Top 5 Ways Small Smiles Dental Centers has violated their Corporate Integrity Agreement

I knew they would disregard each and every word of the Corporate Integrity Agreement.  I said so right here, the very day it was announced.  As for the $24 million paid to the Federal government, and just over $2 million to the state of New York, to them it was going to be nothing more than the cost of doing business.  Pay to play-simply another business expense.  Hey, do they get to deduct that from their income tax return?

The current CSHM crew took over the operation of the Small Smiles dental clinics after they purchased all of them in the fall of 2006-actually they hired the old bunch to do it for a while. 

The arrogance shined like a beacon from the start. The investigation by the Justice Department started in the fall of 2007, just about the time Alberto Gonzales resigned.  All the while, thumbing their very long-and continually growing-nose directly at the entire United States Department of Justice, the US Attorney General and about 23 state Attorneys General and the public at large. No settlement was announced and signed until January 2010.   During which time, they didn’t slow down, skip a beat, miss a step-or any other idiom you want to use.  The child abuse and Medicaid fraud continued-business as usual. 
I originally planned to take all 65+ of the Corporate Integrity Agreement (CIA) that Church Street Health Management (CSHM)- formerly FORBA – signed in January 2010 and mark all the ways, I knew for sure, CSHM had violated said agreement.
I had not got past Section III before I was overwhelmed. No, that’s not right, I was pissed off! Why? Because of the continued arrogance.
So I decided to pick out my top five
1.  Continue with bonus program that is based on “production” or in CSHM speak, “Collections”  To this day, everyone gets bonus if they meet “collections” goals, and it gets bigger if they meet set intervals, no max they can make.  See below.  BTW the Lead Dentist gets 12.5 times the said amount.  Lead Dental Assistant gets 1.5 times set amount.

2.  They are not supposed to base any compensation that would create an atmosphere for overtreatment and fraud, i.e. no % based pay.  Well, continuing with the bonus program didn’t thumb their nose to the CIA enough, no, they created a whole new contract for new and current dentists called “Collection Based Compensation”.   It’s all set out in a 30+ page contract that most CPA’s can’t figure out.
3.  Compliance Officer is not supposed to be the Chief Financial Officer – so they put the SVP of Financial Operations, Lorri Steiner in that position.  No, she’s not the CFO, but c’mon!
4. Appoint Compliance Liaisons at each center who are not afraid to report compliance breach to the board of directors, the compliance officer or anyone else.  So, what dose CSHM do, they make the Compliance Liaison the Office Manager!  Guess who gets a nice size bonus if all things go well at the center and they make their production goals, yep, the Office Manager!!!

5.  Hire an Independent Monitor to “monitor” their misbehaving.  So what does CSHM do, they have amazing made sure that N. Sue Seale, DDS, a great buddy and colleague of their Chief Financial Officer, Steven Adair, is the “pediatric dental professional” to check in on things with the Independent Monitor.   Reports to me are Sue and Steven come to some of the centers together and are quite cozy!
There you have it, my top five.  Well, the top five I picked out in the first few pages of the CIA anyway. 

Small Smiles Dental Centers: Reporting of Adverse Events

The Corporate Integrity Agreement requires Church Street Health Management to self report what is referred to as “Reportable Events” that take place at their Small Smiles Dental Centers across the US. 
What is a “Reportable Event” as seen by Small Smiles Dental Clinics:

1. Billing that would generate more than $4000 in overbilling – Keep erroneous or any fraudulent bilking billing under that mark and they are good to go.  Is that per child?  Could also be defined as a matter that a reasonable person would consider a probable violation of civil, criminal or administrative law applicable to federal health care programs . Or a matter that a reasonable person would consider likely to render CSHM insolvent.
2. Quality of Care Reportable Event– Adverse Events (AE).  These are a bit more difficult to define, since they are in the eyes of the beholder.  Basically anything that involves a violation of the obligation to provide items or services of a quality that meets professionally recognized standards of care.  In my opinion, that would include unlocking the door to any of the now, 72 clinics. The great White Paper King, Steven Adair is making those decisions.  Not a good choice in my opinion.  What is his pay based on?   Does he get a “production” bonus too? It may be that these are only events reported that cause a Corrective Action Plan (CAP) to be initiated.  What is a CAP, you ask?  Well, it could be a simple letter of instruction to the treating dentist/staff member,  a DVD for them to watch, or further training that they decide will do.
3. Event that would cause law enforcement to be notified–  I wonder if that means local law enforcement or the Feds?  You know what I mean, a dentist punches a patient in the face or staff forges names and signatures on documents?  Could also be defined as a matter that a reasonable person would consider a probable violation of civil, criminal or administrative law applicable to federal health care programs .  Again I feel that unlocking the doors on these houses of horrors should be criminal since I promise something illegal happens in each one of them everyday.

If CSHM doesn’t correct the billing within 30 days or

Allison Luke - No longer Chief Compliance Officer at Church Street Health Management

Lorri Steiner has been with Church Street Health Management for a very long time.  I would say at least 4 years, maybe a little longer.

Up until last Friday, April 8, 2011, she has been SVP of Financial Operations.  Currently she is carrying the title of Chief Compliance Officer!

Well, at least she is going into this eyes wide open!  She's been around long enough in the financial operations to know how much they need to make each day and how to get it done.  Now, does she know how to cover it up so that it goes unnoticed?  Time will tell.

Anyone notice Lorri was put into this position just about the same time they were able to land an in house attorney, Erika Ruiz.  I'm sure Lorri and Erika can get the job done.

(By the way, there is NO Erika Ruiz listed at the Tennessee Bar Association.  There is only one Ruiz and it's not Erika when you search the Board of Professional Responsibility here )

What happened to Allison Luke, you ask?  

Allison Luke was hired in November 2008, according to Church Street Health Management's own press release, dated 11-5-2008.

Lately her job has been more of that of "fireman" putting out fires created by Small Smiles dentists, staff and corporate heads who are determined to continue on with their bad ways.  After just over a year into the Corporate Integrity Agreement you would think things would be getting a bit better, well, not so much.

Did she figure out it was a lost cause trying to maintain any kind of "Compliance" with Small Smiles Dental Centers?  

Did she get tired of stretching the truth?  Was she tired of rounding 4.2 percent to 5 when it benefited the companies appearance.  Did she tire of rounding a 3.9 to 3.0 when told to do so?

Well, maybe she will do the right thing now and spill her guts to the OIG.  Keeping crimes a secret kind of makes you guilty doesn't it?  Especially when it's you that writes that quarterly report and you sign it, Allison Luke, SVP of Compliance.

Keeping big secrets and covering up fraud will sure weigh heavy on your mind.

Lorri, do you really know what you are in for here?  Me thinks you are in way over your head and guess whose head will role when the rubber meets the road.  Yours.

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