North Carolina takes action against Dental One Partners: operating dental clinics illegally–unnecessary treatment– false diagnosis periodontal disease

Appears Dental One Partners has been doing a bit of “up selling”  or should it be put “up diagnosis”.  Court Pleadings at the end of article.

 

Published: 10:38 PM, Tue Mar 05, 2013

 

N.C. sues DentalWorks, alleges unnecessary treatments pushed, illegal ownership

By Paul Woolverton

Staff writer

State officials allege in a lawsuit that the DentalWorks dentistry chain pressured dentists and dental workers at its North Carolina locations to give patients expensive, unnecessary treatments.

The claim is part of a lawsuit the state Board of Dental Examiners filed in Wake County Superior Court on Feb. 18. It says DentalWorks illegally owns dental practices in this state - by law, only a dentist licensed in North Carolina may own a dental practice here - and therefore is illegally practicing dentistry.

A related lawsuit was filed Feb. 18 against DentalWorks by 14 dentists with DentalWorks offices, including two dentists from Cumberland County.

The allegations in both lawsuits paint a picture of patients being taken advantage of to boost profits.

They say DentalWorks used financial incentives, protocols, internal recommendations, warnings of malpractice lawsuits and other pressures to push dentists and hygienists to make diagnoses that patients had gum disease when they did not.

The patients were given unnecessary treatments, leading to excessive billing, the Dental Board says in its lawsuit and in other documents.

The dentists' lawsuit also accuses DentalWorks of pushing them to give patients unneeded veneers and ceramic crowns in order to boost revenues.

North Carolina–Crackdown on healthcare fraud laughable

Is this not ridiculous; in so many ways?!

WRAL

December 18, 2012

 

 

 

I suppose some could read this as message that they are very serious in NC when it comes to Medicaid fraud. HOWEVER, since one set of clinics in particular defrauds Medicaid more than this in an hour, it’s laughable.

Compromise Reach in North Carolina Dental Board of Examiners v Private Equity Dental Chains: NC residents lose

 

Detente reached in dental dustup

June 27, 2012 2:53 PM

Raleigh, N.C. — A high profile legislative battle -- complete with television ads and attention from federal bureaucrats -- between various groups of dentists has ended in compromise.

The North Carolina Board of Dental Examiners and the state's Dental Society had been pushing a bill that would limit dentistry management arrangements. Under those agreements, dentists affiliate with companies that handle certain aspects of their business.

Some of those agreements ceded too much power to the corporations, members of the board and society said. They worried that corporate officials based in other states would make treatment and scheduling decisions for the dentists. 

But the dental management companies and dentists allied with them said the board was interfering in private businesses. They said DMAs give younger dentists trying to open a practice and older dentists winding down their work options that lone practitioners don't have.

"The DMA organizations are going to grow," Dr. Alec Parker, executive director of the dental society, said today. "We just want to make sure their growth includes patient protections."

The House Health and Human Services Committee approved a much shorter bill than the society had originally sought. Language in early versions of the bill that would have given the dental board sweeping policy powers -- such as being able to scrutinize business records -- were not included in the compromise bill.

Existing dental board rules will be allowed to stand, but both sides agreed to create a task force that would recommend changes that would accommodate new business arrangements. 

Representatives from both sides say they expect that task force and the dental board to hammer out a revised set of rules to the liking of all parties and avoid a return trip to the General Assembly.

Over the past several months, both the dental society and the Alliance for Access to Dental Care, a group funded by dental management executives, aired hundreds of thousands of dollars worth of television ads.

Advocates fighting for the bill painted the fight as one that pitted dentists in traditional practices against big corporations funded by private equity groups more concerned with making money than providing quality care. Dental management firms hit back that old-school dentists were trying to limit competition as thousands of North Carolina residents went without affordable dental care. 

Lobbying was intense and involved well known figures in the national Republican Party such as former Florida Gov. Jeb Bush and Grover Norquist of Americans for Tax Reform. In addition, the Federal Trade Commission weighed in, saying the bill first proposed by the Dental Society would have improperly cut down on competition and consumer choice.

"The tensions between both groups will be considerably less," said Tom Fetzer, the alliance's lead lobbyist in Raleigh.

Making the negotiations even touchier was the push and pull between members of the legislature who were dentists and the stated goal of most Republicans to cut back on regulations. 

"It is in the best interest of all parties that the law be clarified," said Rep. Bert Jones, R-Rockingham, a dentist and one of the members tasked with helping both sides find consensus.

In addition to creating a task force, the bill also redefines terms in dental regulations and clarifies how and when the dental board can exercise oversight powers over dentists entering into dental management contracts.  

The full House is expected to hear the bill Wednesday afternoon.

Bloomberg’s Private Equity in Dentistry Series Gives New Meaning to “Drill Baby Drill” for 2012 Republican Campaign

May 16, 2012
By Sydney P. Freedberg

Dental Abuse Seen Driven by Private Equity Investments

May 30, 2012
Republicans Target Dental Bill That Private Equity Hates
By Sydney P. Freedberg and Jason Kelly - May 30, 2012 11:01 PM CT

The likes of Jeb Bush, William Frist, Tommy Thompson and Haley Barbour aren’t typically heard from in the office of Thom Tillis, the Speaker of the North Carolina House of Representatives.

Yet the four Republican Party stalwarts, none of them a Carolina resident, have contacted Tillis’s office over a little- known bill to toughen state regulation of dental companies. They’ve been joined by Grover Norquist, the Tea Party favorite and anti-tax crusader who heads the Washington, D.C.-based Americans for Tax Reform.

“It’s not terribly common to have these types of names” intervening on a state bill, said Jordan Shaw, a spokesman for Tillis.

Their interest marks the Tar Heel State as the front line in a national struggle over dental management companies. Fueled by Wall Street money, at least six such firms are under scrutiny by two U.S. senators and authorities in five states over allegations that they soak taxpayers through excessive Medicaid billings, abuse patients via needless treatments and run afoul of laws that say only licensed dentists can practice dentistry.

READ the entire article on BLOOMBERG

North Carolina HB 655–The story of the campaign ads and commentary

 Yes, this is a repost but last time I didn’t have time to comment, today I made time. The people of North Carolina need our support to pass HB 655, this is my part.

Dentists take battle over regulations to the public WRAL -TV

Posted: April 12
Updated: April 13
One commercial warns that "out-of-state special interests" are going to put your local dentist out of business. Another 30-second spot says viewers should be concerned about "powerful lobbyists" pushing a bill that will close your local dental practice.
Given the similar style and claims, viewers might think the same group is behind both ads. But the 30-second spots actually come from different groups of dentists battling over how North Carolina regulates their profession. A legislative proposal likely to be heard this May would restrict contacts dentists can forge with dental service organizations. 

The legislature of North Carolina has the opportunity to cure this cancer before it metastasizes and before they end up in the exact situation Texas has now found it’s self-which is run over by corporate dental clinics. Many of which are stealing every penny they can from the not only the taxpayers of Texas, but yours as well.  I’m talking about the Medicaid system – 1/2 paid for from state funds and 1/2 paid for by federal funds. You want a good look at North Carolina's future, see the Recent Hearings in Texas dated April 11, 2012. Or read this from the hearing: Texas Dental Board Accused of Ineptitude

"The North Carolina Dental Board has denied my patients what I feel is the best dental care," said Dr. Gary Cameron, an Asheboro dentist who faced state sanctions after affiliating with an Illinois company. His case helped spark the push for the new law. 

Dr. Gary Cameron is either stupid, brainwashed, or being paid very handsomely by Private Equity firms for him to say such things, in my opinion. They only thing being denied is poor care, dental care based on corporate bottom lines not treatment needed, and his personal bank account. Ask yourself why Dr. Cameron was sanctioned. It was because he and Heartland Dental tried to skirt the laws already on the books in North Carolina. The laws are clear! Check them here.

Seven Years After First Reports–Dr. Tish Ballance Appears To Still Be Raping Medicaid System in North Carolina

WCNC TV-Stuart Watson's January 2010 report

Link to report

It has been seven years after Stuart Watson first reported on Doctors Tish Balance and Michael DeRose and their chain of dental clinics in North Carolina abusing children for financial gain.  It has been two and a half years since Tish and Meatball Mike settled with the government for $10 million dollars, yet Dr. Tish appears to still be doing her best to rape the medicaid system and abuse children doing it.
Who in North Carolina is NOT doing their job and protecting the children??  Who in North Carolina is turning a blind eye to Tish Ballance stealing your/our tax dollars? 
That is what is happening.  It has been reported right here for three years.  I know the agencies visit this blog.  I'm waiting on an answer.
What is the reason Dr. Tish Ballance is still allowed to steal money from us?  Why is she not been put on the "Exclusion" list; barred from participating in the Medicaid programs?   Meatball Mike finally made it, but not until 2009 and millions and millions of dollars later.
(of course we know there are ways around that little inconvenience don't we)
Here is a warning I received today from a parent:

I live in Hickory, NC.  I had heard about Tish Ballance on the news getting in trouble for Medicaid fraud, but did not remember her name. My son is 6. He went recently for a cleaning to a different dentist and they found a cavity. While I was waiting for his appointment, they did a free screening at his school which also detected a single cavity. When it came time to be filled, our dentist wanted to refer him to another dentist 30 miles away. i decided to find a local dentist that took Medicaid. i found Carolina West Dentist in Conover near my home. I took him there to Tish Ballance's new clinic for children with Medicaid. Just 2 weeks after 2 dentists had diagnosed him with a single cavity, she said he needed caps on 3 molars in addition to the cavity. That's when I checked into her office and found out she had been in trouble before. Beware of this office!!!

Related:
December 2009 Report on Dr. Tish and her horror house

Smiles Starters North Carolina Still Delivering Overtreatment to the Underserved via Elysa Bailey de Morias, DDS

Thousands of complaints made on Internet "message" and "review" boards.

Hundreds of legitimate complaints filed. 

At least 8 lawsuits.

Ten Million dollars ($10M) in restitution to the government for fraud. 

Under observation since 2003. 

Under my watchful eye since 2007.

Name changes of the facilities.

North Carolina State Board of Dental Examiners spending hundreds of hours reviewing complaints on former owners, current owners, past employees, current employees. 

Warning after warning issued, Consent Orders for Disciplinary Actions passed out like programs at a school play.

Surprise inspections from state and federal agencies.

It is almost October 2010 and we still we have Elysa Bailey de Morias, DDS.

Elysa may well be a very nice person, there are a lot of people who are stupid and/or crooks. 

 Here is the Compliant and Consent Order for Dr. DeMorias

Highlights

Practicing at Smiles Starters in Greensboro, North Carolina

A three year old girl was seen by Dr. Elysa on November 3, 2008, we will call the child HW.

Dr. Elysa “was unable to conduct an adequate visual clinical exam or take sufficient radiographs to support her treatment plan.

Dr. Elysa decided to develop a treatment plan anyway that consisted of restoration of 6 of HW’s teeth, “with possible stainless steel crowns on three of her teeth.”

Dr. Elysa placed “watches” on six of HW’s other teeth. That should be about all the three year old had in her mouth. Looks like Dr. Elysa was going to get at least ½ of them.

HW’s mother felt this was not right and took her child to a second dentist the very same month.

The second dentist wasn’t able to perform a through examination on HW.

In June 2009, 7 months later, HW’s mom took her to the second opinion dentist again who then was able to perform a full and comprehensive assessment.

All the second dentist found, 7 months after Elysa de Morias of Smile Starters saw this child, was a discoloration on tooth A and a minor fracture in the enamel of tooth N. He found NO decay on ANY of the teeth Dr. Elysa de Morias has supposedly found 7 months earlier.

In November 2009, more than a year after Dr. Elysa de Morias wanted to drill away and put stainless steel crowns on 6 of HW’s teeth, HW was seen by yet a third dentist. Dentist three found the very beginning decay on tooth A which he felt probably was not there a year earlier when Dr. Elysa laid claim to a mouth full of restoration needed, but found no other tooth problems what so ever.

All the Board nailed Dr. Elysa for was “violating the standard of care for dentists licensed to practice dentistry in North Carolina by proposing a definitive treatment plan without having conducted an adequate clinical examination and sufficient radiographs.”

Dr. Elysa de Morias agreed that there was sufficient evidence against her, but did not admit any wrong doing but decided not to oppose the allegations and agreed to whatever the Board decided to hand out as punishment.

Elysa Bailey de Morias, DDS has her dental license suspended for 30 days. For the next 2 years she must:

Not do that anymore

Not direct her employees to do that anymore

Allow random inspections and interviews

Complete continuing education designed especially for her at the North Carolina School of Dentistry

Reimburse the board $650.00 for their time and trouble.

Have her name reported to the National Practitioner Data Bank (which is no big deal these days).  Former owner and rumored to be current financier, Dr. Michael DeRose was put on that list many years ago and kept his licenses until 2009!  As did his partner in crime, Dr. Tish Ballance-she is still practicing.

Dr. Elysa Bailey de Morias has been in operation in North Carolina since September 2007!  Imagine the number of underserved she has overserved.

The Possibilities

I'm sure I've missed some billing codes and this isn't exact, but it sure is close.

North Carolina Reimbursement rates:

D0150 – Comp oral evaluation - $44.61
D1120 Prophylaxis (aka cleaning)- $27.21
D0210 Intraoral-complete series w/bitewings $71.79
D1203 Fluoride $16.04
D3220 Therapeutic pulpotomy - $81.09
D3220 Therapeutic pulpotomy - $81.09
D3220 Therapeutic pulpotomy - $81.09
D3220 Therapeutic pulpotomy - $81.09
D3220 Therapeutic pulpotomy - $81.09
D3220 Therapeutic pulpotomy - $81.09
D2950 Core Buildup, including pins $98.25
D2950 Core Buildup, including pins $98.25
D2950 Core Buildup, including pins $98.25
D2950 Core Buildup, including pins $98.25
D2950 Core Buildup, including pins $98.25
D2950 Core Buildup, including pins $98.25
D2950 Core Buildup, including pins $98.25
D2930 Prefab stainless steel crowns –primary tooth $144.28
D2930 Prefab stainless steel crowns –primary tooth $144.28
D2930 Prefab stainless steel crowns –primary tooth $144.28
D2930 Prefab stainless steel crowns –primary tooth $144.28
D2930 Prefab stainless steel crowns –primary tooth $144.28
D2930 Prefab stainless steel crowns –primary tooth $144.28
D2940 Sedative filling $39.77
D2940 Sedative filling $39.77
D2940 Sedative filling $39.77
D2940 Sedative filling $39.77
D2940 Sedative filling $39.77
D2940 Sedative filling $39.77

Total - $2339.99

If the procedures was upcoded to the D3230/D3240 it would be an additional $50 per tooth totaling just over $2600.00.

It's not uncommon to upcode the pulpotomies (D3220) to pulpal therapy (D3230/D3240).

D3220 - Pulpotomies are performed on vital teeth, while pulpal therapy (D3230/D3240) is performed on necrotic primary teeth, with resorbable medicament placed down the canals.

Conclusion

The only conclusion I can come to is Dr. Elysa de Morias  unnecessarily tortures and mutilates children, defrauds the medicaid system and got caught this one time. 

However, all that happened was a slap on the greedy little hand and back to work. 

Nothing was mentioned about the full extent of her attempts, just the actions; “violating the standard of care for dentists licensed to practice dentistry in North Carolina by proposing a definitive treatment plan without having conducted an adequate clinical examination and sufficient radiographs.

Questions

As with all of these cases, we have to ask what caused a person who spent thousands of dollars for her education to attempt not only fraud, but needless suffering of a 3 year old child, and to do it as casually as taking her next breath.

How many patients does she see in a week, a month, that she tries and succeeds in this exact scam?

Why are dentist caught doing this not prosecuted?  Doing an investigation, slapping a seeming large fine on them, but letting them keep right on is doing nothing to stop it.  So I have to assume the powers that be support.

Why do support staff not report this? 

Does it make those in the office who turn their head just as guilty?

North Carolina Board of Dentistry Wants To Hear From You.... really?

The North Carolina State Board of Dental Examiners is holding a public hearing at it's office at 507 Airport Blvd, Ste 105, Morrisville, North Carolina.  The meeting will take place this Thursday, June 17, at 7 PM.  

Written comment from the public will be accepted through August 8, 2010 and can be sent to the board at the address above.  They don't seem to offer an email address.

The meeting  is to consider the following amendment to rule:
 

21 NCAC 16F.0103 CORPORATE OR LIMITED LIABILITY COMPANY NAME(the strikethrough is to be deleted and the underlined to be added to the rule)

Corporation or limited liability company designations shall consist only of the use of the words "Professional
Association," "P.A.", "Professional Corporation," or "P.C." for professional corporations and "Professional Limited Liability Company", or "P.L.L.C." for professional limited liability companies. All names shall also contain only the name or surname of one or more of the shareholders or members and may include the word "Associate(s)." the words “Associate(s)”, “D.D.S,.” “D.M.D.” and the geographic location of the company, provided that the company name may not be false, deceptive or misleading.
History Note: Authority G.S. 55B-5; 57C-2-01; 57C-2-30; 90-48;E
Eff. September 3, 1976;
Readopted Eff. September 26, 1977;
Amended Eff. August 1, 2010; August 1, 2009; August 1, 2002; April 1, 1994; May 1, 1989.

It can be seen here.

Seems to me the only people who would object to the, still very liberal verbiage, would be the crooks.  However I believe the language could be much tighter.  Adding some name of a North Carolina licensed dentist, the last name of a shareholder or member of the PLLC and a location clears nothing up.  Am I wrong?  For example, FORBA's Small Smiles clinics in Ohio alone are listed as follows: 

SMALL SMILES DENTAL CENTER OF COLUMBUS, LLC - JODI KUHN, DDS AND OLIVIA CROOM, DDS  with a Trade Name of Small Smiles Dental Centers of Columbus.  You pick the city then add the two names and file a DBA (doing business as) or a Trade Name, as it's called in some states and you still don't have a clue who your dentist is, who is going to treat you, or whose name will end up on the billing.

This is EXTREMELY misleading.  Why, well because Olivia Croom, DDS is listed on various dental plan sites as working in Farmington, MI, Mishawak, IN, and Dayton, OH.  In fact her name didn't even show up of state corporate filings until February, 2010, just four months ago.  Until then it was Jodi Kuhn and Patricia Nicklas, DDS and before that it was Kenneth Knott and Robert Andrus, and they NEVER treated one patient in OHIO.  

Here you can see when it was SSDC of C, LLC Kenneth Knott and Robert Andrus the phone book ad looked as though you would be making an appointment with either of the above dentists, but you would be dead wrong!   By the way, these clinics have changed their legal name 4 times in 6 years. 

 Let's look at the clinics in North Carolina that Michael DeRose and Tish Ballance owned and operated under the name Medicaid Dental Centers then changed it's name to Smile Starters.

Everyone thinks good ole Michael Anthony DeRose was ran out of North Carolina on a rail, well they too would be wrong.  He's alive and active in North Carolina.  As recently as September last year (2009) he changed the name of one of the companies.  (yes, I said one)  He changed Michael Anthony DeRose, DDS, PA to Michael Anthony DeRose, Inc.  (I suppose the DDS had to go after Colorado finally got off their asses and revoked his licenses).  

When Michael changed the name to Michael Anthony DeRose, INC he also amended the Articles of Incorporation to read to a Chapter 55B General Status and the nature of the Michael Anthony DeRose, Inc to: GENERAL BUSINESS MARKETING & CONSULTING.  (yes, his marketing ideas and advice is exactly what the dentists ordered!)

  

 HOWEVER, on October 6, 2009, the North Carolina Department of Revenue had other ideas for Michael Anthony DeRose, INC. and put the business was on suspension for violating N.C.G.S. 105-230 (a).  (he owes them money).  The suspension notices mentioned that once this was corrected they would remove the suspension.  It's hard to tell, but I believe everything was set straight with the Department of Revenue since it's status is Current-Active-Multiple.

 

But wait!  There's more!  Yes!  Ballance & DeRose, DDS, PA is Current-Active as well.  That's right, these two are still hooked up it appears.   Wanna take a guess where the current address is...  awe...c'mon...  YES!  2211 Executive Drive, Charlotte, NC  28201.  Not sure why, but one Incorporators name was left off the name of the company, his name- Robert D. Hinshaw, 185 Kimel Park Drive, Ste 200, Winston-Salem, NC  27103, he's an attorney.  But shouldn't he have been held as responsible for the actions of Ballance & DeRose, DDS, PA?   Just saying....

Ballance & DeRose, DDS, PA's Professional Service is -Dental Services.  So under the proposed change to North Carolina's rules, what would Mike, Tish and Robert do?

Well, the name contains the name or surname of one or more of the shareholders or members, it's a PA (professional association), so they are good there.  Since they are allowed to use "Associates" or "DDS" or DMD" in the name, that would be ok too, Tish Ballance is still licensed but they could always drop that and use Associates.  The only issue then is the location.   Well, all they have to do is add "of Charlotte" or "of Asheville" or "of Fayetteville" or "of Winston-Salem" or "of Greensboro" or "of Raleigh".  Then file the DBA as they do in Ohio and you still get Smile Starters and it clears nothing up and is still misleading.

If they are worried about something being 'misleading' they should look at the decor and advertising these places do that makes parents feel they are seeing pediatric dentists when they are in fact seeing someone who doesn't deserve to be called a dentist at all!

I know some are going to scream, oh no, Dr. Rafael Rivera, Jr. owns these clinics, and I say Bull!  He's just started his own PLLC (Professional Limited Liability Company) and contacts his services to these clinics...or something close to that.  

Root Dental Management is also alive, current and active in North Carolina, address is still the Executive St address in Charlotte.   Ryan P. Root filed his annual report in March 2010, wonder if Roger Walters is still on board there?  Ryan P. Root's address on the annual report is PO Box 816, PUEBLO, COLORADO.

So after looking at this, the only thing I see that improves the 'rule' is for the State of North Carolina Department of Revenue.  More filing fees for each location of each of the 'clinics', tax returns for each individual clinic as a separate business...

I don't see what the point is to add the geographic location of each clinic, if it doesn't matter whether the dentist who provide the services there are not necessarily on the ones on the state corporate filings, heck they may well not even live in the state!  

C'mon North Carolina Board of Dentistry, you can do better, children are being abused, medicaid is being defrauded and children are dying.

Where am I wrong here?