Showing posts with label Heartland Dental Management. Show all posts
Showing posts with label Heartland Dental Management. Show all posts

Thursday, June 25, 2015

EXCLUSIVE: Dental Service Organizations (DSO’s): Truth Revealed by Financial Insider

June 25, 2015

By: Michael W. Davis, DDS

By Michael W. Davis, DDSDr. 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, and expert legal work. His publications and lectures are on ethical and whistleblower issues within the dental profession, as well as numbers of clinical research papers. He may be contacted at:

Dr. Kevin CainDr. Kevin Cain is an Assistant Professor of Management in the James M. Hull College of Business and guest lecturer in practice management in the College of Dental Medicine at Georgia Regents University. He teaches courses on strategy and entrepreneurship and does academic research in the fields of strategic management, organizational theory, and healthcare management. He also serves on a task force with the Georgia Dental Association and teaches continuing education courses focused on the business of dentistry. Additionally, he is a co-founder and board member of several companies serving the dental industry. He earned a PhD in Business Administration at the University of Georgia, an MBA from Wake Forest University and a BA in Economics from the University of North Carolina at Chapel Hill. He can be contacted at:

Introduction from Dr. Michael Davis-

Dr. Kevin Cain has an interesting and established history in study of the dental industry, and particularly dental service organizations (DSOs). He does research and has given lectures on the risks this business model presents against the public welfare and the integrity of the dental profession. Dr. Cain effectively counters the private equity spin of unlicensed corporate managers keeping at arm’s length from clinical decisions, within the doctor/patient relationship. He confronts DSO industry misrepresentations, of which there are many, head on.


Dr. Davis: Dr. Cain, please relay the personal story of your mother, a practicing nurse, and the degradation of her once honored profession by corporate health care. How did that affect you personally and influence your fields of academic research?
Dr. Cain: My mother has been a nurse within the same healthcare organization (and its predecessor hospitals) for 40 years. Since the late 1980s, she’s seen her role increasingly shift from being a caretaker to being part of a production line. The healthcare group she works for – mind you its a not-for-profit – sets performance benchmarks for pre- and post-operative care that her and her colleagues must meet. Additionally, her organization implemented EPIC Systems as its EMR provider last year and the time it takes to document patient care further decreases the quality of care she can provide patients.Capture
She is no longer a happy nurse, and actually tried to dissuade my sister from majoring in nursing. At the center of her frustration with her company is its inability to treat patients as idiosyncratic. There are aspects of her job that, if not performed adequately, can jeopardize patient lives. However, her company pushes for efficiency and sets limits on the amount of time allocated for intake. When you generalize patients to the extent that her company has, and minimize the time nurses have to gather information about patients, it is inevitable that those nurses will miss something critical.
My mother’s frustrations with her organization have really shaped my perspective of the dental industry. She and many other healthcare professionals I have spoken with are disillusioned by the current state of their industry. The drive for growth and profitability in healthcare has superseded the drive for quality care, and I do not want to see the dental students I have the pleasure of interacting with here face the same disillusionment for their entire careers. It is imperative that the dental community protects the general dentist from becoming marginalized in the same manner as the primary care physician.
My research on the dental industry is driven, primarily, by the desire to help dentists remain clinically autonomous. In order for the dental profession to maintain its clinical autonomy, practitioners need to understand how institutional forces shape industries. In my field, we study institutional isomorphism – that organizations within an institutional environment look the same – because it helps explains how mimetic, coercive, and normative forces influence those organizations. There are currently no coercive (regulatory) forces preventing the DSO model from becoming the de facto dental model in the U.S., and there is very little normative pressure coming from private practice dentists to change that course.
With regards to mimetic forces, you have baby-boomers selling their practices to DSOs because a friend did and got more money than they would have in a private transition, and you have dental students – year after year – going to work for DSOs because they have been told that the high guaranteed salary is the quickest way to pay off student debt. Meanwhile, a few “business savvy” – or opportunistic – dentists are building their own DSOs and acquiring other practices because they see founders of the large DSOs driving twenty-five million dollar classic Ferraris and want in on that kind of wealth. These mimetic forces are shaping the industry, and the confluence of these forces is leading dentistry down a familiar path (i.e. optometry, pharmacy, primary care medicine).
Dr. Davis: We continually hear and read the misrepresentations from DSO private equity managers and their hired supporters that they keep at arm’s length from the practice of dentistry. Yet, we know they establish production quotas and bonuses upon employee dentists. Every doctor’s production metric is monitored on a daily basis. Each clinic’s bank account is swept clean, at least two to three times weekly. They determine clinic scheduling, staffing, as well as purchases for dental materials, dental laboratories, and dental equipment. State regulatory dental boards and even the Federal Trade Commission (FTC) seemingly have bought into these outlandish misrepresentations. (1) What private equity firm, whose sole responsibility is towards its shareholders and not patients, would not logically control every aspect of its business, inclusive of the practice of dentistry? (2) Why do we see so little regulatory enforcement for the unlicensed and unlawful practice of dentistry? Is it a matter of laziness, corruption, or some other factor?
Dr. Cain: The short answer is that private equity (PE) firms routinely leave control of their investments to the top management of those companies, but charge those managers with generating the best possible returns. The pressure of those expected financial returns can drive decision-making by managers of those companies, which is where you would see diffusion of pressure from top managers to the level of the organization at which revenues are generated. In the DSO model, that level is the dentist. To think that PE investments in the practice of dentistry, or the legal structure – where the DSO and the professional corporation that employs the dentists are connected only via a management service agreement (MSA) – keep DSO dentists immune to this pressure for financial returns is naïve. I would venture to guess that most dentists working for a DSO would tell you that they are not told to do certain procedures or pressured based on performance, but the psychology of seeing their production and their office’s production ranked against other associates and offices in the DSO probably provides enough of a catalyst to pressure driven, competitive individuals (generalizing here based on current crops of dental students) to alter treatment plans. That pressure might cause the best-intentioned dentists to compromise their training and ethics in order to climb rankings or achieve desired results (or bonuses). Because continuing education for DSO dentists is provided at corporate headquarters in some companies, treatment plans, labs, and materials used across the company probably begin looking very similar – and profitable – over time.

Wednesday, April 16, 2014

Herbert Salisbury, III, DMD vs. Heartland Dental: Seller Beware

So you want to sell the dental practice you worked years to establish instead of just retiring and closing the doors? Were you offered, a “too good to be true” deal by Heartland Dental, or some other Dental Practice Management organization?

Do yourself and your patients a favor and decline. Take the lesson’s learned by Dr. Salisbury and don’t be swayed with visions of riches offered by Rick Workman. Otherwise be ready to become the slave of white collar suits sitting in a Canadian board room. Why? Because you will have to hit their production goals in order to receive the your final installment payments. (Read the lawsuit below).

Wednesday, October 30, 2013

Ontario Teachers Union Pension Fund takes over My Dentist Complete Care Dentistry


My Dentist Complete logoAccording to reports, including the one at The City Wire, Heartland Dental has taken control of My Dentist Complete Care Dentistry, founded by the late Dr. Rodney Pat Steffan in Oklahoma City, OK. What reports fail to mention is who actually “controls” Heartland Dental.  That would be Ontario' Teachers Union Pension Fund.  According to Business Week, the union pension fund took over in December 2012, to the tune of $650 million.


city wire logo“Heartland Dental’s vision and values align perfectly with the principles on which Dr. Steffen founded My Dentist,” stated Kevin Offel, My Dentist president and CEO said in a statement.

That is a scary statement for any and all My Dentist patients! 

city wire logoThe My Dentist locations will continue to use the same branding and signage now used.


This is what makes it so shady and hard to determine the ownership and control of these corporate mills. 

city wire logo“Through our affiliation with Heartland Dental, I am confident we will continue operating My Dentist with the integrity and same caring heart we have always demonstrated,” Dr. Jennifer Chambers said. “I am personally excited as both a Clinical Director and a practicing dentist to carry-on the values and practices instilled in us with My Dentist while enhancing our capabilities going forward with our Heartland Dental affiliation.”

There is that word, ‘affiliation” again!  Jot down Dr. Jennifer Chambers’ name, I’m sure someone will need this information in the future.


city wire logoThe transaction is subject to certain regulatory and other approvals and is expected to be completed within 60 days. Upon completion of the transaction, My Dentist will be affiliated with a company that provides dental support services to more than 500 dental offices in 26 states.

Tuesday, December 18, 2012

Heartland Dental–Fact or Fiction–Propaganda

Anyone find it funny Heartland Dental even needed to publish this propaganda piece.

Fall 2012 – Smiling Magazine – A Heartland Dental Care Publication

Heartland - Fact or Fiction

Friday, December 07, 2012

Just saying...

The Ontario Teachers Union is to Heartland Dental as the Teamsters Union was to the Mob - bankrolling illegal business.

Actually if you think about it the DSO is modeled much like a mafia organization. They steam roll over your business, telling the people, the state agencies, the dental associations and the dentist exactly what they want to hear. But as soon as they have infiltrated, it's their way or the highway. Laws? What laws? They are the Mob.

This is the Dental Service Organization! This IS the DSO!

The DSO model mostly originated in Pueblo, Colorado; rich is mafia bloodlines and history. So what else should be expected?

Tuesday, November 06, 2012

Ontario Teachers Union Pension Plan “takes control” of Heartland Dental–Anyone Thrilled?

Wasn’t it this same union who invested heavily in some dental clinics in NY a few months ago? No, it was Ontario Municipal Employees’ Retirement System (OMERS )and GEDC Super Holdings Inc., who bought 170 Great Expressions dental clinics.

WOW, that’s two Canadian pension plans who are invested in American’s dental care to the tune of 545 dental clinics!! Is anyone concerned about this at all? Buehler?

I don’t see the words: sell, sold, bought, but rather “take control” in the Heartland take over. I’m told it is all about Heartland’s ESOP plan.

November 6, 2012

Reuters – Ontario Teachers Acquires Control of Heartland Dental

Ontario Teachers’ Pension Plan has agreed to take control of Heartland Dental Care Inc in a deal that values the US dental practice management firm at about $1.3 billion, writes Reuters. Ontario Teachers is buying a majority stake in Heartland, while founder and chief executive Rick Workman will retain a minority stake along with management and employees.

Reuters – Ontario Teachers’ Pension Plan said on Monday it has agreed to take control of Heartland Dental Care Inc in a deal that values the U.S. dental practice management firm at about $1.3 billion, according to a person familiar with the matter.

Thursday, October 25, 2012

Final Bids in for Heartland Dental

Update Thursday October 25, 2012:

Effingham Daily News:

October 25, 2012

Heartland Dental Care for sale

Bill Grimes Effingham Daily News

EFFINGHAM — While international news services are reporting that Heartland Dental Care is for sale in a potential 10-figure deal, a Heartland executive said Wednesday that no deal would affect the local presence of the dental practice management giant.

    “We want the people of Effingham to know that we are committed to Effingham,” said Chad Thompson, the company’s vice president of administration.
  Thompson declined to comment on the potential deal, but international news service Reuters reported earlier this week that private equity firms KKR & Co., Apax Partners and Madison Dearborn Partners have bid for Heartland Dental. Reuters said the sale price could reach $1.3 billion.


Tuesday, October 09, 2012

A peek under the sheets at Heartland Dental

I ran across a propaganda piece today on – about the super duper fantastic Heartland Dental Care.
It tells about Heartland Dental, in Effingham, IL and what they can do for dentists who are finding it hard to develop their own dental offices. It tells dentists, that by becoming an “affiliate” of Heartland, it can “make your career better.” Their career will be better because Heartland “will increase your creditability and reputation”. It goes on to say:

  • “Working with this company will never lead you to regret”
  • ”your office will be way better”
  • “The company will help in marketing your office, providing you qualified staff,, managing your office, advertising your services and many more.”
  • ”people consider that dentists who are working under the name of the company are all professional”
  • “it is not the company that decides how your office should work. You can decide how you run your business yourself. The company just helps you reach your dream.”
  • “if you face serious problem when running your office, the company will give you effective suggestion in how to break the problem.”
  • “you will likely to become a partner of the company”

But what really happens?

Here is what I’m told

Thursday, September 06, 2012

Is Rick Workman trying to dump his baby - Heartland Dental - before its value is zero?

Many in the industry don’t see it.  Even more are in denial about it. But it’s happening, non-the-less. Corporate Dentistry is under attack. Federal, state and local governing boards as well as law enforcement agencies are making bold moves to clean up what has been left to run amok for years. This “clean up” may be fatal. Which is fantastic for every person in America, because everyone sees the dentist at some point.

Though it may be slow and painful. Has Rick Workman finally come to gripes with that reality? I think this is a HUGE signal to all “corporate dental chains” out there. When one of the first, largest and most influential entities in the industry is ready to tuck it’s tail and run, you know it’s bad.


prhubHeartland Dental Care, Inc. Sale
September 6, 2012
Heartland Dental Care Inc., one of the largest dental practice management companies in the United States, is exploring a sale that could fetch as much as $1.4 billion, according to two people familiar with the matter, Reuters wrote Thursday. The company, in which Chicago-based private equity firm CHS Capital Partners has a stake, has hired investment banks Jefferies and Moelis to find a buyer and has drawn interest mostly from other buyout firms, the people said.
(Reuters) – Heartland Dental Care Inc, one of the largest dental practice management companies in the United States, is exploring a sale that could fetch as much as $1.4 billion, according to two people familiar with the matter.

The company, in which Chicago-based private equity firm CHS Capital Partners has a stake, has hired investment banks Jefferies and Moelis to find a buyer and has drawn interest mostly from other buyout firms, the people said.

The sources asked not to be identified because the process is not public.
Heartland Dental has about $120 million in annual earnings before interest, tax, depreciation and amortization (EBITDA) and could be sold for 10 to 12 times EBITDA, they added.

The auction is early in the second round and final bids are expected about a month from now, according to the people. Jefferies has offered to provide financing for potential buyers, they added.

Representatives for Heartland Dental, CHS Capital, Jefferies and Moelis did not immediately respond to requests for comment.


Monday, December 05, 2011

Heartland Dental, ReachOut America, Dental One, and others...

I notice a lot of folks visit this blog looking for information on Heartland dental; complaints, fraud and lawsuits.  Same with this rogue Reachout Healthcare America mobile dental setup.  If you've got something you would like to share, email here.  

Don't go nuts, this has nothing whatsoever to do with CSHM!

Friday, November 04, 2011

North Carolina Dental Board nixed Heartland Dental’s attempt to take root, taking the bull by the horns.

It looks like North Carolina is taking the lead to put an end to the corporate take over of dentistry.  Now, if they would just look into the Smile Starters agreement with Root Dental Management, and the sales agreement between Dr. Rivera and Dr. Michael DeRose another income flow to the DeRose family might be cut off. 

If you want to understand how the corporation do business, you should read this.  It lays it all out for you.

North Carolina State Board of Dental Examiners (NCBDE)


Heartland Dental Care, Inc
d/b/a Heartland Management, Inc
Gary Cameron and Associates, P.C and';
Gary L. Cameron, DDS

Case 11-CVS-2343

Heartland Dental Permanent Injunction

heartlanddentalThe NCBDE filed a complaint in Superior Court, Randolph County, North Carolina in September accusing Heartland Dental of implementing a series of transactions, contracts, documents and agreements to which Dr. Gary Cameron, DDS of Asheboro, North Carolina unlawfully transferred to Heartland Dental; Ownership, Management, Supervision and Control of his dental practice, Asheboro Dental Care..

Dr. Cameron was selling his dental practice to a corporation, “an unlicensed individual or entity.”

Heartland denied Dr. Cameron transferred ownership or management to anyone and maintained Dr. Cameron merely sold certain assets to Heartland then entered into a lawful management agreement with Heartland.

This violates North Carolina’s Dental Practice Act (N.C. Gen. Stat. 90-22) and the Management Arrangement Rule (21 N.C. Admin. Code 126X.0101).

Heartland Dental denied the allegation that Dr. Gary Cameron transferred ownership or management to anyone and maintained Dr. Cameron merely sold certain assets to Heartland Dental then entered into a lawful management agreement with Heartland.

[I’m seriously trying not to roll on the floor while laughing at Heartland’s position]

However, in 2009, Dr. Cameron hired Roger K. Hill and Company to assess and valuate his dental practice and provide him with a valuation of $2,350,800.00.  I’m not even going to get into what was likely done to make sure the the clinic had a high value.

By December 1, 2009 Dr. Cameron and Heartland agreed on a price of $2,450,000.00 PLUS the value of his accounts receivable and entered into a “Letter of Intent to Acquire Certain Assets”.  In this letter of intent it listed the “assets of the Seller” to be:

”All operating assets, leasehold improvements, office equipment, dental equipment, supplies, inventory, trade receivables, licenses, contracts,
trademarks, and other tangible and intangible property necessary to the operation of the Seller

In January 2010 Dr. Cameron established a new company called Gary Cameron and Associates, P. C. with him being the sole owner.

Friday, June 18, 2010

Heartland Dental Complaints

Things must be going to crap at Heartland Dental.  I can’t tell how many people have been to this blog using the term: Heartland Dental Complaints, including the State of Tennessee.

Heartland, whatever you’re doing, you better get it lined out, and fast.

Sunday, May 04, 2008

Warning To Dental Grads Being Wooed By Corporate Dental Companies

Be careful about how you interpret the word "guaranteed” income when being wooed by a corporate dental management company such as FORBA, Heartland or Western Dental. Read this next paragraph very carefully.

A lot of these
corporate associateship contracts are set up so that you are guaranteed a certain salary based upon a specific (and sometimes unattainable) level of production. If you don't hit that level of production, you are still "paid" that salary, but you then owe the corporation the difference between the salary and what you actually produced.

So, in many cases it may seem that you will be guaranteed big dollars right out of graduation, but often that is based upon unrealistic levels of production. They spin it as "guaranteed" because you will in fact be making that money, but you will ultimately have to pay part of it back.
Go ask a few optometrists or pharmacists how much they like the corporatization of their respective professions, and you'll hear all the reasons why every effort should be made to preserve dentistry's professional autonomy.
Then you get hooked up with a Corporate Dental Company that gets nailed for mistreatment, over treatment and over billing insurances or using a blanket DEA number for prescriptions and your once stellar reputation is tarnished forever.

All those long months, days and years spent preparing yourself for a wonderful noble career is gone down the drain in less than 6 months. Not even mentioning the enormous education debt you’ve accumulated and now you won’t be able to get a job that would earn enough wages to make your loan payments let alone live, have a family or anything else. All those dreams of a fruitful life that got you through all those years of study are gone in a flash.

Lets say you don't like the procedures they teach you at their "training camps". What are you to do, you have signed a "non compete" clause in your contract. Then what are you going to do. Talk about stuck between a rock and a hard place!

There's no altruism involved in these corporations' business decisions. Corporate mills are notorious for encouraging over treatment in order to meet production goals. If you're seriously trying to come up with a minimally acceptable treatment plan for a Medicaid patient, you're looking at sealants vs. restoring every pit & fissure in the mouth, complex direct restorations instead of pressed ceramic crowns, periodontal debridement, flippers instead of implant-supported bridges, etc.

Heartland and Western shareholders are just like the ADHP proponents in that respect--they're out for their own best interests, not the public's, but they also know saying "it's for the greater good!" is a nearly impenetrable moral shield for them to hide behind.

The moral in both cases is that dentistry needs to start being proactive about figuring out solutions to the access to care problem, instead of letting other groups seize the initiative and then trying to fend them off while backpedaling.

Some companies like Kool Smiles ask employees to sign a 'restrictive covenant for 1 or more years in a radius of 5-10 miles. This mean you might be SOL if you want to work in that area.

A portion of Small Smiles /  FORBA contract says:
...for a period of 2 years following termination, you can't provide dental services for Medicaid patients within 10 mile aerial radius of the Practice Location, or Employer's practice location on the date of termination if Employer has moved its location, or the location of any of the Employer's related practices.

Add this to the $500 a day penalty for not giving them a 90 day notice and you are just screwed!  What if you had relocated!  What now?

A Discussion on Corporate Dentistry's Workings

Click Here for the sales pitch so to speak about Heartland Dental.

Includes how it works, what cuts the docs get and Employee Stock Options.

But what I find interesting is this: (The Interesting Part, is the Investment Bank involved. They were at this site for several hours last week. Houlihan Lokey Howard & Zukin.

Anyway this is a information release concerning Employee Stock Option...

EFFINGHAM, Ill. (January 21, 2004) – Employees of Dental Health Resources, Inc. (d/b/a Heartland Dental Care, or “Heartland”) have acquired a 38.5% ownership stake in the dental practice management company. The price of the acquisition was not disclosed.

Houlihan Lokey Howard & Zukin, an international investment bank, acted as exclusive financial advisor to Heartland. Houlihan Lokey structured the transaction, designed the ESOP security and arranged the financing for the purchase.

Heartland’s newly formed Employee Stock Ownership Trust, or ESOT, purchased convertible preferred stock representing 38.5% of the ownership of Heartland using senior credit and mezzanine funding. The transaction provided liquidity for certain selling shareholders, including Dr. Richard Workman, who founded Heartland in August 1997. The unique structure of the ESOP security and transaction provides the ESOP with an annual dividend yield while providing the company with significant future tax savings.

Workman, president and chief executive officer of Heartland, said, “Everyone is extremely excited about the ESOP and what it means for our future. The employees understand they have an opportunity to have a positive impact on the dental profession. They also realize they will create an economic interest for their knowledge by helping dental practices with management responsibilities.”

“We appreciate the dedicated professionals Houlihan Lokey Howard & Zukin assembled for the ESOP. The entire transaction team should be complimented for all their hard work and professionalism,” Workman said.

Lou Paone, managing director of Houlihan Lokey’s Washington, D.C., office said the transaction is expected to generate significant value to the employee owners in future years. “Heartland and its executive management team have a very strong employee ownership orientation,” Paone said. “The ESOP transaction and implementation marries a shareholder liquidity event with the corporate goal of aligning the employees with the future direction of the firm.” The Heartland transaction represents an innovative example of the growing trend of shareholders seeking liquidity by implementing a partial ESOP buyout structure, Paone said.

Patrick Hurst, managing director and head of Houlihan Lokey’s Healthcare Group, stated, “There haven’t been many liquidity events for shareholders of dental practice management companies in recent years. The ESOP structure is a creative alternative to selling to a financial or strategic buyer, and has the added benefit of giving the employees a real economic stake in the future success of the company.”

About Dental Health Resources, Inc.
Dental Health Resources, Inc. is a privately held company headquartered in Effingham, Ill., that provides a full range of management, administrative, and financial services to dental practices in the states of Illinois, Indiana, Iowa, Kentucky, Missouri, Ohio, and Tennessee throughout cities with populations that range from 40,000 to 500,000. By providing management services to handle the business aspects of the dental practices, the company allows dentists to use their management and business skills to be responsible for certain operations of the company and to focus primarily on delivering quality patient care. Heartland also provides capital for the development, growth, and acquisition of additional dental practices.

Houlihan Lokey Howard & Zukin, an international investment bank established in 1970, provides a wide range of services, including mergers and acquisitions, financing, financial opinions and advisory services, financial restructuring, and merchant banking. In 2003, Houlihan Lokey ranked as the No. 1 M&A advisor for transactions under $200 million and the No.4 advisor for transactions under $1 billion. The firm has been the No. 1 provider of fairness opinions for the past four years and has the largest financial restructuring practice of any investment bank in the country. The firm has approximately 600 employees in nine offices in the United States and the United Kingdom. It annually serves more than 1,000 clients ranging from closely held companies to Global 500 corporations. For more information, visit Houlihan Lokey’s Website at

© 2004 Houlihan Lokey Howard & Zukin. All rights reserved.
Unauthorized duplication is prohibited.

Friday, May 02, 2008

Former Dental Management Employee Awarded $750,000 For Stepping Forward


Dental Management Companies are on notice.

A former employee was awarded $412,500 for stepping forward and exposing over billing, over treatment, and unnecessary procedures billed by Heartland Dental Management. Heartland also agreed to pay Lori Jamison another $325,000 for wrongful dismissal and attorney fees.

Lori had the courage to step forward and file a claim under the
Federal False Claims Act and Illinois' Whistleblower Reward and Protection Act.

My hat is off to Miss Lori, how about yours?

Read The Full Story Here