Dental Hygienists Struggle In Corporate Dentistry

Deborah Stewart is a dental hygienist, author, mentor, office manager, coach, consultant, and popular speaker for dental hygiene schools. She holds degrees in dental hygiene, organizational behavior and coaching as well as an MBA. She is author of the 2014 book “Perspectives on Dentistry: An Insider’s Guide to the Professional Business of Dental Hygiene (available here).

Deborah passionately promotes collaboration, ethical standards, and high achievement in both hygienists and the dental industry she loves. A proud member of The Daughters of the Republic of Texas, she is also an historian and a civic and community advocate. 

What Do Dental Hygienists Do to be Employed?
by Deborah Stewart

North Texas, the area where I live, was once roamed by Frank and Jesse James, and home to one of the top ten feuds in American history. The Lee-Peacock Feud was a continuation of the Civil War. North Texas was very prosperous with cotton agricultural growth after the Civil War, so a feud developed whether North Texas would continue to have slaves. Fighting a Civil War apparently was not enough for the additional 200 lives that were killed in the feud. 

To say North Texans are a bit hard headed is an understatement.  

One hundred fifty years later, North Texas dental hygienists are fighting another war. Striving to maintain respect for their profession, they fight the battles of what preventive dental hygiene services are to be performed and how they are to work in dental offices. Faced with very few options, what allies do dental hygienists develop in this fight to stay employed? 

What is obvious is disrespect and disregard for the dental hygiene profession by Texas dentists. This behavior by dentists provided a growth opportunity for corporate dentistry business models.  

You don’t have to have multiple offices and a logo to become corporate dentistry, you just have to have a mindset of disrespect. Texas dentists began disrespecting the profession of dental hygiene in the 1980s when the Texas Dental Association (TDA) decided that the Texas Dental Hygiene Association (TDHA) needed to have their own convention.

Since then, the industry has progressed to a corporate way of thinking that now thrives in North Texas. The “dental business” has a checklist for employment of dental hygienists.

Those items include: 

       1)  Businesses will set minimum production dollars per day 

       2)  “CREATE URGENCY” to pressure patients/parents to consent to procedures immediately

        3) Identify 3 patients that need SRP each day 

        4) Use intraoral camera to identify 3 patients per day that need dentistry with $1200-1900 per day. 

        5) All patients seven years and up need an orthodontic appointment    

        6) All patients 14-20 years of age need a wisdom tooth evaluation 

        7) All patients requiring Scaling and Root Planing (SRP) need to be referred to in-house Periodontist 

        8) Call 5 people per day to come into the clinic for treatment

        9) Clean the bathroom 

       10) No employment benefits with longevity  

       11) Hiring through temporary employment agencies; having no intention of providing full-time employment 

       12) Abusive employment policies.

Does anyone think this list of job duties is appropriate?  

National Association of Dental Plans is worried the Texas State Board of Dental Examiners might have too much power! OMG!

No, I’m not kidding. We know that is not going to happen and is utterly ridiculous to even think that could be possible.  The NADP and it’s illegal dental clinic owners they refer to as DSO’s are safer in Texas than any state in the union!

DALLAS, TX--(Marketwired - May 14, 2015) - The National Association of Dental Plans (NADP) has urged Texas lawmakers to take steps to prevent the Texas State Board of Dental Examiners (TSBDE) from passing rules that limit the effectiveness of dental support organizations (DSOs), as such action could jeopardize access to dental care for more than a million Texas Medicaid members.

Many of NADP's member dental networks in Texas include dentists in practices supported by DSOs. This includes carriers providing dental services through the state's Medicaid program.

Read more: http://www.digitaljournal.com/pr/2554531#ixzz3a9T5xFWi

I've had it with agencies and investigators who say that are going to take it to crooked dentists!

After 8 years of blogging and more than a few new stress related grey hairs, I have had it.  I've had it with dentists who hurt kids.  I've had it with politicians and regulators that say they are going to stop children from being hurt.  I've had it with agencies and investigators who say that are going to take it to crooked dentists.  I've had it with a government that doesn't want to protect children.  In the last few months 3!! investigators have told me that after years of hunting, gathering evidence and being sickened at what they found, they have hit brick walls WITHIN their own agency.  Two quit, one after telling me about recent DEATHS in their state that were swept under the rug.

So here is my question for all of you readers - when are you going to wake up and say you've had it, too?  Do you not realize that the mouth and bank account of you and every person you love, is at risk?  This crap started almost a decade ago.  Did you really think that a decade of DeRose trained dentists would simply put in their time and then go into humble private practice without retaining any of their bad habits?

Don't be foolish.

Just like a fart stinks up a whole room, the fraudster dental clinic alumni started a stink that goes DEEP into the dental biz.  Think I'm wrong?  Tell me if this sounds familiar?

Case in point number one:
 
Your friend has a 14 year old boy who has had braces on for 3 years.  The new pediatric dentist who recently bought the practice where this boy is seen announces right before his braces are removed that he has developed 5 new cavities.  Because his brushing was probably not so good with those braces.  And his orthodontist isn't really looking for decay so didn't mention it.  These aren't your run of the mill pit and fissure cavities - these are the multiple surface (expensive) kind.  Might as well get them fixed and give that kid a lecture about how his lousy toothbrushing just cost you $1700 ON TOP of the braces, which weren't cheap!

So the dentist "fills" 5 teeth with itty bitty wholly enamel contained occlusal surface only goop and sends the bill to the parents.  Oh, I forgot to mention that the parents are both corporate lawyers.  With no dental insurance.  But nice cars and kids in private school so odds are that bill is going to be paid.

If you think Medicaid has no oversight, guess how much you get when you pay cash?  ZERO.  That 14 year old boy is a real kid - his parents paid $1700 for Dentally (Medically) Unnecessary care.  But how the heck are they going to know that?  Right now they think their son is a lousy brusher who will probably need a few more cavities fixed in the near future.  They may be corporate lawyers but their son is a sitting duck.

Do you really think that none of the DeRose trained dentists who have since moved on to private practice would not sense an opportunity if presented with such a scenario?  Or the ones who did some time at Kool Smiles?  Or maybe All Smiles?  Perhaps Comfort Dental?  Or maybe Aspen dental?

Case in point number two:
 
Last week the state of Texas startled citizens when it settled a $16 million dollar fraud case for less than the cost of a kitchen remodel!

Last week (August 28, 2014) the Texas Health and Human Services Office of Inspector General (THHS-OIG) setting a $16 million dollar dental fraud case against one of their top stainless steel crown fraudsters for $39,000! That’s right! Just about one quarter of one percent!
Someone please tell me how that is possible!!

In an article by “The Austin American-Statesman” it says:

“The deal represents the latest underwhelming outcome for state regulators who say they have identified hundreds of millions of dollars in dental and orthodontic fraud between 2007-2012, yet have struggled to produce decisive legal victories.”

Rachel Trueblood says the reason for the lowball number is, “There was a complete lack of evidence.”

ACS Xerox Answers Complaint filed by State of Texas

 

Xerox's Original Answer to Texas Complaint

 

Texas v. ACS Xerox - Xerox's Original Answer to Pleas in Intervention

 

Link to other Pleading in the case, including the original Complaint

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

Faulted in Medicaid Fraud, Company Keeps Contract

Faulted in Medicaid Fraud, Company Keeps Contract

For nearly five years, a state contractor allowed workers with limited expertise to approve dental claims for Texas’ Medicaid program, the joint state-federal insurer. State spending on orthodontic services spiraled out of control; by 2012, federal and state auditors found that the contractor’s actions had opened the door for a “massive Medicaid fraud scheme” that cost taxpayers hundreds of millions of dollars.

More than two years later, Texas health officials have reeled in spending on Medicaid orthodontic services and pursued legal action against health care providers who billed for the services. But a Texas Tribune investigation found that while health officials have repeatedly raised concerns with the contractor, a Xerox subsidiary called the Texas Medicaid and Healthcare Partnership, they have not severed its multiyear contract worth hundreds of millions of dollars.

Critics accuse the state of dragging its feet because of the contractor’s political ties to Gov. Rick Perry, a claim the governor’s office says is not true.

Continue reading at New York Times…

Read Texas Tribune Article Here - Company That OK's Unnecessary Braces Kept Its Contract

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Related:

“Ho” Down in Texas – James W. Orr, DDS Testifies for Antoine Dental Center

Analysis of ADC vs. Texas Health and Human Services Commission

Analysis of ADC vs. Texas Health and Human Services Commission

By Michael W. Davis, DDS, DrBicuspid.com contributing writer

March 6, 2014 -- Why should anyone care about a dental Medicaid ruling from an administrative law court in Travis County in Texas? One reason is that this case involves several millions of taxpayer dollars. Other similar cases brought before this court of alleged dental Medicaid fraud and abuses have and will involve taxpayer money, in excess of $100 million. 

The vast majority of dental Medicaid fraud cases are generally resolved in settlement agreements. Alleged violators usually pay some amount of restitution to the government in exchange for no admission of wrongdoing. Often, the alleged violators return to "business as usual." We, the public and dental profession, receive little or no data on case specifics. Records of investigations are sealed upon settlement.

Public record disclosure of this particular case exposed some of the dark underbelly of the dental Medicaid industry, along with some of its nefarious inner workings.

Read the entire article on Dr. Bicuspid

Antoine Dental Centers Creditable Allegation of Fraud (CAF) Hearing

If you haven’t read part 1 of “Ho” Down in Texas I suggest you do so before continuing. Read it here. 

The group calling themselves Texas Dentists for Medicaid Reform posted only two cherry picked depositions on their website in relation to the Antoine Dental Centers State Office of Administrative Hearings(SOAH).  TDMR again portraying the fraudsters as victims, just like they tried to do with Harlington Dental.  Posted on the TDMR website were Dr. Larry Tadlock’s deposition and Jack Stick’s deposition.  Dr. Tadlock was the expert witness for the state.  Mr. Stick is the Director of Enforcement at OIG. You can catch up on TDMR here.

I guess TDMR didn’t want people to read the actual hearing transcripts, and I can certainly understand why.

 

Texas cracking down on unnecessary dental treatment

Texas Law Cracks Down on Unnecessary Dental Treatments

June 27, 2013, 11:55 am ET by David Heath Center for Public Integrity

A new Texas law will give regulators more power to crack down on dentists performing unnecessary treatments, especially on children.

A spokesman for the bill’s author — Republican State Rep. Lois W. Kolkhorst of Brenham, Texas — said the law came about largely because of a joint investigation by the Center for Public Integrity and PBS Frontline. The investigation revealed a pattern of questionable practices by Kool Smiles, a chain focused on Medicaid-provided dental care for children. The spokesman also credited independent reporting by Dallas station WFAA-TV on Medicaid fraud.

The joint investigation by the Center and FRONTLINE, titled Dollars and Dentists, quoted former employees who alleged that dentists at Kool Smiles were encouraged by company production standards to put more expensive stainless-steel crowns, rather than fillings, on cavities in baby teeth. Kool Smiles denies those allegations.

“As a mother of two children, I was shocked to learn that in 2010 there were estimated to be over 15,000 Texas children who were given inappropriate dental care, including braces on baby teeth,” Kolkhorst said in a statement.

Kolkhorst said only one dentist has had his license revoked for Medicaid fraud or patient complaints in the past two years. “That’s just not acceptable,” she added.

The law beefs up the ability of the state dental board to investigate complaints. It also gives parents the right to be in the room with their children while they are at the dentist.

In addition, dentists working for corporate dental chains are required to report information about the chains to the dental board. Currently, the state maintains no information about dental chains.

Gov. Rick Perry signed the bill last week. It takes effect on Jan. 1.

Watch Dollars for Dentists

“Ho” Down in Texas – James W. Orr, DDS Testifies for Antoine Dental Center

Background
Who can forget the reports by WFAA’s Bryon Harris, which spurred investigations in to orthodontic Medicaid Fraud by the State of Texas?
In the fall of 2011 and continuing today, The Texas Health and Human Services Commission (HHSC) Inspector General put Credible Allegation of Fraud (CAF) payment holds on a covey of dental clinics; some general dentistry and some orthodontic clinics.  

Deciding not to take this sitting down, a few of these highly suspect dentists decided to take it to court; appealing to the State Office of Administrative Hearings (SOAH).

Dr. Juan Villarreal, owner of Harlingen Family Dentistry, a Scientologist  and a former  member of Texas State Board of Dental Examiners (TSBDE) appealed the HHSC decision for his CAF payment hold.  In a ruling by the SOAH in October of 2012, Villarreal/Harlingen Family Dental’s payment hold was reduced from 40% to down to 4%.  The ruling for Harlingen was further upheld by an HHSC Administrative judge in January of this year (2013).  Villarreal also heads up Texas Dentists for Medicaid Fraud Reform (TDMR). 

The judge’s ruling in the Villarreal case, by the most part, was based on the testimony of one Dr. James W. Orr.  This favorable ruling no doubt was the impetus to others, like Antoine Dental Centers and M & M Orthodontics in appealing their CAF payment holds. 

One last thing, before we move on — WHAT is the HDL scoring index? Well, it is much like scoring some jurisdiction do to determine if one gets bail or not. A point for this, a point for that and if it totals up to be high enough, bam! You’re outta there. For orthodontics (braces and other appliances) children over age 12 AND have lost all their baby teeth can received services if their HDL score is 26 or higher. Like anything else there are exceptions, but this is the simple explanation.

Antoine Dental Center-Dr. Behzad Nazari
First up, for this series, is Dr. Behzad Nazari and Antoine Dental Center (ADC) vs. Texas Health and Human Services (THHSC) (SOAH docket no. 529-0997).  ADC was represented by Jose A. (Tony) Canales and Oscar X. Garcia. Robert (Bob) M. Anderton.  Many of these clinic suspected of fraud have hired dentist/attorney, Dr. Robert (Bob) Anderton, former American Dental Association president.

Dr. Behzad Nazari/Antoine Dental Center has been under a 100% (that is HUGE) CAF pay hold since March 28, 2012 totaling over $550,000.  On March 29, 2012 the Texas Attorney General’s Medicaid Control Fraud Unit (MCFU) opened an investigation into ADC. 

Dental Medicaid Fraud and Drug Cartels–The Connection In Texas

AUSTIN, TEXAS, May 26, 2013 - The vice chair of the homeland security committee in the Texas House says there is a direct connection between drug cartels and Medicaid fraud being perpetrated along the South Texas border region.

For this and other reasons, state Rep. Allen Fletcher said he offered an amendment to Senate Bill 8 that will allow the Office of Inspector General (OIG) to hire commissioned peace officers for their investigations into Medicaid fraud. Senate Bill 8 is a major piece of legislation dealing with fraud, waste, and abuse in the Medicaid program.

“There is Medicaid fraud all over the state, Dallas, Houston, you name it. The cartels are in Dallas and Houston. But way along the border, and all along the border, McAllen, Brownsville, Cameron County, Hidalgo County, Starr, all those areas, there is huge cartel influence and I assure you that these individuals that are involved in setting up these bogus clinics and hiring these dentists and doctors to file these fraudulent Medicaid claims, it’s cartels,” Fletcher said.

Fletcher is one of just a few retired police officer serving in the Texas House. He investigated white collar crime for Houston Police Department for many years. Fletcher said he spoke to Jack Stick, deputy inspector general for enforcement for the Office of Inspector General Texas Health and Human Services Commission, about carrying an amendment for Stick to allow OIG to have commissioned peace officers working as investigators.

State Representative Lois W. Kolkhorst (R - Brenham) passed Texas House Bill 3201

Dental Medicaid Fraud in Texas Prompts New Legislation for Dental Board Reform and Patient Rights

May 3, 2013

AUSTIN, TEXAS (May 3, 2013) — State Representative Lois W. Kolkhorst (R - Brenham), Chair of the Public Health Committee in the Texas House of Representatives, authored and passed House Bill 3201, a sweeping dental practice reform bill for Texas, calling for parental rights for pediatric dental patient care, additional disclosure information for dental license renewal, and new disciplinary actions by the Texas Dental Board.

“As a mother of two children, I was shocked to learn that in 2010, there were estimated to be over 15,000 Texas children who were given inappropriate dental care, including braces on baby teeth,” said Kolkhorst. “Most of these were Medicaid cases that involved dentists and dental clinics who would not allow parents to observe the dental care given to their children.” Under the bill’s reforms, Texas parents and legal guardians would be given the right to observe most dental services being provided to their children.

Kolkhorst also said her legislation is aimed at cracking down on the millions of dollars in dental and orthodontic Medicaid fraud recently uncovered by both WFAA-TV investigative news reports (in North Texas) and the Texas Attorney General’s office.

Texas AG Greg Abbott disappointed in Dallas DA Craig Watkins’ “sweetheart deal” with Richard Malouf

Sweethearts?

A good example of why you can’t count on local DA’s to enforce the laws!

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Bio | Email
WFAA
Posted on March 5, 2013 at 10:05 PM
Updated today at 9:54 PM

Dallas County District Attorney Craig Watkins accepted — then returned — a 2009 campaign donation from the wife of Medicaid dentist Dr. Richard Malouf, who was under investigation at the time by Watkins' office for allegations of Medicaid fraud.

The Texas Attorney General’s Office says Watkins’ settlement of the case was a "sweetheart deal."

Dallas dentist Dr. Richard Malouf is the founder and former owner of All Smiles Dental Centers in Dallas. From 2008 through 2010, All Smiles billed the state of Texas more than $20 million for putting braces on children under Medicaid.

For the past five years, federal, state and local officials have been investigating Malouf for Medicaid fraud.

The Dallas County DA's office was one of those doing the investigating. Watkins' office received a criminal referral from the AG about Malouf.

In 2009, Malouf's wife, Leanne, wrote Craig Watkins — who was running for re-election as Dallas County DA — a $10,000 campaign donation, News 8 has learned.

Soon after, Watkins was asked to attend a meeting at the office of one of Malouf's attorneys, according to Heath Harris, the first assistant in the DA's office. News 8 wanted to talk to Watkins himself about the sequence of events. His office said he was ill and unavailable. Heath Harris spoke on behalf of Watkins.

Dallas District Attorney Craig Watkins Letter to Stephanie Leanne Lott Malouf Jan 5 2010 Redacted

At the meeting at the attorney's office, Heath Harris said, Watkins was introduced to Malouf.

Malouf wanted to talk to Watkins about his criminal case, Heath Harris said.

"This Malouf person is trying to talk to him about a criminal matter," Heath Harris told News 8. "It's my understanding he [Watkins] immediately shuts him down. And he leaves."

Watkins returned $10,000 to Leanne Malouf with a cashier's check in January, 2010.

Malpractice suit filed against Texas dentists, M. Jerome Holmes, DDS

On February 21, 2013, Cheryl Rye filed a lawsuit (Cause 201310522-7-in Harris County Texas District Court against Dr. M. Jerome Holmes, DDS.  Cheryl's daughter went to Dr. Jerome Holmes for a scheduled cleaning and received the standard dental abuse treatment – restraining, child abuse, mom in the waiting room hearing blood curdling screams from her daughter, bodily injury and lies to cover it all up.  They staff actually told the mom all the red marks on the child was an allergic reaction!

The treatment of this little girl sounds all too familiar.  Wonder if  Dr. Jerome Holmes worked somewhere else prior to his own practice?  As we’ve seen, there is never just one child, there are usually many children that have suffered at the hands of dentists like this. 

A huge round of applause for mom suing and a special thanks to the attorney who took the case - Tami Pierce of Kingwood

Checking Dr. Jerome Holmes Texas dental license shows no disciplinary actions, which means he could have murdered 10 patients – Texas State Board of Dental Examiners are not exactly known for their pro-action to protect public health.

Dr. Holmes picture from his website, speaks volumes as to his attitude doesn’t it?  Looks like a creepy marionette to me.  

                  

Dr. M. Jerome Holmes
9815 FM 1960 Rd. W.
Humble, TX 77338
Phone: (281)548-3384
Fax: (281)548-7336
info@jeromeholmesdds.com

 

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No Way to Treat a Child, Mom Tells Dentist

By CAMERON LANGFORD 

HOUSTON TX - In a horrifying trip to the dentist, a little girl "screamed frantically for her mother," but the dentist kept drilling, with his staff "grabbing her legs and restraining her head," and threatening to call police when the mom tried to check on her daughter, the mother claims in court.
     Cheryl Rye sued Miner Jerome Holmes DDS and his dental office on behalf of her daughter, Katie in Harris County Court.
     Rye claims took Katie to Holmes' office for what she thought was a routine cleaning.
     "Plaintiff was administered nitrous oxide and the dental procedure began," the complaint states. "Plaintiff began feeling intense pain and screamed frantically for her mother. Instead of stopping the procedure or administering any additional nitrous or allowing her mother to enter the room to calm her Dr. Holmes continued to drill into the minor child's tooth.
     "Dr. Holmes, and his agents and/or employees, physically restrained Katie in a prison like manner by holding her down, grabbing her legs, and restraining her head in such a reckless fashion that it caused bodily injury.
     "Plaintiff continued to scream for her mother so loudly that her mother, Cheryl, heard her scream while she was sitting in the waiting area. Cheryl pleaded with the office staff to go and check on her daughter.
     "Cheryl was instructed to sit down, was refused access to her minor child and told the police would be called if she attempted to go back.
     "After several minutes of nerve-racking screams of pain and fear, little Katy finally emerged from the back area sobbing with large red marks on her head.
     "Cheryl inquired as to what happened to her daughter and why she had the injuries that were not present prior to the procedure. Dr. Holme's staff tried to cover up the negligent acts and told Cheryl that it was an 'allergic reaction.'"
     But Rye says she took Katie to her pediatrician, who determined that the marks "were not any type of allergic reaction, but were in fact injuries she sustained by being forcibly restrained."
     An emergency room physician confirmed the pediatrician's diagnosis, Rye says.
     She says Katie is still scared to go to the dentist, months later, and will require sedation to go to the dentist from now on.
     She seeks medical expenses and punitive damages for negligence, gross negligence and breach of duty.

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If anyone gets a copy of the complaint, I’d appreciate a copy.  cckaddie@yahoo.com

Thanks

Senate Panel Backs Bill That Targets Medicaid Fraud

The Senate Health and Human Services Committee gave its endorsement Tuesday to legislation that tackles Medicaid fraud and could save the state millions of dollars.

Senate Bill 8 will “reduce the epidemic levels of fraud waste and abuse that are plaguing our health and human services,” said Sen. Jane Nelson, R-Flower Mound, the author of the bill and chairwoman of the Senate health committee. She added that “no amount of fraud is tolerable, but given our recent budget challenges it is inexcusable” that the Office of Inspector General has identified more than $6 billion in fraud from 2004 to 2011 tied to Medicaid, the state health program for poor residents.

The legislation will now go to the full Senate.

The committee approved a substitute of the original bill. The approved measure would set up a data analysis team within the Texas Health and Human Services Commission to detect trends in Medicaid claims and take a proactive approach to identifying potential fraud; ensure providers found guilty of Medicaid fraud in Texas or other states would be barred from participating in the state’s program; strengthen prohibitions against directly soliciting Medicaid patients for treatments; and reduce transportation fraud by adding medical transportation services to managed care and setting up a relationship between the Texas Department of Transportation and the Health and Human Services Commission to verify the eligibility of a Medicaid patient for transportation services.

Texas orthodontist, Dr. Michael Goodwin to fork over $1.5 million beside fine and facing prison.

I bet Dr. Richard Malouf’s ears perked up yesterday when he heard good ole Dr. Goodwin had to fork over $1.5 million, beside a fine of $250,000 and facing up to 10 years in prison. But come to think of it, Malouf has already agreed to pay up over $1M to settle fraud charges. Hmm…

February 12, 2013

Amarillo orthodontist must forfeit $1.5M

By Jim McBride

jim.mcbride@amarillo.com

An Amarillo orthodontist must forfeit $1.56 million he fraudulently gleaned from the Texas Medicaid program by billing for dental work he never performed, an Amarillo judge has ruled.

In a preliminary order issued Monday, U.S. District Judge Mary Lou Robinson said the government presented “credible evidence” Michael David Goodwin, owner of Goodwin Orthodontics, 3629 Wolflin Ave., reaped $1.56 million in ill-
gotten gains between 2008 and 2011.

Goodwin, 63, pleaded guilty in December to one count of health care fraud. He faces up to 10 years in federal prison and a fine of up to $250,000 when he is sentenced. Under the plea, Goodwin agreed not to challenge the forfeiture.

Prosecutors allege Goodwin frequently billed for work he never performed and scheduled up to 100 patients daily. Employees and patients likened the scheme to “herding cattle,” court documents show.

A phone message Tuesday at Goodwin Orthodontics said the office was temporarily closed.

Texas Medicaid orthodontics spending off the charts; Facts are facts folks.

WFAA’s Byron Harris must be fed-up with his reports and statistics being questioned by folks hoping to keep the Medicaid dental spending unchecked in Texas. 

Here is Byron’s latest:

 

Bracing Ourselves: How Texas spent $705 million on Medicaid braces

by BYRON HARRIS
Bio | Email
WFAA
Posted on February 4, 2013 at 6:35 PM
Updated yesterday at 2:32 PM

Until last year, the Texas Medicaid Dental Orthodontic program was spending money like a Christmas shopper on Black Friday. Between 2008 and 2011, Texas spent $705 million on Medicaid orthodontics, which experts say many children don't even need. That's because the state was paying the bills without adding them up, or even seeing if the money was well spent.

It was what Doug Wilson, the Inspector General of Texas Health and Human Services, calls a "pay and chase" environment. Texas now is earnestly in the "chase" mode. It has between 300 and 400 open investigations. Wilson took over the Office of Inspector General in 2011, and after a series of WFAA stories exposing questionable Medicaid payments, the state is beefing up its investigation of Medicaid fraud.

"Texas is a huge state. There are a lot of kids out there," Wilson told News 8 in a lengthy interview last month. "Some of the things we're seeing are just errors and other things that we're seeing are more intentional. And we're taking appropriate actions and making referrals as necessary."

The state now is holding payments back from 91 Medicaid providers for Credible Allegations of Fraud. Dozens are dentists and orthodontists.

The first signs of trouble were in 2008. That's when an audit by the OIG revealed problems.

"The volume of prior authorizations (for spending on braces) was extremely high," Wilson says. 

The OIG warned the state that applications for braces (orthodontics) were not being inspected carefully enough, and that the state should consider beefing up its staff. 

"We thought things were going to get better," Wilson says. "As we now know, they didn't necessarily get better. The volume of orthodontia in our state was extremely high. We warned them, and I think they tried to act but they didn't go far enough."

In 2011, News 8 began asking for Medicaid records under the Freedom of Information Act (FOIA) and the Texas Public Information Act (TPIA) to see how much Texas was paying to put braces on kids under Medicaid, and how it compared to the rest of the nation.

Data obtained by News 8 from TDHHS showed that Texas spent $184 million on orthodontics for Medicaid kids in 2010. News 8 had to pay for this data because the state did not compile them on its own. TDHHS has now adjusted the total upward to $200 million.

To get a national picture, News 8 obtained total spending figures from the federal Medicaid Statistical Information System (MSIS). These numbers, which took weeks to obtain, had never been compiled until News 8 asked for them. The most recent totals available were, and still are, from 2009. The entire nation spent $355,550,331 in 2009.

 

Texas alone spent about 70 percent of the rest of the nation combined.

Trueblood Dentistry and their string of Carousel chops shops finally forced to close!

In all the raw data I’ve seen out of Texas, this one would nearly always fall in the top 5.  This one alone is said to have stolen $18 million from taxpayers.  Just imagine the hundreds and hundreds of millions, if not billions stolen from scam dentists and dental companies in the state of Texas!  Perp walk please!!

I’m sure the “pity” party has begun.

 

By Chuck Lindell

American-Statesman Staff

Carousel Pediatrics began shutting down its Austin dental practice Tuesday night, displacing about 28,000 low-income pediatric patients, after state health investigators cut off Medicaid payments over allegations of fraudulent activity.

Carousel’s owner, Dr. Glenn Wood, who disputed the fraud allegations, said the loss of about $400,000 a month in Medicaid payments required him to shut down his dental affiliate, Trueblood Dental Associates, and lay off about 40 staff members and six dentists.

Texas Vows to crack down on dental Medicaid fraud

I’m guessing Texas is not exactly the best market anymore for the Medicaid dental mills and DSO’s in general.

by BYRON HARRIS
Bio | Email
WFAA
Posted on January 16, 2013 at 6:48 PM
Updated yesterday at 9:55 PM

NEWS 8 INVESTIGATES

AUSTIN — State Sen. Jane Nelson (R-Flower Mound) put it simply Wednesday, speaking to a group of reporters at a news conference in Austin:

"It is infuriating to hear of the kind of problems that are taking place... problems that are particularly serious in Medicaid dental, orthodontia and transportation for Medicaid patients," she said.

For the past two years, News 8 has been investigating the Texas Medicaid Dental program and hundreds of millions of dollars the state has spent on orthodontics under Medicaid.

Sen. Nelson specifically mentioned the parents of Medicaid children who had been solicited by "marketers" bearing free gifts and cash, the subject of several News 8 stories.

Senate Bill 8 is designed to cure some of those abuses.

• READ: Senate Bill 8

"It strengthens the prohibitions against solicitation of Medicaid clients," Nelson said. "We heard story after story about that. We are going to prohibit that and make sure it doesn't take place."

So far, the bill does not specifically prohibit handing out gifts and cash to parents to induce them to take their children to certain dentists. Nelson says hearings over the next two months will flesh the bill out.

The legislation also articulates the Inspector General's role in uncovering and reporting fraud, and bans a dentist from participating in Medicaid if found guilty of fraud.

The bill moves Medicaid Transportation into managed care, and directs the Department of Health and Human Services to reduce inappropriate ambulance use.

Even though the specifics of this bill haven't yet been hammered out, there's already huge opposition to it. That's a sign, Nelson says, that as it is, some dentists are making lot of money.

E-mail bharris@wfaa.com

Texas tries to crack down on dental chains that put profits ahead of patients

 

By David Heathemail

January 8, 2013

A leading Republican in the Texas legislature, who says she’s outraged by allegations that corporate dental chains put profits ahead of patients, has introduced a bill that would allow the state to regulate chains and forbid them from forcing dentists to meet revenue quotas.

A joint investigation by the Center for Public Integrity and PBS Frontline last summer found that two of the largest dental chains owned by private-equity firms, Aspen Dental Management and Kool Smiles, put pressure on its dentists to meet production goals, prompting complaints of overbilling and unnecessary treatments.

Both companies deny this. And a coalition of dental chains in Texas contends that their dentists have total control over patient care. But the chief sponsor of the bill remains skeptical.

“Several reports, including the Frontline program, have uncovered outrageous activities involving the illegal enticement of patients, especially among our Medicaid providers and often involving dental service organizations,” said Republican Sen. Jane Nelson, who chairs the Senate’s Health & Human Services committee.

Nelson did not name a specific chain. Aspen Dental does not accept Medicaid and has no offices in Texas. But Kool Smiles has clinics throughout Texas, and public records show that the state Attorney General has been investigating Kool Smiles for Medicaid fraud.

Read the entire story at Center for Public Integrity