Nearly 100 Indiana dentists found to have questionable billing in HHS Report

 

Feds: 95 Indiana dental providers have questionable billing

Marisa Kwiatkowski, marisa.kwiatkowski@indystar.com 7:01 a.m. EST November 5, 2014

A federal report released Wednesday found questionable billing practices by 94 dentists and one oral surgeon who treat Indiana children on Medicaid.

Those providers received about $30.5 million in government funds for pediatric dental services, according to the report by the U.S. Department of Health and Human Services’ Office of Inspector General.

Federal officials did not cite specific dentists or clinics in the report, but said the findings demonstrate the need for improved oversight of pediatric dental services paid by Medicaid in Indiana.

Officials studied claims paid by Medicaid in 2012 for such dental services and focused on those who served more than 50 children.

Two-thirds of the dentists cited in the report for questionable billing worked for four dental chains. Three of those chains have been the target of state and federal investigations, according to the report.

Read the entire story here

 

 

HHS Report - Indiana Questionable Pediatric Dental Mediciad Billing November 2014

 

• Here is the March 2014 New York Report

More Casamassimo propaganda; he needs more money from Medicaid. He says the same crap year after year, and never is enough ever enough. Kinda of like a drug addict chasing the dragon isn’t it.

I’m so sick of people like Paul Casamassimo, DDS spewing his bullshit. He has a vested monetary incentive to mouth off this crap and people just keep right on publishing it. Amazing! I’m sick of him and the elites like him saying people on public assistance are no show losers. And I’m sick of him trying to say the American taxpayer should pick up the bill for doctors who have missed appointments, or empty chairs as he puts it.  Empty chairs may be a problem. Shit, don’t have 14 chairs you need to fill, Dr. Cass-ass! Think about it, you fool! BTW, are you still on the “advisory board” of that child abusing, scumbag company Small Smiles Dental?? If Cassamassimo would stop helping corporations steal Medicaid dollars to line their pockets there might be more money for us to pay for empty chairs and those missed appointments. Of course, that’s just how I see it… and I’m an idiot…so who cares what I think, right?

 

Dentists, Medicaid don't mix
Dental care for poor faces challenges of culture, funding

Marionstar.com

You're at a job interview, so smile. But if you're missing teeth, you're less likely to get hired.

Ohio's Medicaid-eligible population largely ignores dental health, dental professionals say. This means minor problems turn into big problems, which frequently end up with the dentist yanking out the problematic tooth.

Dentist admits filing false Medicaid reports | The News Journal | delawareonline.com

 

WILMINGTON — Prominent Wilmington dentist Marieve Rodriguez admitted to 10 misdemeanor counts of filing false Medicaid reports today in exchange for state prosecutors dropping 19 felony counts of health care fraud.

In addition Rodriguez, who operates Gentle Care Family Dentistry on Gilpin Avenue, will pay a $100,000 fine, repay $72,000 to the state’s Medicaid program and $50,000 to cover the costs of prosecution.

She also agreed to have her license to practice medicine suspended for a year and to not participate in the state’s Medicaid program -- should she get her license back -- for at least five years.

Shreveport dentist convicted of Medicaid fraud | Shreveporttimes | shreveporttimes.com

It’s not been a good month for dentist committing Medicaid Fraud has it?

Shreveport dentist convicted of Medicaid fraud | Shreveporttimes | shreveporttimes.com

Shreveport dentist David Earl Reed faces prison and fines after a conviction on two counts of Medicaid fraud.

Reed, 56, was barred from participating in the Medicaid program after a fraud conviction in 1992.

He continued applying to participate in the program from 2006 to 2008 and was denied. In 2009, state health officials told him he would be barred from the program for at least five more years.

However, from 2005 to 2007, Reed treated Medicaid patients while working for another Shreveport dentist. Reed submitted false billing claims to the program under the other dentist's provider number and received payment from Medicaid.

Health providers excluded from the program can't provide any services that will be billed directly or indirectly to Medicaid. It's a crime to be employed by, have a contract with or have an ownership interest in a healthcare provider that bills Medicaid, said Louisiana Attorney General Buddy Caldwell.

Reed will be sentenced April 27. He faces up to five years in prison and fines up to $20,000 on each fraud count.

Centre County Dentist Facing Insurance Fraud Charge | GantDaily.com

 

January 27, 2012 at 6:46 AM

HARRISBURG, PA – Attorney General Linda Kelly announced criminal charges have been filed against a Centre County dentist accused of submitting more than $52,000 in false insurance claims following a joint investigation with the Federal Bureau of Investigations (FBI) State College office. 

Kelly identified the defendant as Dr. Jamshid Assadinia, 53, of 1764 Cambridge Drive, State College, Centre County. Dr. Assadinia owns and operates Jamshid Assadinia DDS,300 South Allen St., State College.

Kelly said Assadinia allegedly submitted insurance claims for dental procedures that he never performed and then billed the insurance companies more than $52,000 under the names of several different patients.

USDOJ: US Attorney's Office - Eastern District of Virginia

 

Alexandria Dentist Pleads Guilty to Health Care Fraud

FOR IMMEDIATE RELEASE

January 10, 2012

ALEXANDRIA, Va. –Tuan Vu, 43, of Annandale, Va., pleaded guilty today to fraudulently billing insurance providers hundreds of thousands of dollars for dental services that he did not provide to his patients. 

            Neil H. MacBride, United States Attorney for the Eastern District of Virginia, and James W. McJunkin, Assistant Director in Charge of the FBI’s Washington Field Office, made the announcement after the plea was accepted by United States District Judge Liam O’Grady. 

            Vu was charged today by criminal information with health care fraud, and he faces a maximum penalty of 10 years in prison when he is sentenced on May 4, 2012. 

In a statement of facts filed with his plea agreement, Vu admitted to committing health care fraud from at least January 2007 to September 2011.  Vu is the owner of Cosmetic & Family Dentistry, PLLC, a dental practice located in Alexandria, Va.  During the time of his health care fraud scheme, Vu consistently billed dental insurance providers for services that he did not provide his patients.  As a result of Vu’s offense, at least 10 private insurance providers suffered more than $400,000 in losses.  Dr. Vu’s conduct also resulted in a substantial loss to the federal government and the Commonwealth of Virginia, including $87,389 to the Federal Employee Health Benefits Program and $180,048 to the Virginia Medicaid program.

            This case was investigated by the FBI’s Washington Field Office.  Assistant United States Attorney Chad Golder is prosecuting the case on behalf of the United States.

A copy of this press release may be found on the website of the United States Attorney's Office for the Eastern District of Virginia at http://www.justice.gov/usao/vae.  Related court documents and information may be found on the website of the District Court for the Eastern District of Virginia at http://www.vaed.uscourts.gov or on https://pcl.uscourts.gov.

USDOJ: US Attorney's Office - Eastern District of Virginia

The Real Cheaters

Boston Herald Monday September 26, 2011

The cheating done by food stamp recipients is peanuts compared to vendor fraud (“Life’s a beach on EBT street,” Sept. 22).

Most fraud is done by pharmacies, doctors, dentists, nursing homes, hospitals and sellers of medical equipment. The government recovered $2.5 billion in overpayments for Medicare in 2009 as the Obama administration focused attention on fraud enforcement efforts in the health industry.
Click here to read the full story
The Real Cheaters

Jim Moriarty “Only a human can practice dentistry” “No corporation is allowed to practice dentistry.”

by BYRON HARRIS
Bio | Email
WFAA
Posted on September 23, 2011 at 11:15 PM

WFAA's Byron Harris has investigated dental organizations that have charged the government millions for children's braces. Here is the latest from the on-going News 8 investigation which includes a statement from Texas attorney, Jim Moriarty. 

E-mail bharris@wfaa.com

 

Related:

• Feds investigate Texas dental Medicaid program  
• Questions surround lucrative Medicaid dental business
• Tax money for unneeded braces goes to hedge funds
• Texas taxpayers pay big for straight teeth

See all photos »

Medicare fraud strike force charges 91 individuals for approximately $295 million in false billing

 

FOR IMMEDIATE RELEASE
September 7, 2011

Contact: HHS Press Office
(202) 690-6343

Medicare fraud strike force charges 91 individuals for approximately $295 million in false billing

WASHINGTON – Attorney General Eric Holder and Health and Human Services (HHS) Secretary Kathleen Sebelius announced today that a nationwide takedown by Medicare Fraud Strike Force operations in eight cities has resulted in charges against 91 defendants, including doctors, nurses, and other medical professionals, for their alleged participation in Medicare fraud schemes involving approximately $295 million in false billing. 

Attorney General Holder and Secretary Sebelius were joined in the announcement by FBI Executive Assistant Director Shawn Henry, Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division and HHS Inspector General Daniel R. Levinson.

Medicare fraud cost taxpayers $90 Billion a year

DOJ Report To Judicial Committee–FRAUD

 

January 26, 2011

Assistant Attorney Generals Tony West and Lanny Breuer appear before the Judiciary Committee with a recap of funds recovered on behalf of the taxpayer in 2010.  You can read the full statement here.

Needless to say, Church Street Health Management f/k/a FORBA Holdings and their Small Smiles dental clinics settlement came up in the statement.  It was one year ago this month that Small Smiles settled an investigation which began in late 2007 with the Feds for $24 million, as well as settled with the state of NY for another $2 million.

Watch full session here, session begins at 28 minutes in, so move slider bar forward.

Senator Leahy says he wants to see these people go to jail, he compares it to a person who steals a car, who goes to jail.

Senator Grassley wants answers about settlements, who agreed to them and if they are nothing more than the cost of doing business.

Me too, Senator Grassley, me too!

Mr. West said when it comes to Corporate Fraud, they wanted to make it a financial deterrent for corporations committing fraud.

Sen. Leahy wanted to know what was being done to put them in jail!

Concealing Ownership? Good Idea? No

According to the List of Excluded Individuals and Entities (LEIE) it was March 2010 before William A. Mueller, DDS, one of the founders of Small Smiles Dental Centers was excluded from the Medicaid program.

It was August 2010, before Michael A. DeRose, former DDS and another co-founder of Small Smiles Dental Centers was excluded.  Why? Why did it take so long? 

However, now that each of these individual are excluded, it would be illegal for either to hide under a stack of corporations concealing their ownership and control of any clinic or facility that bills Medicaid for services.  Just saying.

Don't believe me, see NY-AG press release July 16, 2009.

So, your doing a procedure …

Dr. George C. Brain: Another Terrorist Dentist In Tacoma Washington

The state Department of Health has opened a new investigation into a Tacoma dentist accused of mistreating young patients.That action comes on the heels of an exclusive KIRO Team 7 Investigation into Dr. George C. Brain.

Children have repeatedly complained over the years that Brain choked, shoved, assaulted or grabbed them by the throat.Now, Investigative Reporter Chris Halsne pins down the Dental Board about its handling of Dr. Brain.Dr. Brain's resume includes nine police reports from kids who claim to have been assaulted during dental work.

Those resulted in a charge of assault on a child, but no criminal convictions.However, in addition, for the first time, we dig inside Dr. Brain's licensing file to discover more accusations of assaultive or threatening behavior.Pediatric dentist Dr. George Brain has been under scrutiny for professional misconduct for years.

Records at the Dental Quality Assurance Commission show seven complaints of assault, abuse or verbal threats towards children.One led to disciplinary action. A 2006 case shows a girl complained Dr. Brain choked her and pulled some teeth without permission. The board assigned Dr. Brain to a "monitoring" program and required an "anger management evaluation."Laurie Jinkins, an Assistant Secretary at the state Department of Health, oversees dental licensing complaints.She tells KIRO Team 7 Investigators, “That would not be a typical number of complaints. That is a high number and it is something that causes us concern.”Jinkins defends the state’s disciplinary process, saying Dr. Brain has been on their radar and they’re watching him.“We're concerned when any patient has a bad experience with their health care provider, but especially with kids or vulnerable people.

That makes us especially concerned because kids can't protect themselves.”Five-year-old Cameron Laducer and his sister, Courtney, are the latest kids to accuse Dr. George Brain of hurting them. A complaint, on file with the dental board this week, alleges Dr. Brain overmedicated Courtney, yanked a tooth, and filled a cavity in another tooth without parental permission.It also accuses Dr. Brain of creating scratches on Cameron's face and causing a grossly infected lip.The children’s mother, Brooke Laducer, tells KIRO Team 7 Investigative Reporter Chris Halsne, “I'm very, very angry with the State of Washington. Number one, I want to know why this man still holds a license. I want to know why he can still work on children. “Laurie Jinkins says she can't talk about the Lacuder's new complaint; it's under active investigation.

She did, however, address another of our questions.We discovered Dr. Brain made around $1.5 million last year from the state in return for treating low-income children and their families.Halsne: “Does a patient who doesn't have any money, who has to use a state welfare voucher to get that work done -- should they receive any lesser care than someone with premium insurance?”Jinkins: “Everyone in this state, no matter how rich or how poor they are, whether they have insurance or don't have insurance, they are entitled to the same level of care, the same quality of care in this state."

Dr. Brain has chosen to remain silent and is not speaking with us regarding our investigation.Others are not so quiet.Dozens of people have called and e-mailed Tuesday, wanting to tell KIRO Team 7 Investigators about their treatment inside Dr. Brain's office.If you have any concerns about his conduct or the conduct of any other dentist in Washington, the state Health Department wants to hear from you.

Click Here for Video Report, Interviews with patients, police reports and more.

Medicaid Dental Center aka Smile Starters Pays $10 Million For Medicaid Fraud

by: Mark Boone

CHARLOTTE, N.C. -- The owners of a chain of dental clinics, with offices in Charlotte, will pay more than $10 million in response to a federal investigation into alleged Medicaid fraud, the U.S. Attorney’s office said Wednesday.

The owners of the company formerly known as Medicaid Dental Center did not admit to any wrongdoing as part of the settlement, said attorney James Wyatt.

As first reported in a WCNC investigation, some parents complained they took their children to the Medicaid Dental Centers on Freedom Drive and N. Tryon Street for what they believed to be routine visits.

The Charlotte offices are now operating under the name ‘Smile Starters.’

Wyatt said the clinics are under new management.

Christy Dillbeck, a west Charlotte mother, said she was asked to wait in the lobby of a Medicaid Dental Center as a dentist placed her then-four-year-old son on a papoose board, a device used to restrain children.

The dentist then drilled into 16 of her son’s baby teeth and installed steel caps, without her knowledge, she said.

“That’s a lot, a lot of work,” Dillbeck said. “And to imagine all of the children that had to go through what my son went through, it breaks my heart to even think of it.”

At least six other families contacted WCNC with similar allegations.

In a statement issued Wednesday morning, U.S. Attorney Gretchen Shappert said Medicaid Dental Center performed “baby root canals,” which were not medically necessary.

The procedures were performed between 2001 and 2003, Shappert said.

“The dentists subjected their child patients to invasive and sometimes painful procedures, often for the sake of obtaining money from the North Carolina Medicaid program,” said Jeffrey Bucholtz, an N.C. Assistant Attorney General.

Dentists Letitia Ballance and Michael DeRose are named in the government settlement as co-owners of the Medicaid Dental Center.

Wyatt, who has represented Ballance and DeRose in both federal and state inquiries, said they are no longer working as dentists in Charlotte and are in the process of selling their North Carolina dental practice.

Federal authorities said Medicaid Dental Center and its owners will reimburse the government at least $5 million for the allegedly false claims and another $5 million in fines.

A portion of the settlement amount will be distributed to the N.C. Education Fund.

None of the settlement money will go to the parents of the children who underwent the treatment, said attorney Darren Dawson, who represents five families which are considering a lawsuit against the company formerly known as Medicaid Dental Center.

Wyatt says the clinics are under "New Management".

This blogger wants to know exactly "who" or "what company" is doing all this new management?

An educated guess would say FORBA, but this blogger has not confirmed this at all. But it is clear that Dr. Michael DeRose sold (so he says) to FORBA, and it is clearly reported that Dr. William A. Mueller, Dr. DeRoses' cohort, is associated with FORBA Dental Management, more on this below.

This same type of practice by the DeRose's and Medicaid Dental Centers and the various other names that were used, was in play as far back as 2004 in Colorado. see here.

According to various reports the DeRose's sold their interest in the Colorado dental clinics to FORBA Dental Management in 2006. Either the DeRose's and Forba are in cahoots together or Dr. Micheal DeRose and his clan just moved to another state and opened the same type of Medicaid Scam dental clinics in North Carolina.

Dr. William A. Mueller, at least at one time was in with Dr. Michael DeRose and we know that Dr. William A. Mueller and FORBA are in bed together, see here.

It's clear there is a connection between all of these dental chains. As reported in this blog in a prior post, Dr. Michael DeRose owned and operated one clinic that went under the name, Smile High in Denver that was part of the entire dental clinic chained owned by Mueller and DeRose.

From documents at the Kansas Dental Board, Dr. Michael DeRose, DDS had been sanctioned in North Carolina in December 2005.

In Sept. 2006, the Kansas Dental Board took action to enforce the North Carolina Order and another hearing is set for December 2008 to see that all conditions of his probation are met. North Carolina ordered him to show and demonstrate the use of a papoose board prior to strapping any child in one.

We also know Dr. Mueller in prior years had been sanctioned by the Tennessee Dental Board, yet in the end we find him in bed with FORBA headquarted in Nashville, Tennessee.

Dr. William A. Mueller has also been sanctioned by Oklahoma's State Dental Board. See here.

This blogger also discovered that Dr. Tu Tran, is one of the founders of Kool Smiles as reported on Kool Smiles website. see here, was the lead dentist at.... are you ready..... Smile High Dental Clinic in Denver, co-owned by Dr. Michael DeRose and Dr. William A.Mueller.

By the way, Dr. William A. Mueller it is reported here that:

Dr. Mueller was charged with gross malpractice for over-using papoose boards on children in his clinic in Memphis Tennessee.


But the Tennessee Dental Board dropped those charges against him.


However, the board voted to reprimand Mueller for false and misleading advertising in his clinic there.

When googling Dr. William A. Meuller, DMD or DDS you will find several listed, but the two that stood out to me was "Chief Of Dentistry" at the Children's Hospital in Denver, and another address at St. Jude's Children's Hospital in Memphis. There is also a review of some children toothbrushes called Kindertools, where a one Dr. William A. Mueller, DDS reviewed the product and listed himself as being: Chief of Dentistry, University Of Colorado Health Science Center. see here.

There is a clear connection between all of these Dental Clinic's.


Dr. Michael DeRose, Dr. William A. Mueller, Dr. Tu Tran - Smile High Dental Clinic


Dr. Tu Tran goes to - Kool Smiles
Dr. William Mueller - FORBA - Small Smiles
Dr. Michael DeRose - Medicaid Dental Center

One would think that Drs. DeRose and Mueller would have learned their lesson about abusing children and the medicaid system since they actually were named in connection with the death of 4 year old Jonathan Barrera in Arizona at one of their co-owned dental clinics.

The Dental Clinics and Dr. Michael DeRose were being investigated as to their practices in treating children and all the vast amount of money they were raking in as far back and 2003. see here.

Here is what Medicaid Dental Center had to say in 2003.

All of this is right on the heals of FORBA Small Smiles questionable practices in Kansas.

Dr. Michael DeRose and Letitia Ballance also have clinics under the name of Carolina Dental Center.

Congressman Dennis Kucinich Call Small Smiles a Dental Mill

Congressman Dennis Kucinich said Small Smiles?FORBA had found way to make money off poor children by creating dental mills to make a buck while blasting Medicaid for not doing more to improve dental care for children on mediciad.

"Medicaid Officials in Congress [02/14/08]"
-----------------------------------------
Small Smiles - Congress

A year after 12-year -old Deamonte Driver died of tooth decay, Medicaid officials were called before congress in February to explain what they've done to improve access to care for poor children.

Four out of five dentists refuse to treat Medicaid patients because reimbursement rates are so low. The congressman heading up the hearing blasted Medicaid for doing little to improve rates.

He pointed to the I-Team's reports on Small Smiles Dental clinics as an example of what can result.

Congressman Dennis Kucinich said "Small Smiles conceived of another away to make a profit: a
predatory mill where multiple, sometimes unnecessary procedures are imposed assembly line style on children for little regard for their welfare or proper dental practice."

Medicaid officials told congress today they are trying to make more dentists available for poor children, but conceded they have a long way to go.