Showing posts with label Texas Medicaid Dental Spending Gone Wild. Show all posts
Showing posts with label Texas Medicaid Dental Spending Gone Wild. Show all posts

Friday, May 09, 2014

Texas v. Xerox in connection with massive dental fraud in the state

 

FOR IMMEDIATE RELEASE
May 8, 2014
www.texasattorneygeneral.gov

State of Texas Files Legal Action to Recover Fraudulent Medicaid Payments from Xerox

State of Texas Files Legal Action to Recover Fraudulent Medicaid Payments from Xerox

AUSTIN – The Texas Attorney General’s Office today filed a civil lawsuit in state district court against Xerox Corporation and its wholly owned subsidiary, ACS State Healthcare LLC. The State’s legal action seeks to recover fraudulent Medicaid payments for orthodontic and dental services that were improperly approved by Xerox.

Since 2003, Xerox has served as the vendor responsible for reviewing dental and orthodontic claims submitted to the Medicaid program. Under state law, orthodontic services are not generally eligible for coverage under the Medicaid program. Only the most acute cases where orthodontic disfigurement poses a health risk to a patient are eligible for Medicaid coverage; the Medicaid program does not cover cosmetic orthodontics. The State’s lawsuit seeks to recover Medicaid payments that Xerox approved for orthodontic services that were not medically necessary and therefore not authorized by law.

Texas Attorney General's lawsuit against Xerox Corporation and ACS State Healthcare LLC

Today’s legal action reflects the culmination of a lengthy multi-agency investigation into orthodontic Medicaid fraud. In June of 2012, the Attorney General’s Office, together with the Texas Health & Human Services Commission (HHSC) and the HHSC-Office of Inspector General formed a dental and orthodontic fraud task force to investigate fraudulent overbilling by dental and orthodontic Medicaid providers. One of the results of the task force’s investigation was the discovery that Xerox had not been properly reviewing orthodontic claims as required by its contract with the State. Further, the task force uncovered evidence revealing that Xerox systemically approved orthodontic claims that were not authorized by state law.

The State’s law enforcement action is seeking injunctive relief, civil penalties and restitution of overpayments made by the Medicaid program as a result of Xerox’s unlawful conduct.

CONTACT
Press Office at
(512) 463-2050

Tuesday, April 09, 2013

Dr. Michael Goodwin gets 50 months in prison

CP orthodontist gets 50 months in Medicaid fraud scheme

An Amarillo orthodontist has been sentenced to more than four years in prison for health care fraud.

Dr. Michael David Goodwin was sentenced Tuesday to 50 months in federal prison and ordered to pay more than $1.8 million in restitution.

The 63-year-old Goodwin pleaded guilty in December 2012 to one count of health care fraud related to the Texas Medicaid program.

Court documents show that Goodwin devised a scheme to defraud the Texas Medicaid program by billing the program for more than $2.6 million for services which he claimed to provide, but were either not medically necessary, or were provided by dental assistants.

Saturday, December 29, 2012

New DSO Regulations on tap for Texas–Batter up!

dbcTexas legislators to consider new DSO regulations

By Donna Domino, Features Editor

December 28, 2012 -- Dental service organizations (DSOs) in Texas would be subject to greater oversight under a bill being introduced by a Texas legislator who accused the groups of "outrageous actions" involving unnecessary pediatric procedures.

SB 151 is designed to "strengthen the Texas State Board of Dental Examiners' ability to ensure that dental treatment is directed solely by licensed dentists, not by corporate entities." The measure would also require DSOs to register with the board and prohibits them from "interfering with dentists' treatment decisions."

“These types of entities have been involved in some of the illegal and, quite candidly, outrageous actions.”

— Sen. Jane Nelson

The bill was prefiled on December 21 by Sen. Jane Nelson (R-Flower Mound) in advance of the 83rd Regular Session of the Texas Legislature, which reconvenes on January 8. It would require DSOs to register with the state dental board, and it also would allow the dental board to impose administrative penalties and disciplinary actions against DSOs that violate the Texas Dental Practice Act. Similar to in many states, the law states that only licensed dentists can own and operate dental clinics.

Currently, DSOs in Texas are not subject to any state regulation, Nelson noted.

"We need to ensure that these organizations are accountable to the board and, more importantly, that they are not substituting their judgment for that of our trained, licensed dentists," Nelson said in a statement.

Read the entire story at Dr. Bicuspid

Related:

Dental Patient Protection SB 151

Dental Patient Protection: SB 151 strengthens the Texas State Board of Dental Examiners' ability to ensure that dental treatment is directed solely by licensed dentists, not by corporate entities. It requires dental service organizations (DSOs) to register with the Board and prohibits them from interfering with dentists' treatment decisions. It also allows the Board to impose administrative penalties and take disciplinary action against a DSO found in violation of the Texas Dental Practice Act. Before performing dental treatment on a child, SB 151 requires that a dentist inform the child's parent or guardian that they have the option to be present in the treatment room, and it prohibits a dentist from performing the dental treatment or procedure without the parent or guardian present if they desire to be in the treatment room. Currently, DSOs are not subject to any state regulation. "We need to ensure that these organizations are accountable to the Board and, more importantly, that they are not substituting their judgment for that of our trained, licensed dentists. No child should undergo complicated, painful procedures without a parent being involved at every point in the process. These types of entities have been involved in some of the illegal and, quite candidly, outrageous actions involving the enticement of children to undergo costly and oftentimes unnecessary procedures at the taxpayer's expense."

Senator Jane Nelson
P.O. Box 12068, State Capitol
Austin, Texas 78711
Tel. (512) 463-0112
Fax (512) 463-0923

Thursday, October 18, 2012

Texas expands Medicaid dental fraud estimates to $154 million

 

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by BYRON HARRIS Bio | Email WFAA-TV Posted on October 17, 2012 at 10:03 PM Updated today at 12:01 PM Story

NEWS 8 INVESTIGATES

WFAATexas Medicaid dental expenditures quadrupled in recent years, from $400 million in 2006 to $1.43 billion in 2011. The Office of Inspector General is now tracking more than $383 million of potential fraud and overpayment, it told a Texas House of Representatives committee.

In a House hearing on Monday, News 8's investigations of Medicaid dental fraud were praised by state representatives. "I have to tip my hat to WFAA in Dallas for doing what they've done," said Rep. Lois Kolkhorst (R-Brenham), chairwoman of the Public Health Committee.

The state has suspended payments to 26 orthodontic organizations under a policy called Credible Allegation of Fraud (CAF). The state can hold money back from Medicaid providers if it suspects it was billed fraudulently. Texas estimates that $229 million in Medicaid payments to put braces on kids' teeth may have been improper.

Audits show as many as nine out of 10 payments may have been fraudulent. For general dentistry, more than $154 million may have been overpaid. Expert analysis shows half the bills checked were erroneous. Eighty-nine dental providers have had payments withheld under CAF.

The OIG told a the public health committee of the Texas House that more manpower, more interest in fraud, and improved software are helping catch more fraud going forward. E-mail 

E-mail bharris@wfaa.com

Thursday, October 11, 2012

Texas Task Force Hunting Down Medicaid Dental Fraudsters

Texas finally appears serious about the state’s extraordinary Medicaid dental fraud. Hopefully indictments will soon be coming. I hear at least one bunch of merry bandits, are locking doors on some of their clinics and owners are scurrying like the nasty rats they are.

tribune

 

 

 

Joint Task Force Tackles Medicaid Dental Fraud

by Becca Aaronson October 10, 2012

Through a new joint task force, the Texas attorney general’s office and the office of the Inspector General at the Health and Human Services Commission have teamed up to strengthen investigations of fraud and abuse in the state’s Medicaid dental program for children. And because the task force allows the agencies to coordinate limited resources, state officials say, the state can advance investigations and recover misused taxpayer funds more quickly. 

“The Medicaid and orthodontic fraud task force was convened to ensure the state had a comprehensive and coordinated response to a dramatic uptick in fraud by Medicaid providers,” said Daniel Hodge, the first assistant for Attorney General Greg Abbott. “The highest levels of all affected agencies and divisions are actively involved in advancing the investigation as efficiently and effectively as possible."

John Scott, the deputy attorney general for enforcement litigation, chairs the task force, which also includes officials from the Medicaid Fraud Control Unit and Civil Medicaid Fraud Unit at the AG's office, and officials from the inspector general and other departments of the HHSC.

In 2010, Texas spent as much on orthodontic services as every other state combined, according to a report released in April by the U.S. House Committee on Oversight and Government Reform. "The state has admitted that widespread fraud was occurring and that the organization the state hired to assess prior authorization forms was essentially rubber stamping forms for approval," the report states. An orthodontist consulted by the inspector general's office at HHSC estimated that 95 percent of approved claims should have been denied, according to the report.

State officials said the task force, which was created this year, allows the agencies to take advantage of what each group brings to the table. For example, the inspector general’s office has software to monitor whether a provider’s claims data looks suspicious and can put payment holds on providers it suspects are committing fraud. And the AG has teams of lawyers from the two Medicaid fraud units who follow through on investigations, subpoena records and press charges. 

The state is also getting an assist from whistleblowers like Dr. Morna Staffel, a pediatric dentist in Fort Worth, who said she has stacks of evidence — in the form of patient records — of children being overtreated and, in effect, abused by dental clinics seeking to profit off the state’s dental program for low-income children.

On Monday, for example, she had to remove six teeth in a child’s mouth that had abscessed less than six months after Medicaid paid for the child to be treated at a nearby dental clinic. “When I see this type of situation, I’m pulling patient records, I’m keeping patient records, I’m calling the [Office of the Inspector General],” said Staffel.

Evidence turned over to the state by whistleblowers is filed under seal. And state officials cannot disclose how many investigations they are currently pursuing. But one provider, All Smiles, which was the focus of a WFAA-TV report in October that brought the allegations of fraud into the national spotlight, appears to be in their crosshairs.

State authorities familiar with the task force’s investigations said the group is committed to recovering all taxpayer funds lost to dental fraud, from both dental providers and the Texas Medicaid and Healthcare Partnership, which was responsible for evaluating the medical necessity of dental claims and approving payment.

The state audited TMHP’s process for evaluating dental claims in 2008 and recommended that the contractor increase the number of licensed dental professionals reviewing orthodontia claims, according to a State Office of Administrative Hearings report related to a recent allegation of Medicaid dental fraud. “TMHP responded to the audit’s recommendation by saying that an increase in the use of dental professionals would require a change in TMHP’s contract, which did not occur,” the report states. 

TMHP recently renewed its state contract, and state officials familiar with the investigations said they plan to work with the company on negotiations to recover state funds lost to medically unnecessary claims.

In an email to The Texas Tribune, Ken Ericson, a spokesman for TMHP, said, “Several providers are under state attorney general investigation — and we are cooperating with that investigation.”

Most of the rise in Medicaid dental claims was probably legitimate, said Stephanie Goodman, spokeswoman for HHSC, because the state had increased reimbursement rates by 50 percent to expand access to care. “Those other factors kind of masked the fact that there was also probably an increase of bad actors in the program,” she said.

Texas became a target for dental fraud after 2007, when the Legislature allotted an additional $1.8 million for Medicaid children’s dental services, as part of a legal settlement to increase access to care.

State authorities familiar with the task force's investigations confirmed it has found that some dental clinics have illegally solicited Medicaid patients by standing outside large retailers and grocery stores and handing out gift cards in exchange for signing up for a free dental exam. And the inspector general recently issued a statement that said, “Offering inducements to Medicaid clients is a violation of state and federal law and is subject to a penalty of up to $10,000 per violation.”

As the Tribune reported in July, the crackdown on orthodontic fraud has left many patients with untended braces, and a difficult transition to Medicaid managed care has exacerbated problems with access to care. The state is currently severing ties with Delta Dental, one of three Medicaid managed care plans, in part because state officials said the company failed to establish a computer system for providers to submit claims in a timely manner. In December, 1.1 million individuals enrolled with Delta Dental will be transferred to the other two managed care dental plans.

Staffel said the transition to managed care has limited the number of orthodontists willing to take referrals for Medicaid patients, and many patients have been left "hanging in limbo," after the state shut down their orthodontic clinic by withholding Medicaid payments while the state investigates allegations of fraud.

HHSC has informed orthodontic providers that the dental board can suspend or revoke their license for abandoning Medicaid patients. 

"We’ve worked really closely with the dental board on that issue," said Goodman, adding many orthodontists have also stepped up to help address the problem with access to care. "Even providers that didn’t normally take Medicaid patients have agreed to take a few."


 

  • Dr. Staffel worked for Dr. Eugene Kouri at Eugene Kouri, DDS MSD, Inc. 2921 Lackland Road #201, Fort Worth, TX 76116

 

  • Gene M. Kouri, DDS, MSD - Dr. Kouri received his MSD in Pediatric Dentistry and his doctorate in Dental Surgery from Baylor University. He began his private practice in 1961 with a brief interruption for service as a captain with the United States Army Dental Corps. Dr. Kouri’s professional associations include the Texas Society of Dentistry for Children, American Academy of Pediatric Dentistry and the Southwestern Society of Pediatric Dentists. – http://genekouriddsmdfortworthtx.com/texas-pediatric-dentists

Dr. Eugene Kouri came in at number 8 in 2010 Texas’s Top Stainless Steel Crown  state records, topping off at 6,108. In 2011 his office billed the state over $2M, nearly $700M for stainless steel crowns alone!

2010 Top Ten Dentists to bill Texas for stainless steel crowns:

  1. Linda T. Burke -  Harlingen, TX
  2. Trueblood Dental Associates - Austin, TX
  3. Buckner Market Place Dental - Dallas, TX
  4. Smile Center – San Antonio, TX
  5. Robert Morgan DDS MSD – Irving, TX
  6. Kool Smiles Laredo, TX
  7. Valley View Smiles/ All Smiles Dental – Dallas, TX
  8. Eugene Kouri, Fort Worth, TX
  9. Bill Pope, McAllen, TX
  10. Robert Morgan DDS, Richardson, TX

 

Wednesday, September 26, 2012

Sun Orthodontix raided by FBI–Life in dental fraud is not as rosy as it used to be, is it?

We’re getting there… 


by BYRON HARRIS

Bio | Email

WFAA-TV

Posted on September 26, 2012 at 5:58 PM

Updated today at 6:18 PM

Story TimelineClick to open timeline

Related:

NEWS 8 INVESTIGATES

In the largest action to date, the FBI, state investigators and the attorney general have raided the offices of Sun Orthodontix.

Sun doesn't have locations in North Texas, but it was the second largest biller for braces under Medicaid in 2010.

Part of its huge growth in Texas is linked to Medicaid dental bills. News 8 found Texas dentists were charging taxpayers for putting braces on kids who didn't qualify for them under Medicaid.

Sun collected more than $9.6 million in 2010, according to state records.

FBI agents were part of Monday's raids at Sun offices, which stretch from El Paso to Corpus Christi.

"The FBI doesn't show up when they think you've committed a crime... they know you've committed a crime long before they show up," said Houston attorney Jim Moriarty, who is part of a whistle-blower case against Dallas-based All Smiles Dental Centers.

The joint raid is the largest action so far against a dental firm in Texas.

"I think you may see tens or hundreds of dentists who end up with civil or criminal charges against them," Moriarty said. "I think there is a tsunami of criminal action against crooked orthodontists in Texas."

No criminal charges have been filed against Sun or its dentists. But the company has been in a dispute with Medicaid. The state quit paying Sun Orthodontix earlier this year, questioning its practices.

Sun has taken the state to court for money it says it is owed.

E-mail bharris@wfaa.com

Sunday, August 19, 2012

Who is Legally Liable in Texas’s Dental Drama?

Who's Legally Liable in State's Dental Drama?

The state's sweeping Medicaid fraud investigation into dentists and orthodontists accused of giving unnecessary treatments to poor children has left Texas attorneys with lots of questions.
Who’s accountable for the Texas orthodontic patients abandoned mid-treatment when the state pulled the plug on their doctors? Could the state be held legally liable for giving doctors permission to perform medically unnecessary dental procedures in the first place? And ultimately, does the state’s method of cracking down on providers — halting funding the moment an investigation is opened — grant sufficient due process to the accused, or could the government be counter-sued for destroying the businesses of providers later found innocent?

Looking for ways to curb the state's budget woes, lawmakers have directed health investigators to amp up their pursuit of fraud and to oust providers who purposefully filed medically unnecessary or fraudulent Medicaid claims. Many of the accused providers have their funding frozen, and can't treat Medicaid patients in the meantime. In the words of Sen. Jane Nelson, R-Flower Mound, “using patients to game the system – and then abandoning those patients when you get caught – is shameful abuse.”

Saturday, July 28, 2012

Texas Stakeholder’s meeting cover a lot, offered no solutions.

In case anyone missed the Stakeholder’s webinar yesterday. Here is a link to it:  July 27, 2012 Texas Dental Stakeholder’s Meeting

They talked about patient recruiting. They talked about the criminal behavior and the $10k fines for each of the people who recruit each time they approach a person in one of their vans. But I didn’t hear anything about who was going to start stopping these vans and handing out those $10K “patient recruiting tickets”. They also mentioned how illegal it was to “hire” a company to recruit and it was illegal to work as a recruiter.

They talked about the horrors and trauma small children are experiencing at the massive number of low quality dental centers, like Kool Smiles, Small Smiles, All Smiles, The Smile Center. They even mentioned babies being tied down and traumatized by hundreds of Texas dentists who are committing Medicaid fraud. Needless to say they skimmed over that subject as fast as possible. Mentioned a couple of words about standards and tabled it for later discussion, as they have for the past 10 years! Hey guys, it’s still on the table, don’t you see it!

The attorney for the Texas Dental Board admitted they have the power to make the rules, but didn’t say a word about if they planned on enforcing the rules they already have in place or any news ones they might create.

They talked about the $63 thousand dollars the government is handing out to Medicaid providers, and stressed the dentists are in the category. Then they told how to apply, what criteria must be met and I believe someone gave a count of 461 dentists who have already signed up for their piece of the pie. I’m not sure but I thought I heard applause.

 

by BYRON HARRIS
Bio | Email
WFAA

Posted on July 27, 2012 at 7:42 PM

Updated yesterday at 7:42 PM

DALLAS - As Texas cracks down on questionable Medicaid dental payments, dentists' offices are going dark all over the state.


From 28th Street in Fort Worth, to Eureka Circle in Wichita Falls, to Amarillo, dentists who've already collected money from the state to treat Medicaid patients are now turning away those patients, because the dentists' Medicaid claims are being rejected. There are more than 4,300 Medicaid dentists in the state.


Tens of thousands of patients are affected. In 2010, Medicaid paid for braces on about 80,000 kids in Texas. Treatment commonly takes two years.


Since March, the Medicaid dental is managed by three Managed Care Organizations (MCO's)  which have stiffened standards. One MCO said 91 percent of new claims are being rejected.


Moms whose kids already have braces on their teeth are being told children's braces must come off halfway through treatment, that they must go to another clinic far from home, or that there will be no more treatment whatsoever.


Friday, Dr. John Roberts chaired his first stakeholder meeting as Texas HHS dental director. The old director left after News 8 discovered hundreds of millions of dollars of questionable payments under Medicaid orthodontics.


Dentists learned the three MCO's have different payment rates and differing standards. But the overall impression was that moving forward, the children with braces already on their teeth would receive treatment somehow.


"There are plans in place to continue treatment on patients, to re-evaluate patients, and to complete every patient's braces," said Dr. Robert Morgan of Children's Medical Center in Dallas, who attended the  meeting.
The meeting was also broadcast over the web for reporters and interested parties.


It was not clear how the process would exactly work.
If the state reassigns patients to new dentists, regardless of their original need for braces, it will cost millions for treatment which may have been unnecessary in the first place.


One example is All Smiles Dental Centers, which is being sued by the state for fraud. All Smiles told The Dallas Morning News it is eliminating orthodontic treatment at 13 clinics. One witness in the state's case against All Smiles said 95 percent of the dental chain's claims in a 300-patient sample were fraudulent.
All Smiles did not respond to News 8 efforts for clarification.

Related:

Friday, July 27, 2012

Texas Stakeholders meeting today at 1PM Central time: Orthodontics on the menu.

Click reserve my seat, fill out the form and they will send you a link to the meeting.

http://www.hhsc.state.tx.us/news/meetings/past/2012/072712-Dental-Stakeholders-Meeting.shtml

Medicaid Dental System an Ongoing Challenge

Texas Tribune July 27, 2012

While Texas works to fix a system that allowed dental clinics to charge the state millions of dollars in questionable Medicaid bills, dental providers say impoverished Texas children do not have adequate access to care and that the state’s rocky transition to Medicaid managed care is compounding the problem. 

Concerns over the system will be addressed Friday, when the state’s Health and Human Services Commission holds a "dental stakeholders" meeting in Austin. John Roberts, an official with HHSC, said the dental directors of managed care health plans, members of state government and other state officials will address 14 questions previously submitted by dental providers across the state. One topic on the agenda: "Discussion on orthodontic continuation of care for abandoned patients."

Shannon Ash of Lewisville says her three teenagers haven’t been able to get their braces checked by an orthodontist for two months and are using wax to hold off the pain from wires cutting into their cheeks. After the dental clinic that had gotten state approval to put braces on her children shut down, the children’s new orthodontist told Ash that the Medicaid managed care dental plan assigned to her children by the state didn’t think her children’s braces were medically necessary. Therefore, it wouldn’t reimburse the orthodontist for treatments.

“I don’t have money to take care of the issue, or else I would have had it done myself,” Ash said. “If I had known this [would happen], I would have just let my kids’ teeth be crooked.”

After news broke last fall that Texas was paying millions to dental clinics for fraudulent or unnecessary Medicaid activities, such as putting cosmetic braces on low-income children, the state cracked down. The Health and Human Services Department's Office of Inspector General has put 23 orthodontic clinics on payment holds since October while it investigates fraud allegations. And managed care organizations that began administering Medicaid dental plans in March are placing stricter requirements on dental providers to prevent fraud.

Thursday, July 19, 2012

Dr. John G. "Jack" Vondrak’s Sun Orthodontix abandon possible 4,000 patients.

 

EL PASO, Texas – KVIA TV Part 2

sunorthodonixParents of former patients, an attorney and Health and Human Services are claiming a chain of orthodontics clinics are committing patient abandonment.


After Texas Medicaid cut off reimbursement to Sun Orthodonix, amid a fraud investigation by the Texas Office of Inspector General, the chain of clinics in turn cut off treatment to its Medicaid patients still in the midst of orthodontic treatment.

The move has left hundreds of teens and adolescents with braces on their teeth but no doctors treating them.

One El Paso orthodontist estimates up to 4,000 El Paso kids could be affected from the response from Sun Orthodontix and other local clinics which may be doing the same to their Medicaid patients.

Not having a doctor is a hard fact to swallow for two Northeast El Paso teens well into their orthodontic treatment they had be undertaking with Sun Orthodontix.

The pair has fought through the discomfort of braces, the pain of tooth extractions and even the stretching of their mouths by orthodontic devices.
"He ran a fever he was in pain, he didn't eat," the boys' mother Emma Diaz said about her 14-year-old, Issac. "And now it's like we go through all of that and what now?"

Diaz says her sons showed up to their routine orthodontics appointment at Sun's Northeast El Paso location in June, where they were handed letters giving the boys two options: have the braces removed by Sun, or leave the braces on and find another orthodontist.

"It would be considered patient abandonment," Health and Human Services Commission spokeswoman Stephanie Goodman said. "And it's true for dentists, orthodontists, doctors, it's fairly standard across the medical profession."


A patient contract obtained by ABC-7 from when a teenager first got her braces at a Sun Orthodontix clinic in El Paso reads:
"Good news! Once the braces have been placed, your treatment is fully covered. Even if you happen to lose your insurance, by keeping your monthly appointments, you are guaranteeing that your insurance will continue to pay for services rendered."

But even though the patient kept her appointments, as soon as Medicaid cut its payments to Sun Orthodontix, a subsidiary of National Orthodontix Mgmt, treatment was cut as well.

Sun Orthodontix's attorney, Frank Sheeder, would not address this "guarantee," but he did say the clinics are following the process for terminating and transferring care.

Sheeder says the state pre-approved the treatments, then without warning, put a hold on Medicaid reimbursement five months ago.

In an email, Sheeder writes:
"An orthodontic practice can't reasonably be expected to continue to provide services for free for such a long time."

In the letters to patients, Sun states that it has been forced to lay off more than a hundred employees and four orthodontists.

Still, Goodman says lack of payment should not translate into lack of treatment.
She says doctors have a professional obligation to finish what they started or they could face consequences.

"In those cases where we have an orthodontist, who is accepting Medicaid, put braces on a child or did any treatment, in most cases braces, and now says that because the payment's not there, 'I'm not going to continue the treatment'? We will be referring those to the dental board, who we're working very closely with," Goodman said. "And they've assured us they will move on those cases."

That assurance is not of much comfort to 16-year-old Andy Diaz.
He has had four teeth extracted as per his course of treatment prescribed by his orthodontist at Sun Orthodontix.

He has been left with the braces on his teeth and big gaps where his teeth used to lie.

"If they can at least just close the bottom ones, I'd be happy," Andy Diaz said. "You can't leave a kid with gapped teeth."

They already have, but for how much longer is the real question.

ABC-7's Matt Dougherty spoke with the owner and founder of Sun Orthodontix, Dr. John G. "Jack" Vondrak, when he was in El Paso recently.
Vondrak refused to comment on the record.

From Sun Orthodontix Website:

Dr. John Vondrak is the founder of Sun Orthodontix. His experience as a practicing orthodontist, that spans over three decades, and his commitment to provide families of all income levels with affordable, quality care have been instrumental to Sun's growth and success. Dr. Vondrak continues to treat patients and oversee the training of new orthodontists in Sun's specialized method of treatment.

Dr. Vondrak earned his orthodontic degree from Howard University School of Dentistry in Washington D.C. and completed his internship in oral surgery at Louisiana State University Medical Center in New Orleans. Dr. Vondrak received his Doctor of Dental Surgery from the University of Nebraska in Lincoln and served in the U.S. Air Force as a dental officer before entering private practice.

Dr. Vondrak is a past president of the New Mexico Orthodontic Society and a member of the American Association of Orthodontists (AAO), the Southwestern Society of Orthodontists (SSO), the American Dental Association (ADA), and local and regional dental societies in both New Mexico and Texas.

Dr. Vondrak's wife, Barbara, is herself an accomplished dental professional, who plays an active role at Sun. She holds a Masters Degree in Dental Hygiene Education, has worked as an Accreditation Consultant for the ADA, and has served as chairwoman of the American Dental Hygienist Association's Dental Education Committee.

The Vondraks have two daughters and a son, all of whom live in Texas. Their daughters, Cameron and Clarian, are following in their father's footsteps and are currently enrolled in dental programs. Their son, Greg, is the Project Coordinator for Sun, and their son-in-law, Craig, is the Director of Operations. The Vondraks are the proud grandparents of seven beautiful grandchildren.

Monday, July 09, 2012

The state of Texas is not done with Dr. Richard Malouf–Orthodontics Fraud King of Texas - and his All Smiles Dental Centers

 

wk



 

FOR IMMEDIATE RELEASE
Contact: Brandy Dietz
bdietz@waterskraus.com
800.226.9880

Waters & Kraus Client Takes on Dental Medicaid Fraud in Texas

Texas AG Joins Whistleblower Lawsuit Against Dallas Dentist and Dental Clinics
DALLAS — July 9, 2012 — Dallas-based law firm Waters & Kraus, LLP announces that Dr. Christine Ellis has sued Dr. Richard Malouf and several All Smiles clinics, alleging violations of the Texas Medicaid Fraud Prevention Act.
Dr. Ellis is represented by Waters & Kraus and Jim Moriarty of Moriarty Leyendecker in Houston. Her lawsuit was recently joined by Texas Attorney General Greg Abbott.

"We at Waters & Kraus are proud to represent Dr. Ellis and to be a part of the fight against dental Medicaid fraud," said Waters & Kraus attorney Dan Hargrove. "Whistleblowers like Dr. Ellis represent our best chance to fight serious fraud that drains the public funds and puts important services at risk."

After serving as an auditor for the Office of Inspector General of the Texas Medicaid Program, Dr. Ellis became concerned about dental fraud she had uncovered. When she spoke before the U.S. House Oversight and Government Reform Subcommittee in April, Dr. Ellis testified to a “flagrancy of fraud that is truly unbelievable." Shortly thereafter, Dr. Ellis filed her whistleblower lawsuit.

The lawsuit alleges that the defendants misrepresented to Medicaid the dental and orthodontic treatment they provided, causing Medicaid to overpay them by many millions of dollars. They allegedly submitted claims for services that were not actually provided or were poorly performed, billed for services that were not medically necessary or were more expensive than those actually provided, and unlawfully recruited patients or paid kickbacks to those who did.

Jim Moriarty, of Moriarty Leyendecker, said, “The courage of Dr. Ellis has shown in reporting these allegations deserves the attention and respect of anyone who cares about public health and the responsible stewardship of taxpayers’ funds. We’re honored to work with Waters & Kraus and Dr. Ellis on this important case.”
If the lawsuit is successful, Dr. Ellis will be entitled to 15 to 25 percent of the recovery, in addition to her costs and attorneys' fees. Whistleblower awards encourage people who know about fraud to come forward. The government relies on citizens like Dr. Ellis to identify and fight fraud.

About Waters & Kraus
Waters & Kraus is a national firm with highly skilled lawyers practicing qui tam whistleblower litigation as well as complex civil litigation in four offices, including Dallas, Los Angeles, San Francisco, and Baltimore. Our attorneys have decades of experience successfully representing whistleblowers in a variety of fraud cases. Contact us or call our attorneys at 800.226.9880 to learn more about our practice and how we can assist.

About Moriarty Leyendecker
Houston-based Moriarty Leyendecker has represented thousands of consumers in cases involving allegations of healthcare fraud, consumer defects, and securities fraud during the past 20 years.


Brandy C. Dietz | Public Relations Coordinator
3219 McKinney Avenue | Dallas, TX 75204
Toll Free 800-226-9880 | Phone 214-357-6244 | Fax 214-357-7252
www.waterskraus.com

Wednesday, May 16, 2012

Husband and wife dental team plead guilty to Medicaid fraud in Texas

May 1, 2012 -- Carlos Armin Morales-Ryan, DDS, 45, and his wife, orthodontist Nelia Patricia Garcia-Morales, DDS, 42, of Laredo, TX, have pleaded guilty to making false statements on bills to Texas Medicaid.

Drs. Morales-Ryan and Garcia-Morales owned and operated Orthogenesis International Centre, a dentistry and orthodontics business, and a substantial portion of their business was targeted toward Medicaid-eligible children.

Medicaid regulations required them to be in their offices when services are provided to Medicaid patients.

Dr. Morales-Ryan has admitted that though he and his wife were in Hawaii on or about October 12, 2007, he falsely represented to Medicaid that he performed an evaluation and management of a new patient on that date. Dr. Garcia-Morales has also admitted she falsely represented to Medicaid that she performed an orthodontic retention on March 23, 2007 when she and her husband were en route to the U.S. from the Virgin Islands.

As a result of their plea agreements, they will be sentenced to five years' probation and will pay $686,545 to the Texas Health and Human Services Commission-Office of Inspector General.

Dr. Morales-Ryan currently is not licensed to practice dentistry in Texas due to another unrelated criminal proceeding.

Saturday, May 05, 2012

Richard J. Malouf–A call for every item this man has had his name attached to or inscribed on to be seized! Not tomorrow, but by 5 this afternoon. And don’t forget his passport!

 

E-mail bharris@wfaa.com

Related:

maloufdancingThis should make every man, woman and child world wide, mad as hell. There should be crowds of people in front of the “gansta's house along side the news trucks.

Richard J. Malouf, just gave the, Department of Justice, the US Attorney’s Office, the citizens of Texas as well as every prosecutor in Texas the finger. But not the one he is using in the picture to the left.

On March 21, 2012 the US Attorney’s office in Texas allowed Richard Malouf to say he would pay them $1.2 million dollars to walk away from fraud charges he committed between 2004 and 2007.

 

Thursday, April 26, 2012

Byron Harris was in Washington for the hearing on Medicaid fraud. You don’t want to miss his report.


by BYRON HARRIS
Bio | Email

WFAA
Posted on April 25, 2012 at 10:11 PM
Updated today at 7:36 AM

WASHINGTON — "It took a reporter to unlock the mystery that Texas is spending more on braces than the rest of the country put together?"

That was the half-humorous question Rep. Trey Gowdy (R-South Carolina) asked his fellow members of the House Oversight and Government Reform subcommittee in Washington on Wednesday.

Looking at Medicaid fraud, the committee talked to whistle-blowers and lawyers from Minnesota and New York, all of whom discussed scandals in their home states.

But the witness at the heart of this hearing was from Texas.

Dr. Christine Ellis, a North Texas orthodontist, credited News 8 with revealing a "flagrancy of fraud that is truly unbelievable."

News 8 spent thousands of dollars to acquire Medicaid records from the State of Texas and discovered that the state paid out $424 million to put braces on poor kids' teeth from 2008 to 2010.

News 8 also obtained spending totals on orthodontics from other states individually, after the federal government said it did not compile them.

"As they say, everything is bigger in Texas," Dr. Ellis told the panel. "Thanks to the investigative reporting of WFAA's Byron Harris, we now know that orthodontic Medicaid fraud is no exception."

Wednesday, March 28, 2012

FINALLY!! Texas State Dental Board Director resigns before big hearing. Come One, Come All to the April 11, 2012 10:30 Texas State Dental Board Meeting!

By Mary Ann Roser
AMERICAN-STATESMAN STAFF

Statesman.com Article

Published: 8:47 p.m. Wednesday, March 28, 2012

Sherri Meek, executive director of the Texas State Board of Dental Examiners, resigned earlier this month and will not be present at an April legislative hearing where board critics plan to testify.

Meek, who cited personal reasons for her resignation, is using up personal leave time before her resignation takes effect Aug. 31, said the board’s general counsel, Joy Sparks. Glenn Parker, former executive director of the Texas Board of Chiropractic Examiners, has been the dental board’s director of administration for the past several months and has taken over as acting executive director with a salary of $75,000, a $5,000 increase to compensate him for his additional duties, according to a letter from Meek to Parker.

Parker will be at the hearing of the House Public Health Committee at 10:30 a.m. April 11 in the Capitol Annex, E2.012.

At the hearing, lawmakers will hear public testimony about various health registries maintained by the state and concerns about the operations of the dental board, including its enforcement practices and a law that allows board members to act as expert witnesses in cases involving dentists, as long as the board does not object.

“No board member has ever asked for permission to serve as an expert,” Sparks said, adding that she “would have absolutely no problem” with an outright ban on it.

Members of the Houston-based Texans for Dental Reform say they plan to speak at the hearing and voice their ongoing concerns about the dental board, including uneven and unfair enforcement of the law; “overemphasis on protection of dentists;” and conflicts of interest.

The hearing is open to the public.

Sherri Meeks has been there since 2007, that’s when it all went to hell in a hand basket in Texas. I’m sure there were initially good intentions with the Frew v Texas lawsuit, but damn!! If I were a conspiracy theorist, I’d think that Private Equity firms and corporate practice of dentistry bandits (DGPA) were at artful play here.

I’m not really a betting person either, but I’d wager the Texas State Board of Dental Examiners are going to need a larger venue come April 11 at their 10:30 AM hearing!!  I also think, Sherri Meeks should be dragged to that hearing, hog tied! What a chicken shit, she is!

What do you think?

Tuesday, March 20, 2012

Dental Braces: Once Again Texas Makes News with Braces

 

Dental Braces: Once Again Texas Makes News with Braces

March 20, 2012 By Jim Du Molin Leave a Comment

Dental Braces: Once Again Texas Makes News with Braces What is it with Medicaid dental care and braces in Texas?

The Texas Health and Human Services Commission, which administers Medicaid in Texas for dental braces, has filed a request to be reimbursed for $7.5 million in alleged fraudulent claims it paid to Amarillo orthodontist Dr. Michael Goodwin.

Federal authorities also moved to seize the commercial and personal bank accounts of Dr. Goodwin and his wife as part of a probe linked to a Medicaid fraud scheme, according to the Amarillo Globe-News.

In 2008, Dr. Goodwin became an individual Medicaid provider, which allowed him to bill Medicaid only for services personally provided by the orthodontist.

Soon after the change, the Amarillo orthodontist was reported as scheduling up to 400 Medicaid patients a day and allegedly billing the government for orthodontic treatment he did not perform. The Globe-News further reports that patients and former employees likened the Amarillo Medicaid fraud scheme to “herding cattle.”

Thursday, March 01, 2012

Could Texas Medicaid Dental Program Suck Anymore? Yes.

Just saying…

Big Changes in Medicaid Dental Coverage Could Mean Increased Wait Time 3/1/12

Shelley Childers
CBS 7 News
schilders@cbs7.com
March 1, 2012
ODESSA, TX - Big changes to the Medicaid dental program may mean some children in West Texas have to wait even longer to get treatment.
It's a change that came with very little warning or information from the Medicaid program.
Now it has pediatric dentists across the state scrambling to help their patients maintain their appointments.
"It was a very bad day for pediatric dentists across the state because we do serve the Medicaid population and a lot of patients went without being seen today," said Dr. Joel Edwards, the only pediatric dentist in Odessa who serves Medicaid patients.
He says Medicaid patients went without being seen because of big changes to their insurance coverage that all took effect Thursday.
For years Medicaid dental insurance was a state run program, but now it's being handed over to three different insurance companies Delta Dental, DentaQuest and MCNA Dental.

 

Texas dental centers recruiters solicit Medicaid patients outside food stamp offices promising ipods and more


 

 

WFAA
Posted on February 29, 2012 at 10:03 PM
Updated yesterday at 10:49 PM

NEWS 8 INVESTIGATES

Thousands of kids get free dental care under Medicaid in Texas. Texas taxpayers foot the bill, including putting crowns on the teeth of toddlers who don't yet have their permanent teeth.

A News 8 investigation finds that some dentists want that Medicaid business so badly, they hire recruiters to bring in patients.

At a Texas Health and Human Services Office on Masters Road near Dallas, a man quietly stands in the parking lot, waiting for mothers who've just received food stamps to emerge from the waiting room.

He is a recruiter. He's handing out cards for Happy Teeth Dental, just two doors down in the same complex.

At another HHS office across town, two women also wait for new food stamp recipients. They're handing out cards for Lancaster Dental a few miles away.

And at another HHS office just up the road, Bear Creek Family Dentistry has a small kiosk set up to recruit new patients.

Tuesday, February 28, 2012

Feds link orthodontist to Medicaid fraud scheme

By BOBBY CERVANTES amarillo.com Copyright 2012 Amarillo Globe-News. All rights reserved.

February 29, 2012 - 12:18am

Feds link orthodontist to Medicaid fraud scheme

bobby.cervantes@amarillo.com

Patients and former employees likened the Amarillo Medicaid fraud scheme to “herding cattle.”

Amarillo orthodontist Dr. Michael Goodwin scheduled up to 400 Medicaid patients a day and frequently billed the government for work he never performed, according to court records.

In late May and early July, authorities seized $244,235.67 from five JP Morgan Chase commercial and personal bank accounts associated with Goodwin, his wife and his business.

Goodwin billed the government a total of $1.67 million in fraudulent claims from April 2008 to April 2011, according to a federal forfeiture complaint the government filed Monday seeking to keep the seized money.

Goodwin, who also has an office in Indiana, has not been charged with a crime. His Amarillo office at 3629 Wolfin Ave. was closed Tuesday and messages were not immediately returned.

Goodwin and his wife, Patricia, did not file a claim to the seized money, according to the complaint.