Showing posts with label Dr. Michael W. Davis. Show all posts
Showing posts with label Dr. Michael W. Davis. Show all posts

Friday, June 05, 2015

Basic Economic Models of Large Scale Corporate Dentistry

Basic Economic Models of Large Scale Corporate Dentistry
By Michael W. Davis, DDSBy: Michael W. Davis, DDS
June 5, 2015





The first misnomer and misrepresentation which must be addressed is dental service organizations (DSOs). These are primarily business structures designed to circumvent state laws relating to ownership of dental practices. Most state statutes require only licensed dentists in their states may lawfully own a dental practice. DSOs falsely allege they restrict management to non-clinical areas.

In reality, the corporate entity DSOs own the dental practices they manage. Doctors in those practices are merely employees, whose employment may be terminated at the will of their employer, the DSO. The DSO fully controls the bank accounts of each and every clinic they manage, with accounts usually swept into Delaware banks at least bi-weekly. They establish monetary production quotas and bonuses for patient services. They establish the hours of operation and staff. They usually dictate office equipment, patient clinical supplies, and dental laboratories for patients. They supervise and control patient scheduling. They also dictate numbers of clinical protocols bypassing the doctor/patient relationship, such as mandating crowns over fillings, often unnecessary and more costly “deep cleanings”, antibiotic therapy into alleged “deep gum pockets”, etc.

Most “owner” doctors in these larger corporate practices are sham figureheads. They provide the corporate managers a layer of liability protection, for their unlicensed and unlawful practice of dentistry (see: Federal Fifth Circuit ruling 07-30430). These alleged “owner” doctors are not allowed to freely sell their asset of the dental practice, under their contract service agreements with the DSO. They aren’t as “owners” allowed discontinuing services with the DSO, and must retain the DSO’s services into perpetuity. In effect, the doctor owner(s) represent a façade of nominee ownership. The valid beneficial owner of the dental practices is obviously the DSO.

Friday, May 22, 2015

WARNING: Common Submission Tricks and Common Red Flags at Medicaid Dental Clinics

By: Michael W. Davis, DDS
Dr. Michael Davis
This is a guide for parents, government regulators and law enforcement. The American Academy of Pediatric Dentistry (AAPD) has issued a number of valuable guidelines, which illustrate methods and materials to gain the pediatric dental patient’s cooperation, in the child’s best interest for dental healthcare. This paper is not about that. The manner in which clinical care should be delivered in the child’s welfare is of minimal concern in the Medicaid mill environment.
Medicaid dental mills are clinics primarily focused on delivery of government funded dental services in the private sector. Their chief focus is maximal generation of dollar production. The interests of patients and parents are of minimal concern.
ThreatsParents often receive threats for not consenting to their child’s dental care at these types of Medicaid clinics. Threats come from office managers, doctors, and other staff, most of whom are operating under production bonus and quota programs, unknown to parents. The threats range from intimidation of reporting parents to state Child Protective Services, to reporting parents and children to “La Migra” (immigration authorities). 
A “red flag” for parents is that when they ask questions about the need for their child’s dental treatment, there is never an offer for the parent to seek a second professional opinion or other optional treatment. The clinic representative usually ups the intimidation pressure, when the parent even hints at a desire for a second opinion.

Once the child is successfully isolated away from their parent, they are be frequently threatened to gain cooperation and compliance for clinical treatment. “If you don’t hold still, I promise you’ll NEVER see your mommy again.”  “If you keep moving you head around, a needle will be going into your eyeball.” (Interestingly, I first heard that sick line from a dental educator.)
Keeping Children Isolated from ParentsMost children feel comforted and safe in the company of their parents. They generally enjoy a more positive overall dental experience in the presence of their trusted guardians. This is fully supported by AAPD Guidelines. However, the best interests of the child do not comport with maximizing clinic “Production per Patient” (PPP- a specific term used in the corporate training literature of Medicaid mill, Small Smiles Dental).
Isolation of the child is a method to break the child’s will, and employ further techniques to generate maximal production, at the patient’s psychological expense. In Medicaid mills, parents are often expressly forbidden to accompany their children in dental treatment areas. If there’s no parent to observe child abuses, abusive compliance techniques often ensue.
RestraintsThese devises may euphemistically be called “papoose boards”, “protective stabilization devises”, taco board, or “blanket wraps”. In reality, they represent child straightjackets. If the child is restrained, the doctor is more able to maximize clinical production (dollars generated). There is no longer a need to work within a child’s stamina or their individual understandings and ability to comprehend. It represents a seriously disturbing psychological trauma to a child. Again, usually no parents are allowed to provide their presence, with comfort and reassurance.
There are obvious clinical risks associated with child restraints. If the child is not properly monitored, which is often the case in busy Medicaid mills as dentists hop from patient to patient; the chest restraints inhibit a child’s breathing. This elevates risk of morbidity and mortality. The child may struggle to free oneself, with a potential for a restraining strap to compromise the carotid artery (blood flow to brain) or trachea (airway). At least one confirmed death (possibly more) has been attributed to the use of restraints.
Trying desperately to escape children struggle to the point of falling from a dental chair, while still secured in a restraining devise. They were subjected to needless contusions (bruises), lacerations (cuts), inclusive of head and neck trauma (potential for brain injury or nervous system damage). It should go without saying (and AAPD Guidelines do say so), the potential for a child’s psychological injury is also very real.
Due to wrist injuries being commonly reported by parents from the velcro bindings inside the restraint device, clinics are using socks to cover the hands and arms. If your child reports socks placed on their hands, it is a good indication of the child being restrained.
Hand Over Mouth and Nose Technique“Hand over mouth” (HOM) technique was formerly a mainstay in pediatric dental training. The dentist would place their hand over the mouth of a child, who might be screaming out inconsolably. The child maintained an airway through their nasal passages. Often the child would subsequently calm down. This was never designed to be a method of first resort. In fact, this specific technique is falling out of favor with increasing numbers of pediatric dental specialists.

Medicaid clinics take this technique to a new and highly disturbing level. The doctor will not only cover the child’s mouth with their hand, but use the thumb and first finger to pinch off the nasal airway. In very short order, the child must gasp for a breath. At that instant, the doctor inserts a Molt mouth ratchet, or a rubber bite block (instruments to forcibly hold a child’s mouth open). The child is no longer capable of free will of verbal communication at that point, for the remainder of the dental appointment.

Limiting Amount of Local AnestheticLocal anesthetic is commonly termed “Novocain”. In fact, Novocain is a generic term which might refer to a number of different forms of local anesthetic. This agent is essential for patient comfort, regardless of a dental patient’s age. Many elder patients have tooth nerves which regress, and little to no local anesthetic may be required for patient comfort. Children have relatively very large sized tooth nerves, and generally feel dental pain quite easily.
A child’s lower body weight often dictates a significantly reduced amount in delivery of local anesthetic by the doctor. If local anesthetic is overdosed to a child in particular, death can and does result.
Note: adults can safely receive far more local anesthetic. Therefore, dentists will often limit the amount of dental care they provide a child at a single dental visit, so only a safe and limited level of local anesthetic is given. The child may require several visits to complete planned dental care, in a safe and responsible manner. The child’s welfare should assume first priority.
The Medicaid dental clinic places dollar production ahead of all other concerns. Once the child is firmly secured in a restraining devise, and their mouth held in an open and locked position; dental drilling, pulpotomies (baby root canals) and extractions can proceed, regardless of adequate local anesthetic for patient comfort. Children will commonly generate screams from acute dental pain as the dentist drills on teeth with lack of anesthesia, while their tiny feet ceaselessly kick on the papoose board. The Medicaid clinic’s objective is to maximize PPP, regardless of the patient’s interest, pain and psychological damage.

Screaming in Child’s FaceScreaming in the face of a child by the doctor is a method to break the will and spirit of the child. This abhorrent technique is very similar to a Marine drill instructor screaming in the face of a raw enlisted recruit. Only this isn’t a young Marine, but a very young child. This is but one tool to bring the child into a psychological state of cognitive disassociation. Figuratively, the child leaves their body. The doctor is then free to invoke their more powerful will upon the child. Again, the goal is to maximize PPP, under the broken dental Medicaid program.
Physical AssaultA doctor punching, choking or slapping a child is another unacceptable method to gain a child’s compliance. Strikes may be to the abdomen (stomach), thorax (chest) or appendages (arms and legs), so bruising won’t immediately and as easily show. The doctor is frequently 3-5X the physical size and body weight of the patient. The concept is that with adequate physical intimidation, pain, and additional fear of pain, the child’s cooperation will be achieved. Again, often the patient is rendered into a state of cognitive disassociation, in order to generate maximal dental production. 
Waterboarding
Medicaid mills where this has been done don’t refer to this abuse as “waterboarding”, but that’s exactly what it is. This isn’t inflicted upon suspected Islamic terrorists, but on our nation’s disadvantaged children. Once again, the objective is to fully break a child’s will and spirit, to generate maximal dental Medicaid PPP. I’ll describe the two most common methods (One was common in Oklahoma City and the other in Albuquerque).
Oklahoma City Baby Waterboarding-
Initially, the child is firmly restrained in a papoose board and reclined in a dental chair. The feet are positioned higher than the head, to allow water to more easily flow up the nasal cavity from the mouth. A rubber mouth prop is firmly positioned between the child’s teeth, which will not allow them to close. The swallowing reflex is greatly inhibited, because the teeth aren’t allowed to close together. Next, the doctor fills the child’s mouth with water. The small patient can’t swallow and water flows up into their nasal passages. They experience a terrifying sensation of drowning, alone and without their parent. The concept is to break down the child, in order to maximize Medicaid dollar production.

Albuquerque Baby Waterboarding-This is similar to the Oklahoma City baby waterboarding method, but with a nasty twist. Instead of using a rubber bite block to hold open the child’s mouth, a paper patient bib is forcibly stuffed into the child’s mouth. These bibs are highly water absorbent. The doctor next will saturate the bib with water. The doctor may also elect to pinch off the child’s nose, so they have no ability to breath for a limited time. Other times, the doctor’s hand or a paper bib will also cover the child’s eyes. Again, the child is placed into a highly threatening position, with the sensation of imminent drowning. The spirit and will of the child is fairly easily broken. Maximal dental Medicaid production then ensues.
ConclusionOne will not find any of what I’ve described in the peer reviewed dental literature. It it far too threatening for dentistry’s leadership to face. Adults, who were dentally abused as children, under this toxic dental Medicaid program will have terrible memories surface. Many are suffering from dental post-traumatic stress disorder (dental PTSD). Please bring this article to your counselor or therapist to futher support your traumatic experience. What you faced as a child was horrendous and needless. I will absolutely validate the physical and psychological trauma you suffered.
Parents please do not blame yourself. You trusted a dental professional. You may have trusted what you assumed to be a reputable national chain of dental clinics. You were betrayed on many levels. Yes, doctors took advantage of your child, and cheated taxpayers. State and federal regulators have been hiding under their desks for decades. Leaders in my dental profession abandoned the public welfare. Wall Street bankers have even gotten in on the dishonest action. Politicians have also taken their cut. Those who cheated you and your child have high levels of formal education and are entrenched in our political and economic system. The game is rigged, and the fix is in.
People in law enforcement and government regulations, this should be a wake-up call. Many of our disadvantaged Medicaid kids are being abused by dental professionals. These children aren’t to be blamed for their financial circumstances or disabilities. It’s not their fault. Blaming victims is toxic thinking. Let’s get these kids the helping hand they need. Let’s give very serious attention towards filing criminal actions (not only civil actions) against doctor violators, and the corporate managers, who often pull the strings.
Finally, our dental Medicaid program is in complete disrepair. We need to place this sick program on the scrap pile, and rebuild a dental Medicaid system, which truly assists and honors patients it is intended to serve. Our current system is an out-of-control boondoggle of “welfare for the rich”. American taxpayers deserve better. Our nation’s disadvantaged children deserve better.*

In 2014 Dr. Davis sponsored a proposal to incorporate the AAPD Guidelines for the use of restraints into the New Mexico Dental Practice Act.  Despite much opposition his efforts were successful and in 2015 the AAPD guidelines are no longer “suggestions” by rules in New Mexico. see NMAC 16.5.2.27
16.5.1.27 PROTECTIVE PATIENT STABILIZATION: Unless otherwise stated in rules or statute, the board, licensees and certificate holders shall refer to the American academy of pediatric dentistry’s guidelines on protective patients stabilization. [16.5.1.27 NMAC - N, 01-15-15
Now the challenge is to prevent members at the AAPD from easing their guidelines. In these trying times the AAPD appears to be over run by members who are attempting to rewrite the guidelines that reflect less interest in treatment and more interest in speed and production per patient.

Wednesday, March 11, 2015

Texas Governor Greg Abbott Fails Dental Health Patients- Again

By Michael W. Davis, DDS

Dr. Michael Davis Bio

This report begins in a small Appalachian town in the hill country of East Tennessee; Bristol. Many call this community the birthplace of country music. It also boasts of a very modest but proud NASCAR track. This community is not wealthy by the standards of Westchester County, Marin County or Beverly Hills. Its wealth is in its people, traditions and strength of community. Folks have lived together as friends and family for generations. Success is more often measured in terms of spiritual values and connections with neighbors, than numbers in bank accounts. It’s a place where people trust and rely on family and neighbors. It’s a community where doctors still hold an esteemed position.

This may not be a town which “sophisticated” people on the East or West Coasts can relate to. In fact, they may use demeaning terms like “hillbillies” or “rednecks”, to dismiss these hardworking Americans. However, most of America absolutely respects people and towns like Bristol, Tennessee. That’s definitely true for most Texans, who hold similar values.

A doctor allegedly betrayed the trust of Bristol, TN, back in 2013. This dentist took the money from many patients of very modest financial means, most often for lay-away and payment plan dentures. Then he simply locked the doors to his clinic, and left the state. Unlike the Texas Alamo hero, Davy Crockett also from East Tennessee, Dr. Hardev A. Patel had a different spin on the phrase, “You may all go to hell and I will go to Texas”.

In January 2014, over 100 people filled the Bristol Tennessee General Session Court Room, to discuss the closure of Dr. Patel’s dental clinic and loss of their very hard-earned money. By then, Dr. Hardev Patel had already voluntarily retired his Tennessee dental license and relocated, and allegedly retired to Texas. But, was Dr. Patel truly retired from dentistry? The Tennessee Board of Dentistry listed no disciplinary actions against his license. In effect, weren’t they opting for a geographical solution to abuses on the public interest? Dr. Patel now potentially became the problem of Texas.

Dr. Hardev A. Patel earlier obtained a Texas dental license on 12-06-2013. All the while, multiple reports were in the public domain on his alleged abuses to the people of Bristol, TN. As of this report, the Texas State Board of Dental Examiners (TSBDE) has no public advisories relating to Dr. Patel. Any computer search engine will quickly arrive at numbers of highly disturbing stories concerning Dr. Patel. Any reasonable due diligence background check by the TSBDE on Dr. Patel would have raised a serious alert.

Today, Dr. Hardev A. Patel is publicly listed as a dentist provider at San Filipe Dental Health Center, in Del Rio, TX. Working for this non-profit clinic requires Dr. Patel be credentialed in Texas, as a Medicaid provider. He must pass background checks by this non-profit organization, as well as the Texas Department of Health Services.

Are authorities in Texas all asleep at the wheel, or is there a massive corrupt cover-up in play? Regardless, this isn’t the first cluster-f’ed dental rodeo for Governor Greg Abbott. We all recall the recent debacle and closure of Austin Cosmetic Dentistry, and unlicensed practice of dentistry by an unlicensed manager. We recall the corrupt oversight of dental Medicaid mismanaged by Xerox (ACS) for years. We also remember the troubling oversight efforts by the Texas Health and Human Services Commission relating to dental Medicaid abuses and fraud.

There’s a clear pattern of misconduct from Texas state authorities relating to dental healthcare. Former state attorney general and today, Texas Governor Greg Abbott is leader of the pack. It’s well past time to stop focusing on the myriad of smaller ethical and criminal breaches, from low level political hacks. The top dog needs to be held to account.

Monday, January 26, 2015

Scams on the public by nonprofit dental clinics

 

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By: Michael W. Davis, DDS

Dr. Michael W. Davis practices in Santa Fe, NM. He currently chairs the district dental society peer-review committee, and is active as an expert witness on dental legal cases. He has authored numbers of articles relating to clinical dentistry, dental ethics, and protections for the public.

The recent legal settlement between Sea Mar Community Health Centers, which provides dental services to low-income residents in 10 Washington state counties, and the Washington state attorney general’s office, for $3.65 million highlighted this growing problem. These scams don’t generally benefit the professional staff, patients, contributors, and certainly not taxpayers. These swindles are designed to elevate overall clinic revenues, to enhance salaries and benefit packages of clinic directors. These nonprofit clinic directors often have compensation packages comparable with those working for Fortune 500 companies. Most other employees are not tapping in on the dishonest largesse. Here’s how this particular hustle is played.

These clinics have favorable tax status not enjoyed by private sector companies. They are exempt from most taxes. Clinic “profits” are not taxable. However, these profits are rolled-over in the dishonest clinics, into increased personal revenue for the clinic directors. Dishonest clinic directors may also generate a kickback fee from vendors providing dental equipment and/or supplies, especially if unaudited.

Unlike private sector dental clinics serving the disadvantaged Medicaid population, nonprofit clinics may access federal, state, county, & charitable grant moneys. This can be a huge income generator, especially important since Medicaid fees are often set at a level below the cost to provide that service, to standard of care. Grant moneys provide the nonprofit clinic with a per patient served, “encounter fee”. Patient encounter fees are paid to Federally Qualified Health Centers (FQHC) as a set amount, per patient visit. The patient must lawfully visit with a duly licensed healthcare professional of that nonprofit healthcare clinic, for the FQHC encounter fee to be paid. This nonprofit encounter fee often ranges in the $200 per patient visit range.

Saturday, January 03, 2015

A Wide Range Discussion with Dr. Fred Quarnstrom: Dental Ethics, Regulations and Professional Turf Wars

 

A Wide Range Discussion with Dr. Fred Quarnstrom: Dental Ethics, Regulations and Professional Turf Wars

 

clip_image002By: Michael W. Davis, DDS

Dr. Michael W. Davis practices in Santa Fe, NM. He currently chairs the district dental society peer-review committee, and is active as an expert witness on dental legal cases. He has authored numbers of articles relating to clinical dentistry, dental ethics, and protections for the public.

 

INTRODUCTION

clip_image004With an extensive education and history in the dental profession, Dr. Fred Quarnstrom has been an outspoken advocate for the public when it comes to their dental healthcare. For decades, Dr. Quarnstrom has often taken a heroic stand in protecting the public which often times lands him on the opposite side of fellow professionals and dental organizations.

Recognized as an expert, Dr. Quarnstrom’s many accomplishments include: his current private practice, a faculty member at 3 dental schools, quality assurance consulting, independent expert testimony, and speaker. He has also held positions on what is the equivalent to the dental board in Washington state and Western Regional Examining Board. Dr. Quarnstrom graduated from the University of Washington in 1964 and completed a residency program in General Anesthesia at Washington Hospital Center, Washington D.C. in 1967.

INTERVIEW

Dr. Davis: Dr. Quarnstrom, a number of years ago, you completed a residency program in anesthesiology. You went on to utilize sedation services for your patients, and taught sedation courses, to fellow dental professionals. We both see how dental sedation can be a very helpful adjunct in the practice of dentistry.

What concerns do you have relating to weekend seminar sedation courses, often offered hotel conference rooms? What are the dangers to the public, as well as professionals offering sedation, for marginally trained and minimally emergency equipped dental clinics? Do you have specific concerns relating to the public health and safety; is the public being protected or it is buyer beware? What are the regulating agencies who are setting the standards and rules, and do you feel there is “agency capture” at work?

Are you concerned that it seems violators of sedation rules and regulations of state dental boards, far too often receive little or no disciplinary actions, and what advice do you have for state dental boards?

What advice can you offer to the public, whereby they can more actively protect themselves and their families? What advice do you have for the professional who chooses to offer sedation to patients?

Dr. Quarnstrom: First, I along with a Doctor of Pharmacy and a Professor Emmeritis teach weekend courses in the use of nitrous oxide and oral CONSCIOUS sedation. There is heavy emphasis on CONSCIOUS. We do not teach multiple drugs. When you add a little of drug A plus a little of Drug B plus maybe a little of drug C, D, and/or E. There is simply no research to suggest what the results will be. Personally, I have taught 245 nitrous oxide courses and 110 oral conscious sedation courses. image

Nitrous Oxide is very safe. You really only need to know a few things. Never give more than 50% nitrous for more than a minute. Always check your system to be sure the gases have not been switched.

I know of one near death from switched gas in a surgery office doing IV sedation/general anesthesia and another 70 cases, where gases were switched but there was no damage to the patient.

In the oral surgery office the one patient was under general anesthesia. The surgeon expected him to be unconscious. He discounted the fact that the pulse oximeter reading dropped as low as 35%. His staff had asked him several times if they should call the paramedics. The third time he agreed. But the oxygen levels had been very low for too long. 95% to 98% is the normal saturation at sea level. You should get concerned if it drops to 90%. The patient who was an a student and star athlete ended up with severe neurologic and vision problems. 

In the other 70 cases patients either got too relaxed or went to sleep.The dentists have been taught when this  happens you should take the mask off and get them breathing room air and they quickly returned to normal with no residual problems. I published research 15 years ago to show it was safe to do this. If a dentist insisted on giving the patient 100% Oxygen and the gas lines are switched they would be giving 100% nitrous oxide. You need a minimum of 30% oxygen when being sedated preferably it would be 70 to 80% oxygen. I have taught for 40 years— “if something is wrong take the mask off”. 

The final thing you need to know. IF THE PATIENT BECOMES UNCONSCIOUS OR STOPS REACTING TO VERBAL COMMAND, TAKE OFF THE MASK. If in doubt it is never wrong to call 911. My patients who are paramedics plead with me to tell the dentists at our courses that they will not get into trouble for calling 911. As they state, “Our save record goes way up if we get there while the patient is still alive”.The ADA guidelines and most states require a 14 hour course to administer nitrous oxide sedation.

Wednesday, December 17, 2014

Rick Perry and Greg Abbott Culpable in Debacles of Corporate Dentistry DSO Poster-Boy, R. Kirk Huntsman

 

Michael Davis DDSby Dr. Michael Davis

 

December 17, 2014

Soon to assume the Texas governor position, from his prior office of Texas state attorney general, will be Greg Abbott. Mr. Abbott takes over the governor’s office from another dental industry failure, current Governor Rick Perry. Mr. Perry is most noted in dentistry for his dubious appointments to the Texas State Board of Dental Examiners (TSBDE). The consumer protection group, Texans for Dental Reform, have highlighted a number of these self-serving and corrupt appointments. Members of the TSBDE included a number of notorious Medicaid fraudsters, and at least one convicted sex offender.

pull quote 1Hapless state watchdogs for Texas citizens extended not only to the TSBDE and their incompetent legal counsel, but also to the Texas Office of Inspector General. Despite the fact that Texas is currently the state most recognized for the severity and volume of dental Medicaid fraud, the Texas Office for Inspector General has so far failed to effectively prosecute violator after violator. These habitual failures go directly to the (in)activity of Greg Abbott and Rick Perry.

Federal Fifth Circuit Ruling 07-30430

Let’s examine a case in point. Federal Fifth Circuit Court ruling 07-30430, which is largely based on Texas state statutes, determined that non-dentist ownership of a dental practice in Texas represents the unlicensed and unlawful practice of dentistry. The ruling further stipulates that corporate violators are to receive the same legal penalties, as individual person violators, with no special treatment. The acts of establishing doctor production quotas and bonuses are an action only lawfully permitted by a licensed dentist. State dental regulatory boards are charged under this federal ruling with the responsibility and obligation, of disciplinary actions against both individual person violators and corporate violators. The federal court also determined OCA (f/k/a Orthodontic Centers of America) could not enforce employment contracts with duly licensed Texas doctors, because the corporate entity OCA was not in fact a licensed doctor. The dentist employment contracts were determined unlawful and unenforceable, in their entirety, without being severable.

The federal court clearly saw though the sham presented by OCA (a dental service organization, “DSO”). OCA presented licensed dentists, whom they retained to misrepresent themselves as clinic “owners”. OCA controlled the dental clinics’ bank accounts. OCA held the power to buy and sell assets, such as the doctor employment contracts and individual clinics. In reality, these “owner dentists” were merely nominee owners. OCA, like nearly all DSOs, was the true and unlawful beneficial owner.

In conflict with this federal ruling —and further, avoiding addressing this ruling —the TSBDE has repeatedly stated they have no mandate to enforce the unlicensed practice of dentistry by a corporate entity. This flagrant obfuscation of law by legal counsel for the TSBDE is highly disturbing. Even more troubling is watching Rick Perry and Greg Abbott hide under their desks. Additionally, Mr. Abbott further abandoned his duty as Attorney General by failing to provide a legal advisory opinion based on clear and current legal precedence.

Xenith Practices, LLC & Austin Cosmetic Dentistry

Let’s examine another case, where Mr. Abbott was asleep at the wheel leaving dental consumers in harm’s way. In October 2014, Austin Cosmetic Dentistry simply closed and locked their doors. No notice of the closure was given to patients or staff. The staff was left unexpectedly unemployed and patients were illegally abandoned. Many patients were in the middle of their treatment. Many others, who had pre-paid, were scheduled to begin or finalize their restorations.

Representatives of Xenith Practices purchased the now-failed Austin Cosmeticpull quote 2 Dentistry clinic from Dr. John Schiro, a couple of years earlier. The highly disturbing public record of Dr. Schiro with the TSBDE must have been aware to Mr. Huntsman and principles of Xenith Practices. It’s easy to download from the TSBDE website, with the slightest due diligence check. The earlier legal disputes between Dr. Schiro and Dr. Douglas Terry, who openly spoke out about alleged improper clinical care by Dr. Schiro, were also of public record. I have no idea what matters the investors were informed, by way of a lawful full disclosure by Mr. Huntsman. None of this should have escaped the attention of the Texas attorney general’s office, governor’s office, nor the TSBDE.

Xenith Practices, LLC, a DSO, managed the failed Austin dental clinic. Mr. R. Kirk Huntsman, —a business executive with no formal dental education and unlicensed to practice dentistry—formerly served as CEO of Xenith. As we shall see, Mr. Huntsman has quite the storied history in the dental industry. As for the true beneficial ownership of Austin Cosmetic Dentistry, that will be for the courts to sort out. It is alleged that Mr. Huntsman’s son-in-law—a Texas licensed dentist who lives and works in Colorado— signed on as the figurehead, “owner dentist”. Mr. Abbott could not have missed this obvious violation to Fifth Circuit ruling 07-30430, and negative fallout to the public health and safety.

Monday, November 24, 2014

Myths, Rumors, and Bald Faced Lies- Truths Revealed about the DSO Industry

Myths, Rumors, and Bald Faced Lies- Truths Revealed about the DSO Industry

By: Michael W. Davis, DDS

There exists a great deal of misinformation, as well as intentional misrepresentations, within the dental service organization (DSO) industry. Much, if not most of this of this, is fostered by the DSO industry itself.

Historically in healthcare, dentists were held to ethical and legal standards within the doctor/patient relationship (legal contract) always placing their patient’s interest, above all other interests. Court rulings have determined that because of a doctor’s expert knowledge, which is not easily accessible to the general public, the patient is at a distinct disadvantage within this contract agreement. Obviously, the delivery of healthcare services is a very different matter, than the buying and selling of widgets.

A corporate third party, the DSO, may enter into this contract agreement (doctor/patient relationship). This is usually without the knowledge or consent of the patient. Such an action may invalidate as unlawful, the doctor/patient relationship. (Please reference Fifth Circuit Ruling: 07-30430.) DSOs, which utilize bonus systems and production quotas for professional providers, are engaging in the unlicensed and unlawful practice of dentistry. Such corporate violators are subject to the same regulatory sanctions and disciplinary actions, as individual violators. Unfortunately, too few government regulators have advanced past their current ineptitude and corruption. This must change.

“At XYZ Dental, we allow you to focus on what you do best; provide excellent dental care for patients. We take care of all the rest.” is a common corporate dentist-recruiting message. Even the provider contracts include a proviso waiver that only licensed dentists provide dental care. Unfortunately, contract verbiage is far from the reality.

Unlicensed corporate managers, not doctors, very often make clinical decisions effecting direct patient care. This may include the quantity and quality of dental supplies for a dental clinic. It may include a very limited selection of utilization of dental laboratories, many of which are undisclosed offshore dental lab sweatshops. Unlicensed corporate clinic managers, who are not under any doctor’s supervision, may be utilizing arm-twisting sales techniques, to get patients to sign on for financing of unnecessary dental care. Similar arm-twisting may be used on doctors and hygienists, to increase clinic profits, by selling unneeded dental treatments to their patients.

Hygienists, who lawfully must be working under the direction and supervision of a duly licensed doctor, are today working for whomever writes their paycheck. Periodontal probing measurements are invented, to generate additional cases of unnecessary scaling and root planing (deep cleaning). Sulcular antibiotic therapy is sold to patients, even before assessment of results, to initial therapy of scaling and root planing. Adult cleaning visits are often restricted to 20-30 minutes, which nearly always leaves excessive disease-causing agents. In fact, often unlicensed dental assistants are providing hygiene services.

Generation of corporate profits trumps the interests of patients. Any dental professional employee who dares question the corporate model will soon be out the door. After all, a corporation’s first fiduciary responsibility is to generate maximal returns for shareholders. The interests of patients never enter the picture.

Upper management in the DSO industry will often argue, that numbers of non-corporate doctors are engaging in the same or similar patient abuses, within their smaller businesses. And, this justifies their grand scale abuses, how? It’s the old lame failed argument, of justifying bad behavior, with other examples of bad behavior. Reality: dental regulatory boards have reported a far greater percentage of statute violations originating from corporate dentistry, than from smaller doctor-controlled practices.

Another DSO fallacy often relates to doctor financial compensation. Verbally, their management and doctor-recruiters advise dentists of compensation, clearly based on a percentage of the doctor’s clinical production and/or hourly wage. Yet, the complex legalese of the employment contract, seemingly tells another story. These contracts are often so complicated, only a law firm concurrently expert in business law, contract law, and finance could hope to decipher the maze of legal verbiage.

Fortunately, any American Dental Association (ADA) member can have these contracts reviewed, as a benefit of membership. Few recent grads take advantage, as they not only lack finances to hire an appropriate attorney for contract review, but also are often not ADA members.

Wednesday, November 19, 2014

Mechanisms of Dental X-ray Scams

clip_image002By: Michael W Davis, DDS

Dr. Michael W. Davis maintains a private general practice in Santa Fe, NM. He chairs the Santa Fe District Dental Society Peer-Review Committee. Dr. Davis is active in dental care for disadvantaged citizens. His publications are on ethical issues within the dental profession, as well as numbers of clinical research papers.

 

November 19, 2014

Frequently, the media, non-dentist investigators, and the public ask me, the methods and means of swindles played out with dental x-rays. Most incorrectly assume, that patients are simply given excess numbers of unnecessary radiographs, to increase billing statements.

Both the insurance industry and Medicaid generally pay 100%, for the costs associated with dental x-rays. These third party payers have limits on the frequency and types of radiographs, which they will cover for benefits under their contracts with dental providers. Most dental insurance carriers have computer-generated algorithms, which are triggered when excessive x-rays are taken. Moneys are then not paid out, or immediately recuperated, in the next insurance payment cycle.

Medicaid oversight is generally more lax. However, there is a very real risk with dental x-ray over-billing, that this will be caught by Medicaid oversight mechanisms, even as incompetent as they usually are. Generally, large sums of Medicaid over-payments are generated, and regulators chase down very large sums, well after the fact (“Pay-&-Chase”). Often, only pennies on the dollars are returned to taxpayers. However, it represents a scam with some element of downside risk. As dental Medicaid fraud has become an accepted business model with in the dental industry, swindlers desire to minimize or eliminate regulatory risk.

Today, large interstate corporate dental providers retain former state and federal dental investigators. These corporate dental providers, which are usually beneficially owned by the private equity investment industry (Wall Street parties), have a good idea of which forms of fraud will be potentially investigated, and which methods of fraud will fly under the radar. Regardless, the corporate beneficial owners always retain licensed doctors acting as nominee owners (sham-owners), to assume any potential regulatory liabilities.

Most commonly, we observe the following forms of dental scams with dental radiographs.

Unbundling of X-ray Services

The American Dental Association (ADA) has established a clinical coding system called, “Common Dental Terminology” (CDT). Numerical codes are designated for nearly every possible dental service. This system is updated annually. Every insurance carrier and Medicaid will establish fees for each dental service, for which coverage is provided under their program. One such dental service is called a “complete series of radiographs”, which has a set fee, and CDT code number.

The scam involves taking a fair number of x-rays on a patient, and charging out for these multiple individual radiographs with multiple different CDT codes, to a sum greater than the fee, for a complete series of radiographs. This dishonest billing is termed unbundling.

Upcoding of X-Ray Services

Many pediatric dental patients, especially those with short attention spans, and who physically move about frequently, are unable to sit still long enough for a panographic x-ray (very large radiograph, approximately the size of a small loaf of bread). Thus, two occlusal radiographs (these approximate the size of a playing card) are often substituted. Cheats will frequently take a standard sized periapical x-ray (approximately the size of a domino), and turn it 90-degrees, and misrepresent that radiographic service, as an occlusal x-ray, and not a periapical radiograph, which it truly is.

This scam is usually played out, when the CDT code fee for an occlusal radiograph is more than a periapical radiograph. Since the only way to catch this fraud is with a physical auditing of the patient records, it’s easy to get away with. 

Non-Diagnostic Quality X-rays

When dental providers bill for x-ray services, they are assumed to bill for diagnostic quality x-rays. Any reasonably qualified doctor should be able to view the radiographs, and use that data to assist in generation of a patient treatment plan with their total examination. A patient treatment plan is generally an essential and required part of any patient record. Further services (fillings, crowns, extractions, root canal therapies, etc.) provided to a patient are based upon the patient treatment plan, and diagnostic quality x-rays.

When a doctor utilizes non-diagnostic quality radiographs (x-rays with processing errors and distortions, incorrectly positioned x-rays, etc.) to generate a patient treatment plan and provide clinical services, the patient and third party payer may be cheated. Not only is it unlawful to bill for the non-diagnostic quality radiographs, but also dental services delivered based upon these x-rays may represent malpractice and/or fraud.

Again, this form of malpractice/fraud is difficult to catch, without an on-site patient record audit, or physical examination of the records. Once patient records are subpoenaed for a civil or criminal legal action, a Medicaid audit, or a state dental board administrative law complaint, we commonly see non-diagnostic quality x-rays to be the unreasonable standard-of-care, for an unfortunate subset of practitioners. Too frequently, we see very extensive patient care (multiple steel crowns, pulpotomies a/k/a baby root canals, extractions, etc.) based on non-diagnostic x-rays and a very sketchy patient treatment plan.

Missing X-Rays

This too often comes down to three possible situations, none of which are good. The doctor claims the x-rays have gone missing. Patient records are assigned a responsible custodian for ownership. In most states, this is a licensed doctor. In other states, a corporate dental service organization may be assigned ownership, and treating doctors have specific and limited rights to access patient records (Again, a dangerous situation for patient rights. Also, potential for a corporate dental provider, to blackmail employee dentists’ testimony, when the corporate model of dental practice is outside the norms of the dental industry, involving fraud as an overall business model. “If you talk doctor, we’ll throw you under the bus, just like we did with the current defendant.”).

Missing records, inclusive of dental x-rays, does not bode well for defendants in civil or criminal malpractice or fraud cases. A judge will most often make a ruling, which casts a negative inference, upon subpoenaed and non-produced discovery material. Records not produced are deemed to negatively impugn defendant(s). 

The third possibility is that the dental radiographs never existed, in the first place. Yes, billing statements were generated for dental x-rays, but these services were not provided. Extensive treatment plans and other dental services were provided, all without supportive dental x-rays. A good question for plaintiff’s attorney to ask a defendant/doctor at deposition may be, “Are you related to Superman, because you must have x-ray vision?”.

 Conclusion
Scams involving dental x-rays may be somewhat more complex, than many assume. Implications for malpractice and/or fraud go far beyond the radiographs themselves. Auditors, investigators, policy makers, legislators, leaders in organized dentistry, and the public must be alerted, to these common frauds played out in the dental industry. The crooks aren’t simply a handful of small-time dentist bunco operators. These swindles go directly to the heart of unregulated corporate America, which beneficially owns many of these disturbing dental clinics. The public interest must supersede the interests of all others, when it comes to our nation’s healthcare.


Tuesday, September 16, 2014

Mechanisms of Dental Sealant Scams

By Michael W. Davis, DDS"Dr. Michael W. Davis maintains a private dental practice in Santa Fe, NM. One day per week, he assists at a dental clinic focused on disadvantaged children and adults. Dr. Davis chairs the Santa Fe District Dental Society Peer-Review Committee. He is also an active member, in the New Mexico Dental Association House of Delegates, which drafts legislation relating to public protections in dentistry. Dr. Davis also serves as an expert witness, in dental legal cases. He may be reached at: MWDavisDDS@comcast.net

Mechanisms of Dental Sealant Scams
By: Michael W. Davis, DDS
September 16, 2014


Dental sealant scams have been a mainstay hustle, in unethical dental practices for numbers of years. The insurance industry terms this dishonest and unlawful activity, “upcoding”. It’s a highly lucrative and successful play, especially in Medicaid settings, because it costs nothing from the patient, and there’s no pain or discomfort generated. Here’s how it works.

The crooked doctor etches the tooth’s enamel surface with an acid gel, which has no dental caries (dental cavity). The tooth may or may not have a stain, which certainly doesn’t require clinical restoration (filling). Next, they place a flowable resin-composite into the tooth’s pits & grooves. This is a tooth-colored material, which lacks physical properties of strength and wear resistance. Manufactures never recommend flowable resin-composites to be used in high physical stress areas, like the chewing surfaces of teeth. Basically, the clinician has delivered the service of a dental sealant.

However, unlike a preventive service like a sealant, this “service” is billed out as a resin-composite restoration. Not only does this activity generate more billable fees, but also each surface the flowable resin-composite contacts generates additional billable fees. While a preventive dental sealant may command in the neighborhood of a $35-40 fee, a multiple surface resin-composite restoration will produce a fee ranging from $85-170. The only real limitation is the greed of the dishonest dentist.

Sometimes, the doctor may actually roughen the enamel surface, for better adhesion of the restoration (in reality, a sealant). However, because of the compromised material used, a general lack of adjusting of the patient’s occlusion (the manner in which teeth bite together), and the rush to maximize production under a challenging Medicaid fee schedule, this form of restoration has a compromised longevity. The compromised longevity is yet another moneymaker, in that these “fillings” require frequent replacement.

When I’ve audited Medicaid patient records, it’s rare to actually see any radiographic evidence of tooth decay on teeth restored like this. (On review of x-rays, there’s no indication of any prior tooth decay.)  Further, once these teeth are restored, there’s still no evidence of these restorations entering dentin (Dentin is the tooth structure under enamel, which is a qualifier for a definitive dental restoration, under most Medicaid and insurance programs).

One exception is “preventive resin restorations” (PRRs), which are not a covered service under most insurance and Medicaid plans. Under magnification, and using micro-air abrasion or a fissurotomy bur, the doctor selectively removes only the caries-affected enamel. PRRs do not command an equal fee for restorations, which enter into dentin. However, that won’t stop an unethical dentist for charging, for the more lucrative service.

A sealant scam is difficult to pull off, with private pay and dental insurance patients. Here are the reasons why.

Whether the patient (or their parents) pays the full amount, or simply a lesser-required co-payment, they have “skin in the game”. They feel a pinch in their pocketbook. If these “fillings” fail to hold up, which is virtually guaranteed, patients will complain. They may complain to the doctor, the state dental board, professional peer-review, a civil attorney, their insurance company, or their employer who purchases the dental plan. They are also highly likely to discontinue services with an unethical doctor, who provides this disservice.

By contrast, Medicaid patients have no skin-in-the-game. They pay nothing. They absolutely rejoice, when a dentist places a large “filling”, which doesn’t require Novocain (local anesthetic), and never hurts. They have no concern; this “restoration” is replaced or repaired every 2-3 years. This creates an ever-renewing financial annuity, for a crooked doctor. 

Further aiding the dishonest doctor is the abysmal to nonexistent oversight provided by Medicaid regulators. While dental insurance auditors are very well aware of this common dental scam, Medicaid auditors are generally clueless. I seriously don’t know if Medicaid auditors are mostly corrupt, lazy, or stupid. Regardless, I don’t have the time or energy, to broker fools.

So far, I’ve focused on the role played by dishonest dentists. Numbers of corporate dental clinics also play this fraudulent game on Medicaid. These dental service organizations (DSOs), which purport to limit their supervision to non-dental activities, misrepresent the reality. They are active in instructing doctors, on how to cheat the system. The private equity investors, clinic managers, and fraudster doctors all dip their collective beaks, in taxpayer largesse. This represents corporate fraud on a massive interstate level. Unfortunately, since the victims are disadvantaged Medicaid beneficiaries and US taxpayers, regulators generally sit on their hands, or hide under their desks.

In conclusion, misrepresentation of dental sealants as resin-composite fillings is not a “billing error”, as some dental crooks would have you believe. These “fillings” are often placed upon specific teeth, and surfaces of teeth, not covered under a Medicaid program for sealants. These are intentional misrepresentations to deceive the Medicaid program, for one’s financial gain at taxpayer expense. This represents violations to the Unfair Trade Acts and False Claims Acts (both state and federal), which is fraud. Fraud is not malpractice, and a doctor’s malpractice insurance generally doesn’t cover for acts of fraud. Acts of fraud often carry both civil and criminal penalties. Financial penalties are generally treble (3X) damages.

We already have state and federal legislatures, which have enacted powerful laws onto the books. The problems primarily lie with worthless regulators. They are unwilling to enforce existing laws, to protect the disadvantaged and taxpayers. Government regulators too often serve as enablers, for white-collar criminal activity.

From my perspective, I hold Medicaid auditors and regulators to equal culpability, as the actual violators. By ignoring their lawful responsibility to enforce the rule of law, regulators give criminals a tacit green light. Sadly, this green light perpetuating dental Medicaid fraud has been frozen on “go”, for many years.

Thursday, August 07, 2014

Dr. Michael Davis’ Series on Dental Scams- Parts I and II

 

Scams played on dentists: Part 1

By Michael W. Davis, DDS, DrBicuspid.com contributing writer

July 30, 2014 -- In a new three-part series, Michael W. Davis, DDS, details some of the ways dentists and dental offices are vulnerable to scams. This first part will introduce the series and discuss embezzlement and scams that are played on vulnerable employee dentists.

Dentists are played as marks for scams for several reasons. First, we are targeted because our earning potential is much higher than the general population. Traditionally, dentists have often operated in an isolationist bubble and often confer with colleagues on nonclinical matters only in unusual situations. The demanding focuses of the technical aspects of our profession often preclude us from closer examination of what may be obvious to others. We have blind spots. We are vulnerable.

Recently, courageous leaders in the dental profession such as Drs. Gordon and Rella Christensen have openly discussed embezzlement actions against them. These disclosures help dissolve any shame or guilt that other doctors/victims may carry. No one enjoys admitting they were scammed. However, open disclosures by victims help erode the smokescreen, which perpetrators depend on to pull off their scams.

Embezzlement

Embezzlement and employee theft against an owner/doctor can take many forms. The ADA estimates about a third of all dental offices will be or have been victims of embezzlement. Experts in systems management to prevent and investigate dental office embezzlement and fraud say estimates are greater than 50%. Regardless of the exact number, these risks are very real and potentially devastating to a dental practice.

The exact method of the scam can take on enough discussion to fill several volumes of books. In a common method, the office manager, who is generally valued and trusted beyond reason, pockets office receipts. These may be cash payments from patients that the office manager writes off.

Read the Rest of Part 1 on Dr. Bicuspid

 


 

Scams played on dentists: Part 2 -- Consultants and practice brokers

By Michael W. Davis, DDS, DrBicuspid.com contributing writer

August 6, 2014 -- In the second of a three-part series, Michael W. Davis, DDS, details some of the ways dentists and dental offices are vulnerable to scams. This part discusses unethical practice management consultants and practice brokers.

Who doesn't receive via email, fax, telephone, or mail a solicitation from a dental practice consultant on a weekly basis? As a young doctor, I saw many that would promise the "Million Dollar Practice." Today, those figures have grown to the $8 million, $10 million, or $12 million practice. The promises are ridiculously laughable. As the man once said, "If it seems too good to be true, it is."

A number of big-name consultants spend a great deal of time with legal actions brought forth from dissatisfied doctor clients. Using a boilerplate formula from a household name consultant has brought many a dental practice to bankruptcy or near bankruptcy. They may also have multiple endorsements from organized dentistry, which today is little more than paid advertising.

Simply because a consultant has exposure, with prolific publication of consulting articles, does not ensure his or her competency to manage the unique specifics of your dental office.

Here are some suggestions.

  1. Do a background check on former doctor clients who the consultant has served. Do they have philosophies and goals similar to yours? What were the specific objectives? Were goals met?

Read the Rest of Part II on Dr. Bicuspid

Wednesday, April 09, 2014

Praise for prosecutors: Ind. attorney general sets high standard

Praise for prosecutors: Ind. attorney general sets high standard

By Michael W. Davis, DDS, DrBicuspid.com contributing writer

April 9, 2014 -- On April 1, 2014, the Office of the Indiana Attorney General filed criminal charges against principles and employees of Anderson Dental Center. Defendants are alleged to have engaged in variety of criminal conduct, including dental Medicaid fraud, forgery of documents, money laundering, theft, corrupt business influence (racketeering), prescription drug fraud, and practicing dentistry without a license. All defendants are presumed innocent until or unless found guilty beyond a reasonable doubt by a court of law.

Several elements make this case very special. First, in the spirit of governmental full disclosure and transparency, the complete investigative report of Diane Hedges, the state investigator for the Indiana Medicaid Fraud Control Unit (MFCU), was posted on the Office of the Indiana Attorney General's website. This report and investigation, assisted by Sheila Green of the U.S. Health and Human Services Office of Inspector General (HHS-OIG) and Neal Freeman of the FBI, was exemplary in its thoroughness and detail. This type of evidence and report is the solid backbone of a criminal case for any state or federal criminal prosecutor. Good governmental investigators such as these are not paid nearly enough, nor appreciated enough by the public. Their work deserves great praise.

Too frequently, criminal charges are not brought forth in prosecution of dental Medicaid scams. Often, only civil charges are rendered, and cases are usually settled for pennies on the dollar, with no admission of guilt. Prosecutors are allowed to close a case. Nondentist owners who may be pulling all the criminal strings are rarely indicted. The crooks go back to business as usual, poor children are hurt, and taxpayers are ripped off once again. The cycle continues. Perhaps this time a chain was broken?

Read Complete Article At Dr. Bicuspid

Saturday, March 15, 2014

Interview with Gary Iocco, President, National Association of Dental Laboratories

Interview with Gary Iocco, President,
National Association of Dental Laboratories

March 2014

By: Michael W Davis, DDS

clip_image002Dr. Michael W. Davis maintains a private general practice in Santa Fe, NM. He chairs the Santa Fe District Dental Society Peer-Review Committee. Dr. Davis is active in dental care for disadvantaged citizens. His publications are on ethical issues within the dental profession, as well as numbers of clinical research papers.

 

 

clip_image003Gary Iocco is the current president of the National Association of Dental Laboratories (NADL). The NADL promotes the highest standards in the dental laboratory industry through education of its members, advancing technology, raising standards, and serving the public interest. Communication with dentists and the public is also an important role of the NADL.


NADL Website
http://www.nadl.org/home-page.cfm
National Board of Certification in Dental Laboratory Technology http:///www.nbccert.org
The Foundation for Dental Laboratory Technology
http://www.dentallabfoundation.org
NADL What’s in Your Mouth
http://www.whatsinyourmouth.us

 

Questions

Dr. Davis: Many in the general public may not know the vital role of the dental technician, within the dental team. From my perspective as a restorative dentist, a dental technician can make me look like a superstar, or a nitwit. What exactly does a dental technician do, and why is that so critical in successful clinical results for patients?

Mr. Iocco: As dental laboratory technology professionals we transform the dentists directions from the prescription or work order and create the actual treatment option that the dentist has chosen to provide their patient. Quality dental laboratory professionals employ knowledge of modern materials and available technologies to provide our dentist clients with a restoration that is consistent with the high standard of care and esthetics that our dentists expect to provide for their patients.Gary Iocco pull quote

This is only possible if there is sufficient communication and understanding and a mutual knowledge of and commitment to what is required for a quality outcome.

While good communication is always important, the more complex or involved a case is the earlier in the planning process a dentist should bring their dental laboratory technology professional into the conversation.

Highly skilled and experienced dentists will tell you that to provide the standard of care and esthetics that they seek for their patients restorations, they work closely with a quality dental laboratory.

Thursday, March 06, 2014

Analysis of ADC vs. Texas Health and Human Services Commission

Analysis of ADC vs. Texas Health and Human Services Commission

DrBicuspidBy Michael W. Davis, DDS, DrBicuspid.com contributing writer

March 6, 2014 -- Why should anyone care about a dental Medicaid ruling from an administrative law court in Travis County in Texas? One reason is that this case involves several millions of taxpayer dollars. Other similar cases brought before this court of alleged dental Medicaid fraud and abuses have and will involve taxpayer money, in excess of $100 million.image 

The vast majority of dental Medicaid fraud cases are generally resolved in settlement agreements. Alleged violators usually pay some amount of restitution to the government in exchange for no admission of wrongdoing. Often, the alleged violators return to "business as usual." We, the public and dental profession, receive little or no data on case specifics. Records of investigations are sealed upon settlement.

Public record disclosure of this particular case exposed some of the dark underbelly of the dental Medicaid industry, along with some of its nefarious inner workings.

Read the entire article on Dr. Bicuspid

Monday, February 17, 2014

Interview with Dr. Mark Malterud — Academy of General Dentistry Region-10 Trustee

 

clip_image002Interview with Dr. Mark Malterud

By Michael W. Davis, DDS | February 17, 2014

 

 

clip_image004Dr. Mark Malterud has been practicing Minimally Invasive Restorative Dentistry for over 30 years in St Paul Minnesota. He has had the opportunity to help many patients achieve excellent oral health. His passion for Dentistry has led him into involvement into Organized Dentistry where he has been Minnesota’s President of the Academy of General Dentistry and has chaired at the National level, the AGD’s Council on Dental Education and is the current Region-10 AGD Board of Trustees member. He helped get the Academy of Biomimetic Dentistry up and running and sits on the Board of the World Congress of Minimally Invasive Dentistry. As a consummate student and innovator in Dentistry he has been invited and presented lectures around North America and the World. Mark@drmalterud.com

 

INTRODUCTION

Dr. Davis: Dr. Malterud, I’m honored to bring forth this interview. You’ve done a great deal facilitating education for the dental profession, which eventually serves the public interest. Services dentistry can provide patients today is greatly advanced, from 10-20 years ago. You have personally contributed to this wonderful progress, some of which I hope to expand upon with our discussion.

 

INTERVIEW

Dr. Davis: The dental profession today is exposed to newer concepts, such as “minimally invasive dentistry”. Over time, these principles are becoming accepted into dental university curriculums and the general practice of dentistry. Please explain to the average person, what is meant by minimally invasive dentistry and how it may benefit them. Please give a few specific examples, in our rethinking of traditional treatment protocols.Mark Malterud pull quote

Dr. Malterud: I appreciate being asked to be interviewed for this column. As far as the meaning of Minimally Invasive Dentistry (MID), I can sum it up fairly easily. It is a philosophy that tooth structure is sacred and once removed it cannot be brought back. So, treat every lesion and problem from the perspective that we remove the problem (pathology) and restore it as definitively as we can with modern technology.

The reality is that whatever we place in the mouth to restore what has been lost will break down, and, in time, given enough use, will fail. However, technology, materials and techniques are constantly being developed, and, when the time comes for restorations to be replaced, we will have better materials to restore the tooth. I heard it once described as tooth banking by Dr. Ray Bertolotti and that is a good description.

Thursday, January 09, 2014

Dr. Chris Salierno: Good Dentists Can Make Bad Decisions

Interview with Dr. Chris Salierno

Dr. Michael Davis

By Michael W. Davis, DDS | January 9, 2013

 

 

Dr. Chris Salierno Introduction

Chris1

Education
Dr. Salierno received his B.S. from Muhlenberg College and his D.D.S. from SUNY Stony Brook School of Dental Medicine. He completed his formal training at Stony Brook Hospital’s General Practice Residency program where he focused on implant prosthetics. Dr. Salierno practices general dentistry in Melville, New York. 

Leadership
Early in his career Dr. Salierno served as president of the American Student Dental Association. He has continued to lend his leadership skills to serve his colleagues, as well as the public, by serving on a variety of committees that promotes enhanced professional ethics for the dental profession—including advocacy for new dentists.

His published professional papers and educational lectures have elevated quality care in dentistry. He writes and lectures internationally on a variety of subjects including, implants, occlusion, TMJ disorders, and practice management.

Much of his lecture content is available on his blog, The Curious Dentist, which also features candid discussions about everyday dentistry. Dr. Salierno is  co-editor of The Surgical-Restorative Resource, which focuses on the team approach to complex dental care. He is a past Chair of the ADA New Dentist Committee, and is currently the President of the Suffolk County Dental Society.

 

Interview Questions

Dr. Davis: Dr. Salierno, your blog, “The Curious Dentist”—directed at our Dr. Chris Salierno pull quote 2junior colleagues— is very eye opening. It is troubling to see the minefield recent dental  graduates often must navigate. Senior doctors like myself often have no idea what challenges our next generation of doctors are facing with future employers.

One example, of course, is transferring the tax burden of federal FICA taxes from the employer, to the employee dentist, therefore increasing the employer’s bottoms line. Employers habitually misclassifying “employees”, as “independent contractors”. This, of course, is illegal and in direct contradiction to well established and routinely enforced IRS Guidelines.  

We have seen employers configure employee dentist compensation, using a convoluted structure of percentage of collections or billable services which would require a doctorate degree in economics and quantum mechanics to decipher. In numbers of cases, employee dentists are not getting a fair deal. 

There is also indisputable evidence of the pressure experienced by our junior colleagues to provide high-skill services, such as molar endodontic therapy in a rapid cut-rate manner. None of this serves the best interest of the patient, nor the dental profession.

Dr. Salierno, could you please highlight a few of these problem areas for dentist employees. In fact, I’d love for you to publish a paper specific to these issues, and give a lecture to every senior dental school class, prior to graduation.

Dr. Salierno: I’ve actually participated in an initiative just like you’ve suggested. The ADA’s Success Program brings leaders into dental schools to give presentations on subjects like ethics, practice management, and career choices. Programs are offered for first through fourth year and I’m happy to say that the majority of schools take us up on it. The main message to students is that they are not alone, no matter what challenges may face them in the years to come.

The changing landscape of dental Medicaid: Part 2

By Michael W. Davis, DDS, DrBicuspid.com contributing writer
January 9, 2014 -- In the first of this two-part series, Dr. Davis explained how the present degree of dental Medicaid fraud, waste, and abuse is not sustainable and how it is slowly changing. Read that part here.

Dr. Biscupid

In reaction to the public's concern about the excessive abuse of child restraints, a number of Medicaid mills have jumped onto the conscious sedation bandwagon. The best option of treatment is to sedate in a hospital setting with IV sedation, a properly trained anesthesiologist to continually monitor the child's vital signs, with reversal medications at the ready, and the capability of nearly instantaneous airway resuscitation. Since Medicaid often doesn't pay adequately for hospital cases, the children's safety is too-often compromised.

Too often, the dentist has little-to-no advanced life support training. A child going into shock from an adverse drug reaction already has tiny blood vessels in which to attempt to stick an IV line. Their airway is small and often further compromised by enlarged tonsils, with a natural anatomy that already appears anatomically constricted and funnel-like.

I won't say it's not feasible to do this care properly, but a doctor has to deliver conscious sedation (often involving multiple drugs) and monitor all vital signs, while simultaneously roundhousing sedated children with steel crowns and pulpotomies. However, under the present Medicaid program, there are huge financial disincentives to provide this style of care properly. Corners get cut and children get harmed, too often permanently.

So, what is the fallout for the dental profession? Certainly the negative press has added a degree of distrust from the public. Trust is difficult to obtain and easily lost. And once lost, it's even more difficult to regain.

 

Read the rest of Part 2 by clicking here

Wednesday, January 08, 2014

The changing landscape of dental Medicaid: Part 1

The changing landscape of dental Medicaid: Part 1
By Michael W. Davis, DDS, DrBicuspid.com contributing writer

Dr. BiscupidJanuary 8, 2014 -- Some experts examining the Affordable Care Act (ACA) have estimated a 25% to 33% increase in eligibility. What they may miss is that enrollment eligibility for potential patients does not necessarily equate into actual patients having access to dental care. Eligibility for services is a different element than access to those services. While this makes perfect logic to small or large healthcare business owners or managers, it may be outside the comprehension abilities of Washington bureaucrats.

In 2007, the U.S. Health and Human Services Office of Inspector General (HHS-OIG) issued a troubling report, which stated 31% of reviewed dental Medicaid submissions were improper. Again, please take note of that number -- 31%!

That degree of dental Medicaid fraud, waste, and abuse is not sustainable. The taxpayer cannot and should not fund such a dysfunctional program, no matter how well intentioned. Throwing limited public money at problems of disadvantaged children with dental needs, without adequate oversight, regulation, and enforcement represents an abuse to the American taxpayer. That unfortunate reality is slowly changing

Read the entire story here

Tuesday, December 17, 2013

Interview with Dr. Jay W. Friedman

 

Interview with Dr. Jay W. Friedman

Dr. Michael Davisby: Michael Davis DDS
December 17, 2013

 

clip_image002

Dr. Jay W. Friedman has had a significant impact on the oral health of the public. His commitment to public health has spanned seven decades from the 1950s to the present. He pioneered in the development of quality standards for dental care, group practice, and dental insurance. An accomplished clinician, he has been a consultant to a number of state and national organizations. Notable are Dr. Friedman's remarkable contributions in leading the challenge against the prophylactic extraction of third molars, as well as advocating for adding dental therapists to the oral health work force. 

Dr. Friedman earned his Doctor of Dental Surgery degree from Columbia University in 1948. Subsequently, he practiced general dentistry in Farmingdale, New York from 1948-1954, including two years in the U.S. Air Force Dental Corps. In 1955, Dr. Friedman became the director of an innovative group practice dental cooperative in Seattle, Washington, which served as a prelude to his pursuit of a life in public health. He received his MPH in 1962 at the University of Michigan, followed by an NIH Fellowship. Friedman then moved to Los Angeles, California, becoming actively engaged in research, writing, consulting, and clinical practice. Between 1964 and 1977, he served as a researcher at the UCLA School of Public Health. His 1972 Guide for the Evaluation of Dental Care was distributed widely by the U.S. Public Health Service; it set the standard for monitoring dental practice. In 1974, he co-edited, with Jerge, Marshall and Schoen, Group Practice and the Future of Dental Care. In 2002, he reissued a revised edition of his Consumer Reports Book, “The Intelligent Consumer’s Complete Guide to Dental Health.” In 2012, he received the John W. Knutson Distinguished Service Award in Dental Public Health from the Oral Health Section of the American Public Health Association.

Introduction

Dr. Davis: Dr. Friedman I’m honored to interview you, both because of your work to advance public health dentistry over the years, but very specifically your efforts to reduce the routine removal of asymptomatic third molars (wisdom teeth). Extraction of these asymptomatic teeth most often generated no patient benefits. All the while, patient risks of morbidity and mortality were elevated, especially injury to the jaw nerves causing numbness of the lip and tongue, jaw fractures, post-operative infections, and the potential risks from sedation. A number of young adults faced serious clinical injury, inclusive of untimely death. Dr. Friedman, I’m not overstating, that your work to educate our dental profession actually saved many lives. In the face of your work, you were highly criticized by elements of the oral surgery community, whose potential income was threatened. Regardless, you took the high road, in advancing the dental profession, in service of the public welfare.

Interview Questions

Dr. Davis: Dr. Friedman, in recent years we’ve seen advancement of corporate owned and managed dental clinics. These private equity backed dental clinics have a fiduciary responsibility, to place the interests of shareholders to the fore, and generate profits. By contrast, doctors have both an ethical and legal responsibility, to place the patient’s interests to the fore. The conflict of interest seems obvious. Would you like to elaborate?

Dr. Friedman: It is not only excessive third molar extractions that should concern us. They are just one part of a pattern of what I call FUN (Functionally Unnecessary) treatment, which may be physically and fiscally harmful to the individual and exploitive of public funds. It applies to the whole gamut of dentistry, including unnecessary x-rays, cleanings, fillings, crowns, replacement of missing teeth, and the array of “cosmetic dentistry.” Nonetheless, I believe the majority of dentists are well-intentioned and provide care they believe is in the best interest of their patients. That they―we―are not immune to FUN treatment is due in part to deficiencies in our education and the need to generate money to pay rent, utilities, supplies, salaries, and our own income.

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Corporate owned dental clinics and private dental practices share the same objective, which is the generation of profits. In a capitalistic system, corporate shareholders benefit as if their investment produces the profit rather than the workers who perform the service. In a private practice, at least the dentist is part of the workforce. He or she may share some of the “profits” by awarding bonuses to auxiliary staff. In many private practices, the staff is given incentives to generate income and a bonus in the same manner as the corporate practice. So in that respect, I do not see a big difference between the two systems.