Doral/DentaQuest Has Entire States of Maryland and South Carolina All To Themselves - OH NO!

Am I the only one who remembers when Maryland said there were going to be sweeping changes to the way dental services were delivered to the state's littlest Medicaid patients?  If so, you can see the report aired July 2008 here:

Being the busy person I am, I had not taken time to go back and check how things were going. (I do have a life ya know).  Well, today while gathering all the information I can find on Doral Dental USA and Atlanta Dental, Inc (ADI) now joined and named DentaQuest, I found a fantastic  announcement in its Fall 2009 Newsletter.  Doral/DentaQuest was awarded the statewide contract!!  YIPEEEEEEEEEEE!!!  


Here is the announcement:

As of July 1, 2009, the Maryland Healthy Smiles Dental Program became effective in the state. This new Maryland Medicaid dental program provides coverage for children under age 21, pregnant women 21 years of age and older and adults enrolled in the Rare and Expensive Case Management (REM) program. Under the Maryland Healthy Smiles Dental Program, the Department of Health and Mental Hygiene (DHMH) has contracted with Doral Dental to be the sole administrator of dental benefits in the state.

Doral is responsible for building the provider network, processing and paying claims, providing member and provider support and creating outreach activities to educate members on the importance of proper oral care.  Read the entire newsletter here.

 They got the whole state of South Carolina too.  Doesn't everyone feel so much better.  NOT!  

Doral/DentaQuest is the very company who contracts with FORBA Holding/Small Smiles and NCDR/DPMS-Kool Smiles and others, giving those monstrous companies access to your child to be abused, over-treated and traumatized.

Another Small Smiles Business Partner Settles Medicaid Fraud Charges

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

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

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

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

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

Amerigroup contracts with the state

Doral Dental contracts with Amerigroup

Small Smiles contracts with Doral Dental

...to provide dental care to children enrolled in medicaid in Maryland, District of Columbia, Ohio and Georgia.

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

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

Two Doral Dental Opinions: Both raise questions

When asked about signing up to be a Doral Dental Provider here are a few of the responses:

mc2001 says: I have mostly good things to say in Virginia. The rates are reasonable (reimburse at approximately 60-70% of my practice fees depending on the codes). I collected $2.8 million last year with 8 chairs running 5 days a week.

I get a $30,000-$45,000 check every 9-12 business days, very few claims get denied and they cover most ADA codes that a pedodontist uses. Additionally, I am a participating provider with Delta and once the participating provider adjustment is done, I often find that Medicaid reimburses at a higher rate than Delta.

Sounds like to me this guy (or gal) is saying they get more money from Doral Dental and it's Medicaid reimbursements, then through private pay Delta Dental. Do other dentists know about this, since they argue they won't take medicaid patients due to the low reimbursement rates?

Of course I did take note that is was all about the 'coding' used. Wonder what coding one uses to get that high of a percentage of reimbursement? Creative Coding maybe? Like coding on Oral Hygiene instruction which is telling a two year old to brush his teeth twice a day, (can't tell his parents, they are locked in the waiting room at many clinics) wonder how much that pays?

Of course there are two sides to the flattest pancake so here is another opinion from nanham22:

Run away AS FAST AS YOU CAN. Doral manages Kansas Medicaid and it is the reason we absolutely refuse to see Medicaid patients - we don't get paid on time - MAYBE six months later, if we are lucky; and then, minimal reimbursement.
You can never get anyone to help you with claims. Finally, we had to call the governor's office and our state rep to get claims paid that were over a year old.
Pitiful.

Doral Dental Execs Would Invoke 5th In John Ford Trial.

From My Fox Memphis

Defense Rests in John Ford's Corruption Trial

Judge: Key Ford Witness Doesn't Have to Testify

Last Edited: Wednesday, 16 Jul 2008, 2:58 PM CDT

Created: Wednesday, 16 Jul 2008, 1:16 PM CDT

NASHVILLE, Tenn. (WHBQ FOX13 myfoxmemphis.com) -- The defense rested in the John Ford corruption trial after a federal judge shot down attempts to get two crucial witnesses to testify on behalf of the former state lawmaker.
U.S. District Judge Todd Campbell on Wednesday said the former CEOs of two TennCare contractors have the right not to incriminate themselves on the witness stand.

Campbell's ruling left Ford without the benefit of testimony from Osbie Howard, former CEO of Memphis-based OmniCare, and Craig Kasten, co-founder and former CEO of Doral Dental, based in Mequon, Wis.

It is not clear whether the two could also be charged in the case.

(They darn well should be along with Dan DeRose and Todd Curse who no doubt paid Doral Dental to let Small Smiles open up shop in Tennessee)

Ford, 66, is accused of taking more than $800,000 to use his position as a senator to advance the interests of the two companies. Ford has maintained he was being paid for work he did outside the state of Tennessee.

Ford's attorney, Isaiah "Skip" Gant, has said Kasten made sworn statements in a deposition that would vindicate Ford.

Kasten took the witness stand Wednesday without the jury in the courtroom. Asked whether he would be willing to answer questions about the business dealings between Doral and Ford, Kasten said, "I would refuse to answer on the grounds that my answer might tend to incriminate me."

(Incriminate him and a few others I propose)

Previous testimony has shown that Doral paid Ford's consulting group about $1.2 million.

Last week, Gant asked the government to grant Kasten immunity from prosecution in exchange for his testimony.

In considering the request, Campbell asked prosecutors whether the government intended to charge Kasten and if he was the target of a probe.

The prosecution's answer to Campbell's questions was filed under seal and Campbell denied the request for immunity.
Howard, the former OmniCare CEO, took the stand after Campbell advised him to get a lawyer before testifying.

With Nashville attorney Jodie Bell by his side, Howard repeatedly invoked his Fifth Amendment right not to answer Gant's questions.

Gant told Howard he wanted to ask about his personal and business relationship with Ford. He also asked if Howard would answer questions about Managed Care Services Group, a consulting group that Ford and Howard were in together.
"If I were to ask you questions in that regard, would you answer those questions?" Gant asked.

"No," Howard said. "I would invoke my Fifth Amendment rights."
In ruling Howard should not be compelled to testify, Campbell said Howard's concerns about incriminating himself were "substantial and real."

(Substantial and Real, well you bet it is!)

Closing arguments were set to begin Wednesday afternoon.
Ford is serving a 5 1/2-year prison sentence for a bribery conviction in the unrelated Tennessee Waltz sting.

Remember Doral Dental is the company saying it's doing an investigation in Maryland concerning the barbaric treatment of children by Small Smiles/FORBA Dentists.

Oh What A Tangled Web

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

FORBA's Todd Cruse on Witness Stand In Tennessee Senator Trial: No Big Surprise Here

In my opinion Todd Cruse is no better than Senator Ford. I've been trying to tell my readers for months that FORBA, Todd Cruse, Michael DeRose, Doral Dental and the whole bunch associated with FORBA are crooks!

I'm looking forward to other senators to get nailed from doing dirty business with FORBA in the near future.

How many children did Small Smiles/FORBA and Doral Dental, who manages the management of FORBA, abuse to give Senator Ford his 1.7 million dollar cut. Let's see, at $220 per baby root canal that's close to 8,000 teeth just for one senator's payoff.

As you can clearly see, FORBA/Small Smiles just can't seem to keep their asses out of the spot light now can they?

July 8, 2008
Contact Chris Echegaray at 664-2144 or cechegaray@tennessean.com

Former state Sen. John Ford and his business partners were paid roughly $1.7 million in consulting fees from a TennCare contractor, according to a key government witness who testified in federal court on Monday.
Ford, 66, is accused of receiving consulting fees from two TennCare contractors, Memphis-based OmniCare and Wisconsin-based Doral Dental, from 2002 to 2005 while he served as a state senator on the general welfare committee and the TennCare oversight committee.
Ronald Dobbins, a Pennsylvania businessman who was one of Ford's partners in the consulting firm Managed Care Services Group, testified that the Memphis Democrat received 40 percent of the consulting fees from Doral Dental and the other partners got 30 percent.
Dobbins initially worked for United American Health Care, the parent company of OmniCare.
He testified that after leaving the company he created the consulting firm, Managed Care Services Group, in 2001. He said the initial consulting partnership was between Ford and him.
Then he found out that Ford had invited Osbie Howard, the chief executive officer of OmniCare, to join them. Howard handled the money, Dobbins told the jury.
Dobbins testified that he collected around $300,000 from Doral Dental over three years for doing little to no work.
Dobbins testified he had no knowledge of what Ford was doing on Doral's behalf.

'Mr. 15 percent'

Todd Cruse, a lobbyist for Forba, which operates dental centers for low-income children, was trying to get work through TennCare in Tennessee through Doral. Cruse sought out legislators in the districts where the dental centers were being opened, he testified. He sought out members of the black caucus, including Ford.
Cruse testified that after a dinner at a PF Chang's in Memphis, he approached Ford about Forba having a shot to work in the state.
"He chuckled," Cruse said. "And he said, 'They call me Mr. 15 percent.' When a legislator says he's known as Mr. 15 percent, it sorta sticks with you."
In cross-examination, federal public defender Isaiah Gant attacked Cruse for not reporting the 15 percent comment to anyone.
Gant also noted that Dobbins was initially the subject of the investigation into wire fraud. Dobbins received immunity in exchange for his testimony and cooperation with the government.
Ford is charged with two counts of wire fraud and four counts of making false statements on official documents. The wire fraud charges carry a maximum penalty of 20 years. The maximum sentence for each of the four other charges is five years.


I would like to say that Todd Cruse may at one time been a Lobbyist for FORBA, I don't know where he crawled in from, but he's now listed as:

Senior Vice President of Development tcruse@forba.com 615-986-1709

Small Smiles Update from Roberta Baskin 6-16-2008

6-16-2008
WJLA TV's I-Team Reporter, Roberta Baskin, has an update on her Small Smiles Investigation:

-WJLA SCRIPT-

ANCHOR:
TONIGHT FROM THE ABC 7 I-TEAM, DRAMATIC NEW DEVELOPMENTS TRIGGERED BY OUR EXCLUSIVE SMALL SMILES INVESTIGATION OF THE NATION'S LARGEST PROVIDER OF DENTAL CARE FOR MEDICAID CHILDREN.

FOLLOWING OUR INVESTIGATION...MEDICAID AND SEVERAL PRIVATE INSURERS LAUNCHED THEIR OWN INVESTIGATIONS AND NOW, THEY'VE BEGUN TO TAKE ACTION.

THE I TEAM'S ROBERTA BASKIN IS HERE WITH MORE REACTION TO HER EXCLUSIVE REPORTS... ROBERTA?

ROBERTA BASKIN:
MEDICAID SUB-CONTRACTS TO THOSE PRIVATE INSURERS TO PROVIDE DENTAL CARE TO CHILDREN IN NEED. SMALL SMILES HAS BEEN THE BIG BENEFICIARY OF THAT ARRANGEMENT... UNTIL TODAY.

STORY:

The Small Smiles clinic in the District is turning away patients today and like the other four Small Smiles clinics in the area, cancelling most of its June appointments..

"Following audits by private insurance companies discovered hundreds of thousands of dollars in unnecessary dental work. One company reported finding "teeth may have been pulled unnecessarily."

This father doubts his 7 year old son's teeth needed the work Small Smiles recommended.

"He have good teeth so I don't know why they say, fill it up with something."

Doral Dental USA has now terminated four of the 20 Small Smiles dentists in our area from its network and suspended its GROUP practices pending further review.

Colette Phoenix: "I honestly didn't know that they were being audited or even investigated for this." "It does raise some concerns so I'll definitely check into it."

Neither Doral nor Small Smiles will tell us the names of those dentists and declined to be interviewed…but the suspensions affect thousands of families who receive dental care at the chain's five clinics in the district and Maryland.

"After today, you know, I am look into see if I can find another dental clinic for her to go to, for both of them to go to."

Health insurance providers tell us they are contacting families to find new dentists for them.

ROBERTA BASKIN-"Is it difficult for you to find a dentist?"

Mom: "Yeah, yeah, it's difficult."

Our investigation in November exposed callous treatment of children…separating them from parents…strapping them to papoose boards to increase productivity, performing unnecessary procedures, and using unlicensed x-ray technicians.
We also revealed how Small Smiles worked the taxpayer funded Medicaid system.

Dr. Aldred Williams: "They threw up the white flag and said, "Okay, you don't have to preauthorize anything. Just do the work. So we flooded the system."

Doral Dental had suspended Small Smiles for three months following our investigation but has told the state of Maryland is has discovered even more irregularities. It will be another 4-6 weeks for Doral to complete its investigation.

ROBERTA BASKIN IN STUDIO:

UNITED HEALTHCARE, ONE OF THE LARGER INSURANCE COMPANIES CONTINUES TO REFER FAMILIES TO SMALL SMILES DESPITE FINDING MORE THAN A QUARTER OF A MILLION DOLLARS IN QUESTIONABLE TREATMENTS.

MEANWHILE, THE MARYLAND ATTORNEY GENERAL'S OFFICE HAS A CRIMINAL INVESTIGATION UNDERWAY.

WE CONTINUE TO HEAR FROM PATIENTS AND EMPLOYEES FROM AROUND THE COUNTRY ABOUT PROBLEMS WITH SMALL SMILES. KEEP CALLING AND GO TO OUR WEB SITE FOR LINKS AND RESOURCES:

WWW.WJLA.COM.

Click here and go to the bottom of the page to see Doral's Statement, Small Smiles Statement and Small Smiles Audit and Suspensions.

Doral Dental Sending Patients to Small Smiles Across The Nation

Click here
Click Detail Search
Click the Search button beside Office Name
Enter Small Smiles, Kool Smiles, Ocean Dental and just about any state and click search.

What you will find is that Doral Dental is a major "pusher" "enabler" of these rogue dental chains.

Millions must be being made to keep all these hands in the cookie jar full of cash.

Think about it:

Medicaid Dollars pass to the subcontractors such as United Health and Doral Dental and all their stockholders and employees, then on down to Small Smiles/FORBA and all staff there, including investors such as CIT and Arcapita Bank, then they advertise they pay they working dentist $144k a year plus bonuses, and let's not forget the office staff, buildings, equipment etc. And let's not forget all the money the DeRoses have in their pockets, giving millions to Creighton University, living in multi-million dollar homes, etc. Then you have the lobbyist on the Federal Level, and just about every state level, several high powered law firms, and more than one huge PR firm.

Now that's a heck of a lot of money being made by strapping children on papoose boards and drilling away and any tooth they can get.

Heck this thing is so profitable their are other people opening up clinics everyday trying to cash in on the huge cash cow!

Is anyone out there gonna quit pushing these clinics and close their doors or not!

United Health Care Still Using Small Smiles: What The Hell Are They Thinking?

Despite Doral Dental, a sub-contractor for Maryland's Medicaid System, terminating 4 dentists and suspending Small Smiles for another 3 months for highly irregular and questionable practices, United Health Care, another sub-contractor doing business as Americhoice, finding more than $250,000 worth of "questionable treatments" will still send it's medicaid members to the following Small Smiles dental Clinics in Maryland for treatment.

• GRIGORYAN, OVSANNA

SMALL SMILES OF LANGLEY PARK PC
GENERAL DENTISTRY

• KING, TRACY S.

SMALL SMILES OF NORTH BALTIMORE PC
GENERAL DENTISTRY

• MILLS, LINISHA Y.

SMALL SMILES OF OXON HILL
GENERAL DENTISTRY

• PARIRENYATWA, SIMBARASHE

SMALL SMILES OF NORTH BALTIMORE PC
GENERAL DENTISTRY

• PARIRENYATWA, SIMBARASHE

SMALL SMILES OF BALTIMORE PC
GENERAL DENTISTRY

• PFEUFFER, DAVID J.

SMALL SMILES OF NORTH BALTIMORE PC
GENERAL DENTISTRY

• ROBINSON-WARNER, GILLIAN A.

SMALL SMILES OF OXON HILL
GENERAL DENTISTRY

• TOLER, KENYATTA M.

SMALL SMILES OF OXON HILL
GENERAL DENTISTRY

• TOLER, KENYATTA M.

SMALL SMILES OF LANGLEY PARK PC
GENERAL DENTISTRY

• TYLER, DAWN L.

SMALL SMILES OF OXON HILL
GENERAL DENTISTRY

• UMEOZULU, OKEOMA N.

SMALL SMILES OF BALTIMORE PC
GENERAL DENTISTRY

In Washington DC they will gladly send you to:

• MILLER, JULIAN P.

SMALL SMILES, PC
GENERAL DENTISTRY

• MUNDEY, SHAKEYA

SMALL SMILES, PC
GENERAL DENTISTRY

• STEPHENSON, KESHA J.

SMALL SMILES, PC
GENERAL DENTISTRY

• VENIGALLA, LAKSHMI Informed They Are No Longer Employed With Small Smiles

SMALL SMILES, PC
GENERAL DENTISTRY

What the HELL is United Health Group thinking! Hopefully you are one of the lucky recipients of Doral Dental and won't be sent to any of the above dentists and your child will be spared the torture and abuse of unnecessary dental treatment and being tied to a papoose board just for the ease of it all.

I suggest if your linked up with United Health/Americhoice you exercise your American Choice and call, write or email United Health Group and demand better service for yourself and your children.

If you are a dentist and no longer associated with Small Smiles please email me, state when you left and I will note that you are no longer employed with Small Smiles.



Email Me

Update 9/9/2008

I received the following email and after weighting the request I decided there was no real benefit in not granting the request.

Dear Ms. Hagan/To Whom It May Concern:

As best as we are able to discern, the "Dentist the Menace" web site is maintained by a Debbie Hagan. This email is intended to reach all persons responsible for the content of the site.

This law firm represents Sanam Toufanian, D.D.S., whose name appears on the June 17, 2008, "Dentist the Menace" web site posting regarding Small Smiles entitled, "United Health Care Still Using Small Smiles: What the Hell Are They Thinking?". Dr. Toufanian no longer is employed with Small Smiles. During her employment at Small Smiles, Dr. Toufanian at all times acted in the best interests of her patients, and there is no allegation that Dr. Toufanian engaged in any improper conduct. Your web posting is false, misleading, and highly damaging to Dr. Toufanian's reputation. We therefore demand that you remove Dr. Toufanian's name from the June 17, 2008 posting immediately.

Sincerely,

Caroline Judge Mehta