Smiles dental centers fail to pay the fines (they call it a settlement) imposed by several states-some states have been paid more than others-but the whisleblowers have not received their full rewar$ for the hell they went through, filing lawsuits and turning these bastards into the Department of Justice.

There were two or three in the Virginia and DC area as well as Mr. Haney in South Carolina.

I think this issue on Whistleblowing needs some tweaking! One thing for sure, is criminals aren’t good credit risks.

Speaking of credit, Church Street Health Management and their Small Smiles centers sure have a lot of people to whom they owe a shit load of money. For a criminal enterprise to go belly up just over a year after the Feds begin keeping a much closer eye on their operations, by way of that Corporate Integrity Agreement, the CEO Michael Lindley signed, says a lot. A WHOLE LOT!

To me it says, unless we break the law, and commit malpractice on most of the children we profess to care so much about, to rip off Medicaid this business model is not for the profit minded.

I’ve not downloaded and read all the documents of the bankruptcy yet, but, I certainly will. I’ve not found their detailed list of Assets and Liabilities just yet. Last I read said basically they were working on it. I’m just guessing, but I bet this one has to be the one of the most creative “assets” lists the Federal Court system has ever seen.

I’m sure there will be some sort of “pecking” order to settle up these debts, whether there is some fool ass Wall Street firm or Private Equity scumbags to snatch up this hot mess company, which I doubt, by the way.

But the children they have abused and the ones still waiting out there to be compensated for their pain and suffering should be number one, the taxpayers number two and the whistleblowers number three and it would be a tie between, Al Smith, Michael Lindley or Steve Adair down there in Hilton Head last, and should be barred from any claim whatsoever! 

Some other notables on the list are:

Lisa DeRose;
Ameris – Lindley’s other business and the one that owns the plane and the condo in Florida; and,
Jake and Jenna Kochenberger

Small Smiles still soliciting dentists to come to work–it’s wonderful they say!! ROTFLMAO

I just get so tickled with I get stuff like this.

Here we have a flier that Missy Green sent out of the Small Smiles Colorado office, just this week, trying to solicited dentists to come to work for them! 

My first question is what about the Kochenbergers?  Jake and Jenna, did they give it up being - slave hunters for Church Street Health Management? 

Well, clearly Missy Green is stilling trying to recruit. Wonder how she tells sells to dentists how wonderful it will be working for the company saving the underserved children across America with the company in bankruptcy, even their $435 million dollar investment bank – Arcaptia-in ruins. That’s an audio I’d love to hear!

Right now we have people in some clinics who have not been paid their February pay checks. Some are working for pennies, if anything at all, since there are fewer victims to over-treat. Remember, if you’ve been there more than 6 months you are off the guaranteed salary payroll and strictly on the Collection Based Salary – commissions basically.

Heck, there is no telling how many employees who have stuck it out that will be on the “unsecured creditors” list soon. Remember, anything they owe after the filed for bankruptcy on February 20th could surely end up on that very list. 

I know, some are already on there, but they could be “another day older and deeper in debit” and owing their soul to the “company store”.. Why is that dang song in my head… lol

As one person pointed out, they can’t close the 3 patient a day clinics since those are “assets” they need to sell…  Oh, wait, they don’t own those clinics, right?  ROTFLMAO! 

Gosh, dangit!  I just can’t keep that straight in my head. Own, don’t own, owner dentists, lead dentists, associate dentists…  Never have gotten the exact definition of an “owner” dentist, well, not officially, but I have heard it explained on audio.

I guess the owners of those clinics should just sell the equipment and move on.  The owners don’t even have to worry about breaking the lease do they, since Church Street Health Management has their name on those leases.  ROTFLMAO!

Church Street Health Management–Small Smiles Dental, now Arcaptia Bank files for Chapter 11 Bankruptcy…Ahhh….Maaaan,

I’m broken hearted, probably won’t sleep for weeks worrying about how many virgins await these assholes in bankruptcy court hell. Evidently physically and emotionally abusing and traumatizing children isn’t as profitable as Arcapita was told, I don’t reckon. First Islamic Bank, Arcapita, it doesn’t really matter what they name the company, crime just doesn’t pay. ACAS, next? According to the “chatter” in the court room last Thursday in Nashville, ACAS holds “Senior” debt of this boondoggle. (oops, I used that word, “chatter” again.  They don’t like that word…  lol..dangit, if they would quit chatting, there wouldn’t be so much “chatter” now would there!!  Just saying…  Sheila, think about it… think of all the times you’ve been out and about talking this crap…you just never know who is listening!)

Man, this filing should be interesting!! Sharia Law; Virgins; Allah; Jihad – no telling what all will be listed.  LOL

The Smile Behind Small Smiles
Atif A. Abdulmalik

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Arcapita’s Chapter 11 Petition

Arcapita Files for Bankruptcy Protection as Debt Talks Fail

By Arif Sharif and Tiffany Kary - Mar 19, 2012 10:48 AM CT Mon Mar 19 15:48:28 GMT 2012

                                           Arcapita Bank BSC, the owner of Irish power utility Viridian Group Ltd., filed for bankruptcy in the U.S. after failing to reach an agreement with creditors on a $1.1 billion loan due this month.

Arcapita, formerly known as First Islamic Investment Bank, and five affiliates sought Chapter 11 protection today in U.S. Bankruptcy Court in Manhattan, listing more than $1 billion in both debts and assets. Arcapita’s board approved the process “to protect their business and assets and implement a comprehensive restructuring,” the Manama, Bahrain-based private-equity firm said in an e-mailed statement today.

The bankruptcy filing is a “logical step by the company to protect its foreign investments and from individual creditors going after the company’s assets in Europe, the U.S. and Asia,” Serge Lioutyi, a London-based distressed debt trader at Citigroup Global Markets Ltd. said in an e-mail today. It “will help the company focus on reaching a consensual agreement with creditors rather than worrying about individual claims.”

Arcapita is among companies in Bahrain that have sought protection to restructure liabilities after the global credit crisis cut their access to the debt market and as asset prices declined. Awal Bank BSC, a Bahrain-based wholesale bank, filed for Chapter 11 in October 2010, while Gulf Finance House BSC reached an agreement with a group of banks led by WestLB AG on a new two-year $100 million Islamic loan.

Failed Refinancing

The costs to insure Bahrain’s debt against default fell two basis points to 365 today, according to credit default swap data from CMA, which is owned by CME Group Inc. and compiles prices quoted by dealers in the privately negotiated market.

 

So many minds, so little clue–A CSHM Bankruptcy Hearing

Today I made the trek to attend one of the hearings for Church Street Health Management. A court room full attorney’s in dark suits, white shirts and ties but I bet if you asked what assets they were there to talk about “selling”  3/4 of them couldn’t answer and the other 1/4 would be perjuring themselves if they answered.

Actually one of the suits wasn’t sure who he was there to represent, I kid you not, but most of us that know the set up totally understand why he would be confused. He knew he was there for the “Mezz group”. He just didn’t know what that entailed or what all fell under that umbrella. I understood completely. After a short discussion with two other attorney’s standing in the isle, he figured out by process of elimination he was there for the Carlyle Mezzadine Partners, and possibly CIT, but not sure on that one.  Even funnier was listening to them trying to decide if their debt was “secured” or “non-secured” debt. Personally I don’t thing a lick of it is secured! One was trying to include the “leases” but don’t those “leases” belong to the dentist who own the clinics?  Oh, wait, that’s the lie!  Sorry, I got confused myself.

Most of the day was spent with them, and by “them” I mean the two gaggles of attorneys hammering out details on “how” the sale would be handled, but not the actual sale. It seemed they thought they had it all lined out, but then there seemed to be an issue as to Arcaptia being included in the definition of “existing lender”. Personally I would put Arcaptia in the definition of “existing loser” or “existing creditor” since they have a $1Billion dollar payment due in a week or two.

There was a whole lot of huffing, puffing, heads shaking and blown out cheeks.  One, who I called “curly” was nervous as a whore in church.. Pardon the pun! I understand, he was there representing Arcapita and from King and Spalding, which explains his nervousness.

Finally, they came to some agreement and brought it back to the judge. The attorney representing CSHM said they didn’t want to present “evidence” at that time, but would file it in a memoranda later today. I suspect they didn’t want me to hear the “evidence” but I could be wrong. Not that is mattered, I do have access to the documents, so he probably should have given it verbally. Everyone had a copy of it, and they judge had looked it over as well.

The Judge told him to have the memoranda to him by morning, but that he planned on signing the proposed order and stressed to all the suits that if they had any objections they better speak up right now…you could have heard a pin drop. Actually you could hear my pen writing. I took a lot of notes!

However, all this was totally boring compared to listening to Sheila Sawyer!

It was announced last year, the partner ,at Waller law was such a a big fan of CSHM she was giving up her “partner” status at Waller and joining the criminal organization of CSHM, well they didn’t say criminal organization, that’s my term.

Well, they were spot on! She is a corporate person to the core. I expected her to whip off her brown suit and reveal a cheerleading getup, pompoms and all and a rah rah and a couple of cartwheels down the isle of the courtroom.

Get this! – Here all these people, many flown in from across the country to this hearing talking about how the sale of CSHM will proceed and what is she doing? She’s talking production!  I’m not kidding..CSHM’s favorite and only term “production”! 

She has some “sharp dressed man”’s ear and talking production and how to hire 5 or 6 more pedos, have them scheduled at the OR’s two days a week and the other three days of the week they could travel around mentoring and teaching the general dentists. Hmmm…  Ok, so they schedule them for the OR, two days a week. That means they are going to need patients to fills those two days of OR.…  a little bass ackwards to me. She said that would kill two birds with one stone.  Yep, she’s probably right on the kill rate!! She talked about a big week long brain storming session in the next week or two with Adair and I believe she said Kevin and Sue Seal, and revamping the standard of care.  I heard her mention OIG being “frustrated” with she threw up her hands like she really didn’t care.

And twice, not once but TWICE, she said they weren’t doing enough crowns!  I heard her mention Gloria, Terri and Susan… not sure what that was about.

But anyway, right here in the court room, full of attorneys’ representing companies they have screwed over because they got caught illegally practicing dentistry, and she’s talking PRODUCTION! 

I still can’t figure out why her and half the others aren’t in some federal prison!  Well, it’s not over yet, is it!?