Closing Day for Church Street Health Management-Small Smiles Dental Centers

No, not closing the doors, but I expect that soon.

Today was supposed to be the closing day for the sale of Church Street Health Management.

Yes, Church Street Health Management, LLC will now become CSHM, LLC with basically the same Private Equity Investors as before, CIT Corporation and others. The Carlyle Group swears they are out of it, I’m not sure. They say the “exited” in the last year. It must have been in the last 6 months!

Sales and Credit Agreement

The investors basically sunk another $25 million dollars into the company in February to keep it afloat while it “reorganized”. Whatever that means. No one else wanted to jump on the sinking ship so …. it became the property of the same folks.  If they aren’t pissed, they should be.

Since then they have ended up the subject of at least two Bloomberg reports. As usual they never come out looking good. But, honestly, how could they? They whole bunch are dirty rotten scoundrels. 

Abusing children and raping taxpayers is NOT exactly the best way to prosperity. These folks are so bad, even Don Meyer, who is notorious for selling snake oil to American’s can spin this one. All he can say is “we are providing care to the underserved”. He says it over and over and over…  If you listened to them, there would be no sex at all, unless you’re raped.

Still doesn’t it make it so. The once “underserved” are the most “overserved” in America when it comes to dental care these days.

I think things may be getting worse for the CSHM, LLC. I know, it’s hard to believe things could get worse-Bankrupt, Congressional Investigations, Corporate Integrity Agreement, and so forth-but they can.

The first few days of the new ownership is probably gonna suck!

According to sources, Met Life and United Concordia/Tricare are canceling their contracts with Small Smiles Dental Centers. 

If true, revenues just went to hell, again. If they couldn’t make it before, they certainly can’t make it now.

PS – If asked to sign some kind of Transition, Separation, Confidential, Severance and General Agreement, in exchange for a week’s pay, I would have an attorney look it over. Personally, unless they removed sections 4, 7, 8, 13 and clarified in writing why it says it’s governed by the state of Tennessee, and why Church Street Health Management is a “Released Party”, I wouldn’t sign it, no way, no how… Just saying…

Dr. Jian-Fu Zhu, loose cannon!

Someone needs to stop this dentist before he kills someone. Other’s have come forward with similar stories, none willing to speak out of course.

Detroit Free Press - Ashton's story: Michigan Child Nearly Dies

26  Comments

Ashton Adler is the subject of "Ashton's story: Michigan Child Nearly Dies," in which his mother describes complications he had with dental sedation. / Photos by JARRAD HENDERSON/Detroit Free Press

 

Rebekah and Jason Adler and their sons Gabe, 5, and Ashton, 7, at their Royal Oak home.

The case of a 6-year-old Royal Oak boy whose family charges he was unresponsive for nearly six unsettling hours after a dental sedation procedure last year is under investigation by Michigan health care regulators.

The allegations by the family of Ashton Adler, now 7, involves one of Michigan's few known cases involving a child experiencing complications from dental sedation. The incident is the subject of a new video by a national nonprofit organization that monitors deaths and serious complications of children undergoing such procedures.

"Ashton's story: Michigan Child Nearly Dies," is a video interview with Rebekah Adler, the mother of the boy interviewed by the Raven Maria Blanco Foundation. The Virginia-based foundation, which has tracked 45 pediatric sedation deaths around the country, recently led its website with the Adlers' story to show parents and caregivers to "trust their instincts" and "walk away" if they question sedation procedures, Executive Director Nicole Cunha said.

The Adlers contacted the foundation after reading a February report in the Free Press on controversies over state regulation of dental sedation. The article described the national controversy over pediatric sedation deaths and regulatory measures under debate by Michigan and other states to increase training and safety in the field.

Michigan has had no known sedation deaths, according to a spokesman for the Michigan Dental Association. And there have been very few complaints involving sedation dentistry practices, said Rae Ramsdell, chief of the Bureau of Health Professions with the Michigan Department of Licensing and Regulatory Affairs.

The foundation's video does not name the dentist, but the couple's complaint to Michigan regulators lists him as Troy pediatric dentist Dr. Jian-Fu Zhu. The complaint, which the Alders filed June 8, 2011, with Michigan's licensing department, is under investigation, Ramsdell said. No formal charges have been filed.

Zhu declined to comment. He referred a call from the Free Press to Lynda Farnen, a Roseville attorney.

"We're involved in an ongoing investigation," she said. "Under those circumstances, there's very little I'm going to say. Dr. Zhu believes that all the care and treatment he rendered was appropriate and within the standard of care." She declined to answer other questions.

The state website lists no violations on Zhu's record.

Credentials seemed fine

The Adlers say a brochure they picked up in his office on the day of the visit gave them confidence they made the right choice.

Zhu also came on good recommendations from their family dentist, the Adlers said.

The brochure identified Zhu as a board-certified pediatric dentist and clinical assistant professor of pediatrics at the Wayne State University School of Medicine, as well as a previous co-director of the pediatric residency program at Children's Hospital of Michigan in Detroit.

WSU medical school records show that Zhu has not worked there since 2005.

He left Children's Hospital several years ago, a spokeswoman said.

He remains a board-certified dentist, a credential that indicates he passed a tough national exam.

Pediatric dentists undergo at least one month of hospital or office training with an oral surgeon or dental anesthesiologist that allows them to perform light or moderate sedation techniques -- drugs that help people rest during a procedure but that allow them to respond to voice commands easily.

In their complaint to the state, the Adlers say they were told to give two different sedation drugs to their son, a skinny 47-pounder at the time, before undergoing a root canal and five fillings.

The Adlers claim that:

• They were left to give the drugs to their son on their own. When Zhu returned and found Ashton apparently had spit out some of the medicine, Zhu gave them a third cup of medicine to give to their son and then left them alone again. The Adlers say they don't know which medicine and how much of it was in the third cup, requiring emergency room doctors at Beaumont Hospital in Royal Oak to monitor Ashton for more than four hours to observe his breathing and vital signs because he was so listless when they arrived.

• Their son was unmonitored for long stretches throughout the dental visit and was sent home asleep. A staffer for Zhu told them, "We can't be with our patients from start to finish of a sedation process," Rebekah Adler said.

• Zhu didn't awaken the boy before sending him home, did not check his vital signs and gave the parents no reason to think there was a problem.

The allegations, if true, would violate standards of the American Dental Association and the American Society of Pediatric Dentistry, of which Zhu is a member.

The guidelines require "no administration of sedating medication without the safety net of medical supervision." They also say that children must recover to pre-sedation levels of consciousness before discharge; that dentists must document the name and dosages of medications given, and if children receive different sedative drugs simultaneously, they might need more monitoring before discharge. The guidelines say a child should be able to remain awake for "at least 20 minutes when placed in a quiet environment."

Before Jason Adler left Zhu's office the day of the visit, he said he asked for his son's X-rays and medical records. He received only a bill, marked "statement for services rendered." Scribbled on it were references to two sedative drugs: "hydroxyzine 50 milligrams and chloral hydrate 1,700 milligrams."

The statement did not mention that Ashton also received laughing gas, or nitrous oxide, the Adlers say.

Dr. Norbert Kaminski, a Roseville dental anesthesiologist and president of the Michigan Dental Society of Anesthesiology, said the dosages exceed guidelines from the federal Food and Drug Administration and standard reference manuals for dentists, such as the "Drug Information Handbook for Dentistry" from Delta Dental and LexiComp's Dental Reference Library.

Kaminski computed dosages for the boy and said Ashton was given five times the dose of hydroxyzine and two to three times the dose of chloral hydrate, and that even lower doses are recommended when the drugs are used together. Combined with the laughing gas, Ashton was pushed into a level of sedation that Zhu, as a pediatric dentist, was not licensed to perform, Kaminski said.

Kaminski has campaigned statewide to toughen Michigan's sedation regulations.

Michigan is one of only two states that do not require permits for dental professionals performing sedation, Kaminski said. Permits help consumers readily identify what level of sedation a dental practitioner can offer, Kaminski said.

The state Board of Dentistry is reviewing whether to toughen standards in the field. So far it has balked at requiring permits, which would tell consumers whether a dentist has the right training to do either awake sedation or deeper sedation. The board had planned to take up the changes at its April meeting but postponed the discussion, possibly until its next meeting June 14.

'I just want justice'

The Adlers say more parents, even people like them who are familiar with sedation, need to ask more questions before and during a visit. The couple has watched a younger child with a brain injury undergo sedation for brain tests. But now they have to relive their fears -- something will go wrong every time he has another sedation procedure, Rebekah Adler said.

"I just want justice," she said. "I want the people of Michigan to know this can happen to them."

Contact Patricia Anstett: 313-222-5021 or panstett@freepress.com

More Details: Questions parents should ask before pediatric dental sedation

• How much training have you had?

• How do you monitor children to see whether they stay properly sedated?

• Does the office have rescue equipment in the room where the procedure is done, and how often does the staff practice using it?

• How long do you monitor a child before discharge?

• Will I receive a pretreatment report describing what is being done and what drugs will be used in the procedure?

By Patricia Anstett
Detroit Free Press Medical Writer

Western Dental for Sale?

 

May 30, 2012 1:00 pm
Financial Times:

Western Dental mandates Jefferies for sale process

Websites:

Western Dental,

 Court Square

Jefferies

Federal Trade Commission implies Private Equity Executives deciding dental treatment will give North Carolina citizens lower costs.

North Carolina Representative Stephen LaRoque called in the FTC when it looked like SB655/HB698 might pass. Is Representative Stephen LaRoque bought and paid for by Corporate CEO’s? Appears so.

Where has the Federal Trade Commission been all these years if this is such a huge issue? Nowhere to be seen, not until brought in by Private Equity and Representative LaRouque.

 

FTC Staff: Proposed North Carolina Dental Services Law Would Likely Reduce the Benefits of Competition for Consumers

Federal Trade Commission Documents and Publications
May 29, 2012

FTC Staff: Proposed North Carolina Dental Services Law Would Likely Reduce the Benefits of Competition for Consumers

Federal Trade Commission staff, in response to a request from North Carolina Representative Stephen LaRoque, stated that a bill proposed in the North Carolina legislature (http://www.ftc.gov/os/2012/05/1205ncdental.pdf) would likely deny consumers seeking dental services in North Carolina the benefits of competition, including the potential for lower prices, expanded access to dental services, and greater choice.

North Carolina House Bill 698 would give the North Carolina Board of Dental Examiners significant new regulatory and oversight authority over Dental Service Organizations (DSOs), which contract with dentists to perform non-clinical, business management functions, allowing dentists to focus more on patient care and less on administrative tasks. According to the FTC staff letter, the Bill would prohibit currently-used DSO management agreement provisions and give the Board exclusive authority to review and approve all DSO management agreements in North Carolina. The Board could apply these new restrictions and oversight powers to prevent DSOs from entering the state, and to dismantle DSOs now operating in the state by refusing to approve management agreements when they come up for renewal.

"Given that the Board already oversees health and safety issues as part of the licensure regime that governs all dentists in the state, and given that DSOs focus solely on non-clinical aspects of dental practice, it does not appear that the Bill would enhance the Board's ability to ensure patient safety," the FTC staff comment stated, noting that underserved communities, including 78 of the state's 100 counties, may be particularly affected if DSO efficiencies cannot be realized. "Therefore, we urge you to consider whether the Bill's restrictions and grants of regulatory power to the North Carolina Board of Dental Examiners are necessary to protect consumers" or whether they risk "merely protecting those dentists who do not choose to use DSOs against competition from those who do."

"In the absence of DSO-specific safety concerns," FTC staff urged the North Carolina legislature to consider the potential anticompetitive effects of H.B. 698 and reject the Bill.

The comment is part of the FTC's ongoing efforts to promote competition in the health care sector, which benefits consumers through lower costs, better care, and more innovation.

The Commission vote approving the staff comment was 5-0. It was sent to North Carolina Representative Stephen LaRoque on May 28, 2012. A copy of the letter can be found on the FTC's website and as a link to this press release. (FTC File No. V120007; the staff contact is Patricia Schultheiss, Office of Policy Planning, 202-326-2877.)

The FTC's Bureau of Competition works with the Bureau of Economics to investigate alleged anticompetitive business practices and, when appropriate, recommends that the Commission take law enforcement action. To inform the Bureau about particular business practices, call 202-326-3300, send an e-mail to antitrust@ftc.gov, or write to the Office of Policy and Coordination, Bureau of Competition, Federal Trade Commission, 601 New Jersey Ave., Room 7117, Washington, DC 20580. To learn more about the Bureau of Competition, read Competition Counts (http://www.ftc.gov/competitioncounts).

MEDIA CONTACT:

Office of Public Affairs

202-326-2180

Copyright 2012 Federal Information and News Dispatch, Inc.

Federal Trade Commission Documents and Publications

Private equity invests in dentists to pull poor kids' teeth for Medicaid dollars - North Carolina Battle Ground

Daily Kos- Private equity invests in dentists to pull poor kids' teeth for Medicaid dollars

Private equity firms have found a profit center in the teeth of poor children, which the firms are getting to by buying or backing dental management firms and getting their dentists aggressively into the business of over-treating kids on Medicaid.

Just as Mitt Romney's work at Bain Capital was about creating investor profit, not jobs (whatever he may claim now), this is about creating investor profit, not healthy teeth. For instance:

On May 2, All Smiles Dental Center Inc., a management company owned by Chicago-based Valor Equity Partners, filed for bankruptcy protection. Its hand was forced in part by a Texas Medicaid action cutting off payment to some of its clinics because of allegedly “excessive” and “inappropriate” orthodontic care, according to an All Smiles executive’s affidavit included in the filing. All Smiles was part of a state audit in which 90 percent of Medicaid claims for orthodontic braces were found to be invalid because they weren’t medically needed, according to Christine Ellis, one of the auditors.

In some cases, the braces may have been put on children's baby teeth. Another dental management services company, ReachOut Healthcare America, which is owned by Morgan Stanley Private Equity, specializes in going into schools and treating kids in bulk. And when quantity is the priority, well, you make some mistakes. Like the case where six-year-old Sabrina Martinez's teeth were drilled "even after the student’s mother, Valerie Davila, told the company she was seeing a family dentist and didn’t need any work." But, see, there was another student named Sabrina Martinez, and if you're just trying to get through the most procedures you can on the most kids you can, you don't necessarily take time to tell one Sabrina Martinez from another. In another case:

When ReachOut called Stacey Gagnon to tell her the mobile dentist was coming to Isaac’s school, she said she explained that he had seizures and other serious medical conditions. ReachOut was told he could have a cleaning and oral hygiene education, nothing else, according to Gagnon.

After that call, ReachOut dentists held Isaac Gagnon down and gave him two steel crowns, two pulpotomies and 10 X-rays.

Cases like this obviously require individual dentists to suck, both as dentists and as human beings. But if it's just about individuals, such stories don't happen to scale. That takes big money—things like private equity involvement pushing dental management services companies to expand the scope of what they do from providing services like billing and scheduling to coming closer to directing actual medical decisions, something that is potentially in violation of "State laws [that] broadly say only licensed dentists or firms they own can practice dentistry."

Some states are cracking down, and the U.S. Senate is investigating possible overbilling by several firms. But while regulating these abuses is an important first step, private equity firms will find the next under-regulated point of entry into profiting off of the massive inequality that leaves poor families vulnerable to such abuses and creates no meaningful disincentives to rich investors doing things like this again and again.

Ain't it the truth! Again and again and some more agains. North Carolina seems to be the battle ground, with Senate Bill 655/House Bill 698.

Private Equity firms are going all out to STOP North Carolina Dental board from enforcing the laws there. If you are a state lawmaker in North Carolina, I wouldn't be shocked if you got a call from beyond the grave from the likes of Leona Helmsley or Kenneth Lay. 

The News Observer reports - Big buck in dentistry's ownership - "Who should make decisions about your dental care: you and your dentist – or a big, out-of-state corporation owned by Wall Street private equity funds? That’s the issue in the fight over Senate Bill 655 in the North Carolina legislature."

Read more here: http://www.newsobserver.com/2012/05/26/2089687/big-bucks-and-dentistrys-ownership.html#storylink=cpy

Orthodontics Offices Closing in Texas

Looks like the spin has started in Texas. I’m hearing many Orthodontic clinics will  close up shop on July 1, 2012.

In the piece below, Dr. Michael Newman's says, "...about 5 percent of them would meet the requirements now."

Fact is, about 5% qualified EVER! Only thing that is changing is maybe, just maybe, stricter enforcement of standards already in place.

Surely Dr. Newman really meant to say, "about 5% is all we can bill for and not get nailed for Medicaid Fraud, now"

TIMES RECORD NEWS - Wichita Falls, Texas

Orthodontist office braces for closure
Practice was only one in area taking Medicaid

Wichita Falls, TX May 26, 2012 -The only orthodontic office accepting Medicaid payments in Wichita Falls has stopped seeing patients and has locked its doors.

Red River Orthodontics set up shop on Euerka Circle in mid-2010. A sign in the door of the vacated Wichita Falls practice directs patients to an office in Fort Worth.

Representatives of Red River Orthodontics declined to comment, and referred questions to an attorney who could not be reached Friday.

The business was registered in the Wichita County Clerk's office under the title John Gremmels, Grill Repair, PA. The address given was in the 3300 block of Monterra Crest Drive in Fort Worth.

Last year Texas paid out $184 million in Medicare for orthodontics. That's more than every other state combined.

Dr. Bill Hendrickson, of Hendrickson Heetland Orthodontics, said he suspects Red River Orthodontics bolted for the door when they realized the Medicaid money was drying up.

"Their words were, 'It's a good investment,'" said Hendrickson, who visited the office personally. "They said, 'This is a very lucrative business.'"

Hendrickson now is in talks with state officials. He said he's trying to take on the patients who were displaced when Red River Orthodontics jumped ship.

Technically, at least one dental office that offers orthodontic services still accepts Medicaid, but is actually kept from doing so because of more stringent, state-mandated requirements.

In 2005 about 80 percent of dentist Dr. Michael Newman's patients were on Medicare. Newman, who operates Texas Orthodontics in Wichita Falls with his wife Denise, practices orthodontics as well as other dental procedures. Until October 2011 he was able to treat most of the patients who needed Medicaid to pay for his services.

But stricter enforcement of Medicaid standards mean that most of them, even patients who have already been fitted with braces, won't receive his care.

"I would say about 5 percent of them would meet the requirements now," Newman said.

In fact, only one of his potential patients received the go-ahead from the state for treatment. Newman wasn't allowed to treat that patient because he isn't a specialist.

A few factors have contributed to this, he said.

One is that some orthodontists have been accused of taking advantage of Medicaid funds. One case, detailing taxpayer money given to All Smiles Dental Centers in Dallas, has drawn significant media attention.

Another factor is the splitting of the third-party entity that paid Medicaid funds to orthodontists, the Texas Medical and Healthcare Partnership. About a year ago, he said, the company was divided into three new agencies, DentaQuest, Delta Dental, and Managed Care of North America. Newman said it hasn't been the same since.

He said the companies have drawn up constricting new rules that makes it virtually impossible to get a patient approved for payment.

"They started cutting back so that we couldn't get the cases approved," he said.

One rule that's being more strictly enforced is that an orthodontist must prove that a procedure is "medically necessarily" to maintain a patient's health. Newman said this is laughable.

"There is no patient I have ever seen who is going to die because of their teeth," said Newman, an officer of the American Orthodontic Society.

America's ToothFairy forms partnership to help at-risk children

America's ToothFairy forms partnership to help at-risk children

DentistryIQ

May 25, 2012

In an effort to expand oral health services for children, My Kid’s Dentist/Every Kid’s Dentist (MKD/EKD) announced a partnership with National Children’s Oral Health Foundation: America’s ToothFairy (NCOHF) through the Students United for America’s ToothFairy (SUAT) Pediatric Dental Residency Program. As a result of this alliance, NCOHF will become the primary charitable partner for the Pacific Dental Services-affiliated MKD/EKD offices.

Designed to provide critical oral health educational and preventive services for at-risk children, this new program also cultivates interest in the oral health field and unites future dental professionals in a concerted effort to break the cycle of pediatric dental disease in their communities. Guiding chapter activities, members of the SUAT Pediatric Dental Residency Program will serve as mentors for dental, pre-dental, dental hygiene, dental assisting and high school student volunteers.

“We are proud to partner with My Kid’s Dentist/Every Kid’s Dentist through this exciting program and applaud their commitment to children’s oral health,” said Fern Ingber, NCOHF President and CEO. “Their support will enable NCOHF to mobilize graduate, undergraduate and high school students throughout the country in an effort to reach thousands of underserved children with the resources, services and education necessary to prevent pediatric dental disease.”

Stephen Thorne, Founder, President and CEO of Pacific Dental Services, will also join the NCOHF Board of Directors. The NCOHF Board of Directors consists of highly respected and dedicated leaders of national and international organizations, universities and corporations concerned with children’s oral health and elimination of oral health disparities.

“I’m honored to be joining the NCOHF Board of Directors,” said Stephen Thorne, Founder, President and CEO of Pacific Dental Services. “NCOHF provides unparalleled oral health care education and support services for at-risk children and I’m looking forward to working with my fellow board members to shed light on pediatric dental disease and to help break its cycle.”

Dental Center Manager Gets Green Light For Sale To Lenders

Nothing really new here…

Law360, New York (May 25, 2012, 12:36 PM ET) -- A Tennessee bankruptcy judge on Thursday approved a credit bid to sell dental center manager Church Street Health Management LLC to a group of its lenders for $25 million plus their debt, just a few months after fallout from Medicaid fraud claims pushed the company into bankruptcy.

U.S. Bankruptcy Judge Keith M. Lundin agreed to the sale to CSHM LLC, an entity owned by some of Church Street's lenders including CIT Healthcare LLC, after no other bids were received at an auction.

Connecticut attorney general to seek restitution from Winsted dentist over billing practices

I’d say if your are a corrupt dentist in Connecticut and have your name on a PC or PLLC you might be a dumbass. Here is what happened to Dr. Doug Macko. So, if you are in a dental clinic there, and pacing the floor with worry, then you know you are doing criminal acts, right? Get your nitro pills ready. (You know who you are)

HARTFORD –Published: Thursday, May 24, 2012
Attorney General George Jepsen said in a statement that he is seeking restitution from a Winsted dentist and his practice for “allegedly violating the Connecticut Unfair Trade Practices Act by illegally billing the Connecticut Medical Assistance Program from April 2002 through October 2009.”

“The state Department of Social Services administers the Connecticut Medical Assistance Program, which includes Medicaid and other programs that pay for medical benefits for certain low-income and disabled Connecticut residents. DSS terminated the provider agreement for (Dr.) Douglas J. Macko ... and on Oct. 26, 2010, suspended him from the program for 10 years,” the statement said.
Macko and his professional corporation, Douglas J. Macko, D.M.D, P.C., in Southington, “had unlicensed dental assistants perform cleanings and other dental services, which may only be performed by licensed dental professionals, and then billed the state as if Macko had performed the services,” the statement said. “Alleged illegal billings were also made for services that were never provided.”
The complaint also alleges that “the acts, practices and course of wrongful conduct by Macko violated public policies against larceny, vendor fraud, health insurance fraud and against a medical provider violating licensing requirements.”
“This action is being brought to seek restitution, civil penalties and other relief authorized by law,” Jepsen said, also in the statement. “It should also send a clear message to other providers that Connecticut will not ignore fraudulent billing and other illegal practices and will vigorously pursue restoration of taxpayer dollars lost as a result.”
Susan E. Kinsman, director of communications for Jepsen's office said Thursday that the action brought by the attorney general is a civil one and, "It is our understanding that criminal charges have not been brought at this time."

Mom takes 6-year-old out of dental chair to protect him

These places are so corrupt they don’t even care to change their ways during the middle of massive lawsuits or Federal Investigations.

Mom takes 6-year-old out of dental chair to protect him

Jack Dennis

San Antonio Headlines Examiner

When  Karla Cardenas took her 6-year-old son Steven to a San Antonio dentist office on Friday, May 18, 2012, little did she know that she would have to take her son off the dental  chair and refuse the treatment to protect him.

“They wanted to put him in a straight jacket type papoose while he was still screaming in pain from the shots they were giving him in his gum,” Cardenas said. ”They were trying to rush it and they heavily sedated him.”

The single mother of four took her son to The Smile Center Family Dentistry on Blanco Road after getting the approval and direction from Medicaid.

“I had no choice but to take Steven to that center,” Cardenas said. “Medicaid required it.”

“I told them to stop, you are not going to do this while he is in this much pain,” Cardenas said as she grabbed her son out of the chair.

Cardenas now said she is glad she followed her instinct because she has since learned that this dental care chain has been under scrutiny by the news media.

Chantel Brewer said “they did the same thing to my daughter “but “she kept getting out of the papoose so they wanted to send us home with her teeth all shaved down without the caps on.”

It was so bad that “even the assistant had scratches all over her face from my daughter kicking her in the face, neck, arms and even kicked her in the eye because she was in that much pain.”

“How can the Medicaid office send us to that office when there is this much bad news about them,” Cardenas asks. “It looks like they are herding children in and out as fast as they can with little concern about the pain.”  

Earlier this year, Brian Collister of WOAI news issued several reports regarding similar concerns from other parents. According to WOAI, the dental chain has earned $23 million from Medicaid since 2007.

One San Antonio law firm, The Crosley Law Firm, P.C. is representing patients against this chain of dental centers who believe their children “have been victims of substandard dental care leading to injuries and requiring additional treatment.”

According to the Crosley Law Firm website, “many of these parents were approached in parking lots and lured into Smile Center with the promise of dental exams for their children at no out-of-pocket cost to them.”

“In most cases we have seen, the children were covered by Medicaid, and Smile Center would bill Medicaid directly,” the website stated. “ Often the dental care consisted of pulpotomies and the placement of stainless steel crowns.”

Crosley says that for some of their clients “the dental work may have been unnecessary, and resulted in a large bill to Medicaid” and in some cases “the injuries caused from the dental care necessitated visits to the emergency room and/or hospitalization.”

Cardenas, who has been a nursing student, indicated she “didn’t see any kind of resuscitation or life saving equipment or a ‘crash cart’ available” in the event of an emergency.

“This doesn’t mean they don’t have any (life saving equipment),” Cardenas explained. “I’m just saying I didn’t see any there.”

Hey, dental office managers, you too can be arrested, face felony charges, and jail time.

I have to ask is it worth it? Is playing along with the fraud worth giving up your life and family?

Office managers out there, know exactly what is happening with all the Medicaid fraud, children being abused and sit on their asses. Why?

Yeah, I’ve heard it, over and over and over again. “I need to feed my family”. Don’t mean to be so cold, but I’m so over hearing it.

OM’s at the dental mills are paid well, very well, too well in many cases. $50 to $60 thousand dollars a year is over the top to manage an office for a dental clinic. The paycheck is meant to hold them hostage as well keep them gagged and handcuffed.

Several times a week I find folks coming to this blog looking for the answer to their question on whether they- office managers, dental assistants, etc.-can be arrested or held liable in criminal fraud or malpractice behavior they see in their offices. They answer is a big fat YES. Ask Claudia Ventura.

CA Dentist Arrested for Insurance Fraud

Insurance Fraud — By Trace America on May 14, 2012 at 4:48 PM

Beverly Hills often brings up images of huge mansions with beautiful sparkling swimming pools, gorgeously landscaped lawns, and several fancy cars in a large driveway. It often does not bring up images of insurance fraud; but one Beverly Hills dentist to the stars may be changing that.

According to the Beverly Hills Patch and the District Attorney’s Office, Tom K. Kalili, 57, was arrested on May 4^th and accused of insurance fraud, grand theft of personal property and filing a false tax return. He was charged in a criminal complaint with 101 felony counts.

Kalili is the owner and operator of Beverly Hills Medical Suites.

It is reported that Kalili and his partners have several celebrity clients, including Jim Carrey, Kathy Ireland, Adam Sandler, Keanu Reeves and Vin Diesel.

Kalili’s office manager and biller, Claudia Ventura, 38, is also being charged, if only with 10 felony counts, including insurance fraud and accessory after the fact.

These charges all come out of a multi-year investigation by the California Department of Insurance, the California Dental Board and the California Franchise Board.

According to DrBicuspid, Kalili directed Ventura to submit fraudulent billing statements to four different insurers for a total of $339,799.99.

Prosecutors are asking for Kalili’s bail to be set at $500,000 and Ventura’s at $25,000.

If Kalili is convicted, he could face over 50 years in state prison, while Ventura could only receive up to seven.

Errol Gillis, DDS v California Board of Dentistry–Appeals Court Decision–Gillis lost on many levels.

Dr. Gillis worked at Sears Dental and things did not go well for him. He fought the law, and the law won. He lost his licenses for "gross negligent and incompetent" professional treatment. He appealed that decision to an Administrative Law Judge. The Dental Board took it to the First Appellate District Division One in California. The Dental Board won. Errol M. Gillis, DDS v California Board of Dentistry - Appeals Court Decision and Order Case CPF-10-510174

Jot this down: After a five-day hearing spanning days in June, July, and September 2009, an ALJ issued a proposed decision on December 3, 2009. The decision found the facts as set forth above and concluded Gillis was both grossly negligent and incompetent under Business and Professions Code section 16702 for overfilling James J.‟s tooth (paragraph 5E), both grossly negligent and engaging in unprofessional conduct under section 1670 for failing to respond to the wife‟s calls (paragraph 5G), and repeatedly negligent under section 1670 for failing to maintain complete patient records and failing to note the overfill or advise James J. about it (paragraphs 5A and 5F). The ALJ found the Board had not proved the other allegations of the accusation.

The Dental Nightmare of Private Equity

The Dental Nightmare of Private Equity

Wall Street Oasis

After years of getting quarterly dental cleanings, my periodontist said he wanted to pull several teeth and do three or four periodontal procedures. My pockets were too deep, I was told. And don't worry, the receptionist said in a cheerful voice, I didn't have to pay all at once. I was given about nine or ten months to get the $8000 together.

I declined the offer. He is now my ex-periodontist.

Several years later, I was on the verge of losing tooth #16, the left upper quadrant wisdom tooth. And tooth #15, the second molar, was not in good shape either. I was willing to sacrifice my wisdom tooth if it meant saving the tooth next to it, but then my dentist wanted to pull that one too! So I set up appointments with dentist after dentist after oral surgeon after endodontist until I found a dentist I could trust. My new dentist filled the tooth with no guarantees--this was about five years ago--and I've been fine ever since. No root canal. No tooth extraction.

So you can imagine my horror when I read the following (from May 17 on the Bloomberg website, an article by Sydney Freedberg: Dental Abuse Seen Driven By Private Equity Investments):

Small Smiles can’t pay their creditors but can offer $5000 sign up bonuses to prospective employees? Just saying…

http://www.careerbuilder.com/JobSeeker/Jobs/JobDetails.aspx?APath=2.21.0.0.0&job_did=J3I3NB6W7KYYHNSM80R&IPath=JRM0B

I guess they have cut back, it used to be $10k. lol

Speaking of bonuses, maybe the $10K “loans” mentioned in the March 2012 below expense report were “signing loans” not “signing bonuses”.

Anyone closing these illegal operations down yet? Anyone interested?

Wouldn’t dental insurance companies be held liable for recommending their beneficiaries go to these illegal  operations? What about CSM, for recommending them? What about Tristar and Dentaquest for recommending these illegal dental clinics? Just asking…

Doc 272-March-Monthly Operating Report - Church Street Health Management

May 2012 and still disgusting reports about Small Smiles. Can someone just tell me, why that is exactly?

Ever heard of Small Smiles Dentistry?

May 23, 2012

Firstly I want to say that I am speaking from personal experience with a Small Smiles Dental Office.  I have had some what irritating and bad experiences with them.  My son first went to them when he was three and well I thought nothing of it.  We knew he needed his front teeth pulled on top.  He had acid reflux as a baby till about two years old and does have a pretty bad gag reflex. 

So with that being said puking was his middle name if I brushed his little gums with that blue finger thing, he would puke projectile! He still has some issues with his gagging, he also has a bit of anxiety as well, I wont deny that.  However we needed to go in for cleanings that was fine.  They told me he needed to come in 1 time a year or less that he should be okay.  I asked about the cleanings they said just make sure he brushes.  So I did what they said and we went back again later for another issue he was having a tooth that was bothering him. 

They said it was two teeth and capped  them both with silver, he did gag and puke while there.  Then after they said he didn't need to come back at all for cleanings, to just keep him brushing.  I called another dentist who pushed us away, saying sedate him, he needs to be put under.  I really didn’t think that was the smart thing to do.  He has respiratory problems already with asthma.  I was referred by this new dentist to another dentist and they said put him under, he needs to be put to sleep.  I’m sorry if they can work on other peoples kids to fill a tooth, why on earth was it that horrible for mine.  So I called small smiles again because I felt defeated that NO ONE would see him unless sedated or the others I called weren’t accepting new patients.

So after calling Small Smiles again I just didn’t know where else to go, we honestly cannot afford to pay for him being put under, and I’m afraid to!  By this time the dentist said it would be easier to just pull it, and when he came out, he looked horrible my poor baby.  His face was so red and I said next time my husband or I will be going back there.  We attempted to schedule a cleaning and they didn’t seem to have any openings. 

I called them again recently because my son is having issues.  We take him in and they sit there and put there fingers in his mouth and pull them out fast like they are scared of him, cause he may puke because last time he was there for the same tooth he puked on the woman, she was upset and started complaining my hair, my hair.  I told them its been hard just even trying to get him to properly brush.  The puke filled with stomach acid isn’t for the teeth at all and will rot them!  So she was very childish this time, there is no soothing or trying to make him feel comfortable.  So after poking their fingers in and out of his mouth like scaredy cats, they sent in two other women and left. 

Then told my husband his tooth needed extracted.   It had a abscess on it so we got antibiotics thankfully.  The dentist they referred us to was AWESOME!!! Dr Craig Schmidtke, of Metro Oral – Maxillofacial & Facial Cosmetic Surgery.  He looked at his mouth and said I can send you next door to Dr. so and so  to save the tooth and explained he don’t want to put him under because of his asthma, that he could get his tooth out with no problem if there isn’t any saving it.  We called the other doctors next door and another one they referred to but neither were taking new patients.

So I just said its a baby tooth, it will grow in later just take care of it now.   So they took him back and boom it didn’t take long at all a little topical numbing and gas they didn’t even give him a shot of numbing, at least he said they didn’t!  He said that the guy was really nice and made him feel like he really wouldn’t hurt him.  I was so glad and felt so relieved, happy and so grateful he was good to my boy.

What he did explain to me about Small Smiles is that they have no special training to call themselves Pediatric.  He said he took special courses to be an Oral Maxillofacial etc to be the specialist he is.   He took Psychology classes and everything, that he could do it and boom it would be done, no sedation.  I was shocked to hear there is no special training or nothing, they are basic dentists who take a crash course basically in dental.   Kinda scary to think they are only taking care of kids, then to think they tell parents no when they ask to go back with their children.

When I was there a 12-14 year old girl asked if her Mother could go back there with her, not thinking they would say no her mom was right behind her, they said NO you don’t need your mom.  Told the mother to wait out there and she would be out soon.

HELL NO is what I say!  No one tells me that I cannot go back with my child to have a procedure of any kind done!

I don’t recommend this dental company as a good dentist for kids!

They use very tight restraints that strap there arms to their sides, they are being sued for their behavior now by 10 family’s!

American for Tax Reform promoting Private Equity’s take over of your dental health.

As Bloomberg report in “Dental Abuse Seen Driven by Private Equity” as has pointed out, this is NOT a good idea. All American’s should be fighting this issue and support North Carolina’s Senate Bill 655.

ATR is demonstrating the lengths the Private Equity firms will go to in order to line their pockets with your health and health care dollars. These dental management companies could care less about your dental health. But they certainly care about the creative dental care they can deliver to you, your children, your family, and your elderly.

Here ya go:

 

ATR Urges North Carolina Legislators to Reject Anti-Free Enterprise Protectionism

North Carolina is one of the top battleground states for the 2012 election. Ads are already flooding the airwaves from Cape Hatteras to Cashiers and, with the DNC being held in Charlotte, the state is expected to become a political fever pitch over the next few months.

A major topic during the campaign season will be the policies that President Obama has signed into law, such as the 20 tax increases in ObamaCare alone, that will drive up the cost of health care. Indeed, Republicans who hope to pick up three congressional seats in the Tar Heel State will make this a major theme of their campaigns. Yet, in order for North Carolina Republicans to avoid muddling their message and contradicting themselves, Republican state legislators would do well to reject Senate Bill 655, legislation currently pending in the General Assembly that would drive up the cost of dental care for North Carolinians.

Yesterday, Americans for Tax Reform sent the following letter to all members of the North Carolina House, urging them to reject SB 655, legislation that uses the power of government to stifle competition and drive up consumer costs:

21 May 2012

Dear legislators,

On behalf of Americans for Tax Reform (ATR), I write today urging you to reject Senate Bill 655. If passed, this bill would add onerous new regulations restricting the ability of dentists in North Carolina to engage in free enterprise and administer their practices more efficiently. Simply put, this bill is an attempt to use the power of the government to eliminate competition. The effects of SB 655 will harm consumers and taxpayers in the state by limiting access to care, restricting competition, increasing costs, destroying jobs and discouraging investment.

It does NOT add “new” regulations. It further defines regulations already in place, because the Private Equity firms have found, and sometimes created loop holes  with direct access to your dental health.

As it stands, North Carolina faces a shortage of dentists, ranking just 46th nationally in dentists per capita, based on data from the American Dental Association (ADA) and US Census Bureau. The result is less access to needed care and higher costs. Dentists in North Carolina earn 25 percent more than the national average according to the Bureau of Labor Statistics.

Who said there is a shortage of dentist? ADA? Seriously!  WTF! The ADA is in bed with the Private Equity firms! Google Dental Group Practice Association and the ADA. The ADA is allowing the president of the DGAP to host and sponsor simanrs to “sell their snake oil.” Various heads of the ADA are owners or partner in the Private Equity owned changes of dental clinics! What does preventing Private Equity and Hedge funds from deciding the treatment your dentist delivers have to do with the above? Nothing!

This costs North Carolina consumers over $250 million more in additional costs every year, with the effects being the same as that of a hidden tax: increased costs and less disposable income for the citizens of North Carolina. SB 655 would exacerbate these current problems.

Tell us exactly how the above is true? Because the ATR says it is? I say it’s BS. ATR is making this a political issue as if your dental care depends on whether you are a Democrat, Republican or Independent. This is ridiculous.

Given the rising costs of health care across the United States and the resulting burden on employers and taxpayers, states should look to promote more efficient models of delivering healthcare. SB 655 would prohibit dental practices from contracting with Dental Service Organizations (DSOs), which allow dentists to focus exclusively on providing care, resulting in both high quality care and lower costs for patients.

More outright bullshit! DSO’s are owned and operated by Private Equity firms and they could care less about your dental health! These rules were put in place to protect the public and NC is trying to continue to protect the public.

DSOs do not own dental practices,[choking and gagging on this one, pure lies, let’s put a couple of these fake owners in front of a grand jury and see if the DSO’s own the clinics or not, I dare someone to do this one.] and the Dental Board already has the regulatory authority required to ensure that all dentists deliver high quality care to their patients, irrespective of how they choose to contract for administrative services. This is a broadly accepted model utilized by many other medical professions, including emergency room physicians, oncologists, anesthesiologists and hospitalists. In a recent statement, the ADA wrote: “States should implement administrative reforms to cut red tape that impedes dentists from delivering care and patients from receiving it.” SB 655 flies in the face of this advice.

What red tape? Go to school? Pass a test? DEA paperwork? Hell, why require any of this, since it appears this is too much red tape.

As the John Locke Foundation noted in its analysis of SB 655, North Carolina lawmakers “should be looking at ways to expand dental care in North Carolina, not restrict it. If a management company is interested in assuming purchasing, billing and administrative duties and a dentist wants to spend more time on patient care, they ought to be allowed to work out whatever arrangement works best for them.” ATR agrees whole-heartedly with this astute assessment.

While many in the dental industry support SB 655, many other dentists, consumers, taxpayers, employers, and investors in North Carolina would be harmed by this legislation. Rather than consider legislation that stifles competition and drives up consumer costs, North Carolina lawmakers should instead be looking for ways to make the state more economically competitive.  As such, I urge you to oppose SB 655. If you have any questions, please contact ATR’s Patrick Gleason at (202) 785-0266 or pgleason@atr.org.   

Onward,

Grover G. Norquist [head idiot in charge]

Read more: http://atr.org/atr-urges-north-carolina-legislators-reject-a6899#ixzz1vcX74nVb

David Bates, DDS, president of Allcare Dental Management and Allcare Dental and Dentures of New Hampshire, surrendered his license to the state Board of Dental Examiners

NASHUA – The president of a defunct dental chain gave up his New Hampshire dentistry license to resolve professional misconduct charges.

David Bates, DDS, president of Allcare Dental Management and Allcare Dental and Dentures of New Hampshire, surrendered his license to the state Board of Dental Examiners. The board approved the agreement on May 9, according to state Attorney General Michael Delaney.

Bates had been scheduled to appear before the board for disciplinary hearings later this month. Bates has also been the focus of licensing boards in Massachusetts, West Virginia and North Dakota, Delaney said.

Most of the company’s offices closed abruptly in December 2010. In Nashua, that meant hundreds of former patients, some of whom said they prepaid for dental work, descended on the Nashua office shortly after New Year’s Day trying to track down their dental records, X-rays and dentures.

Bloomberg article on private equity firms abusing children with unnecessary and intrusive dental treatment has spurred several articles on the web

Here are some highlights:

Bloomberg – Business Week

• Dental Abuse Seen Driven by Private Equity Investments

• http://www.bloomberg.com/news/2012-05-17/dental-abuse-seen-driven-by-private-equity-investments.html#disqus_thread

Deal Book – New York Times:

• Is Private Equity Contributing to Dental Abuse? Federal and state
  regulators are looking into whether dentistry companies backed by
  private equity are being encouraged to perform unnecessary procedures,
  Bloomberg News reports
  
• http://dealbook.nytimes.com/2012/05/17/morning-take-out-486

San Fransisco Chronicle

• Dental Abuse Seen Driven by Private Equity Exploiting Care Firms

• 
  http://www.sfgate.com/cgi-bin/article.cgi?f=/g/a/2012/05/17/bloomberg_articlesM42NGH1A74E901-M4596.DTL

BoingBoing 40 comments or more:

• http://boingboing.net/2012/05/17/private-equity-driven-dentists.html

Compliance Search

• Private Equity Responsible For Massive Dental Medicare Fraud, According to New Report
  by Beth Connolly on May 17, 2012
  
• http://compliancesearch.com/compliancex/private-equity-responsible-for-massive-dental-medicare-fraud-according-to-new-report/

 

Physicians for National Health Program

• Private equity investors moving into dentistry
  

• http://pnhp.org/blog/2012/05/17/private-equity-investors-moving-into-dentistry/

 

Global Post

• Private equity, profits and aggressive dentistry
  

• http://www.globalpost.com/dispatches/globalpost-blogs/macro/private-equity-profits-and-aggressive-dentistry

 

Watchdog Bytes

• Texas taxpayers soaked for unneeded dental work

• http://blogs.star-telegram.com/investigations/2012/05/speaking-of-texas-teeth-combine-devious-dentists-with-dubious-private-equity-firms-and-what-do-you-get-soaked-taxpayers-ac.html

Huffington Post

• Private Equity Firms Push Dentists To Detrimentally Overtreat Patients:

• http://www.huffingtonpost.com/2012/05/17/private-equity-firms-dental_n_1524342.html

•  

 

Meta Filter

 

• "The dentist man got me" (lot of comments)
  

• http://www.metafilter.com/116030/The-dentist-man-got-me

Weblog

• Dental Abuse Seen Driven by Private Equity Investments
  Munchausen by profit.
  
• http://weblog.sinteur.com/index.php/2012/05/17/dental-abuse-seen-driven-by-private-equity-investments/

Protect Quality Dental Care

• Bloomberg News on Dental Management Corporations: Patient Abuse,
  Private-Equity Funds & Medicaid Fraud - Wall Street Money Fuels Coalition Against SB655 in North Carolina
  
• http://www.protectqualitydentalcare.org/bloomberg-patient-abuse-private-equity-funds-and-medicaid-fraud-mark-dental-management-corporations/

Bangor Maine Daily News:

• Dental abuse seen driven by private equity exploiting care firms
  

• http://bangordailynews.com/2012/05/20/health/dental-abuse-seen-driven-by-private-equity-exploiting-care-firms/?ref=latest

Charleston Daily Mail

• Dental service accused of abuse
  
• http://www.dailymail.com/Business/201205200102

Democratic Underground

• Now Wall Street is f**king with our teeth.......
  

• http://www.democraticunderground.com/1002707485

Summary of Twitter links:

• http://topsy.com/www.bloomberg.com/news/2012-05-17/dental-abuse-seen-driven-by-private-equity-investments.html

 

Happy Birthday to me… Happy Birthday to me….

Dental boards: their mission is clear, but the execution—not so much title

One of my least favorite organizations, but still good points made.

Submitted by Editor at DOCS Education on May 16, 2012 - 4:05pm-Dental boards: their mission is clear, but the execution—not so much

Protect the public. That’s the deceptively simple mission of any American dental board. But while the mandate may be uncomplicated, its execution is anything but. Critics of board actions say they range from misguided and contradictory to baldly self-interested. Controversial decisions are increasingly putting boards under fire. Among the more common sources of complaint are
unfair and unequal treatment of dentists; failure to quickly address malpractice and the unlawful restraint of competition.

Perhaps nowhere is the board under greater fire than in Texas, where the executive director recently resigned. Sherri Meek’s abrupt exit followed a rocky stint punctuated by frequent dispute. In particular Meek was assailed for allowing board members to act as paid expert witnesses in lawsuits against Texas dentists; the practice posed a clear conflict of interest. Long-time opponent Dr. Mark
Stankewitz, a prosthodonist, used YouTube to decry the Texas board as “a good- ole-boys’ network…some dentists receive slaps on the wrists for serious matters and others serious consequences for much less significant offenses.”

Dentist-turned-attorney Frank Recker used the same language—a good-ole-boy’s network—to describe his own experience on the Ohio State Dental Board in the early 1980s.

Parents: Dental Board investigators headed to Bakersfield

Saturday, May 19 2012 10:00 PM

The Bakersfield Californian

Parents: Dental Board investigators headed to Bakersfield

BY KELLIE SCHMITT Californian staff writer kschmitt@bakersfield.com

State dental board officials will come to town in early June to investigate long-simmering allegations that a Bakersfield dentist mistreated children while they were strapped to a papoose, or stabilizing board, several local parents say.

Many of the parents involved also allege excessive, unnecessary or flawed dental treatments from Dr. Edward Dove.

 

"I struggle with the fact that it's taken a long time, but at least movement is coming quickly now," said parent Chris Cook, who has led a grassroots mobilization effort. "I'm exhausted but that doesn't mean I stop -- he ain't getting away from me."

Dove did not respond to an interview request, though he said last year that he gives excellent care, has never hurt a patient and the parents are "making it up." Dove, who has a clean disciplinary record, also said last year that the papoose board was necessary to keep some of his young patients immobile during treatment.

Since the parents banded together with a Facebook page last summer, the Bakersfield Police Department has conducted "a couple of investigations" into Dove's care, said Sgt. Joe Grubbs. He said police have been unable to substantiate any criminal wrongdoing, and are not actively investigating Dove now.

News of the Dental Board of California visit follows the decision by a high-profile Colorado attorney not to take the local parents' case.

Jim Moriarty, who is currently representing a young patient in a case of alleged pediatric dental abuse that's received national lawmaker attention, said the Bakersfield case involved too few local parents, a weak expert on his side, and too much "he said/she said." He also said being an out-of-state attorney was challenging.

Despite that setback, which parent Cook called "extremely shocking," the parents' case is still building momentum. Along with the coming dental board visit, they've collected about 1,000 signatures for an online petition to revoke Dove's license. Several weeks ago, Cook's son was featured with other Bakersfield children in an Inside Edition television segment, which investigated dental papoose boards.

To papoose or not?

Papoose boards, many of which have Velcro straps, are used to hold young patients in a stable position while procedures can be safely done.

Many of the parents' complaints against Dove stem from the slaps and scratches that reportedly happened while their children were restrained on the board, under partial sedation. Parents weren't allowed in the room during the process, something Dove has said is important since they can interrupt and distract from care.

The American Dental Association responded to that Inside Edition show with a press release detailing guidelines on when such stabilization should be used.

The American Academy of Pediatric Dentistry says papoose boards might be used when young patients require immediate diagnosis but can't cooperate due to "a lack of maturity or mental or physical disability;" when the safety of the patient, dental staff or parents would be at risk; or when movement of sedated patients needs to be reduced.

In general, papoose boards aren't considered part of routine dental care, said Dr. Paul Casamassimo, a pediatric expert at the Nationwide Children's Hospital in Ohio and a past president of the American Academy of Pediatric Dentistry. For a typical, healthy child, it would not be the first course of action.

[Dr. Casamassimo has failed to mention since 2008 he has been on the the board of advisors to one of those Private Equity dental chains-Small Smiles. I would like to ask Dr. Paul Casamassimo why he’s done nothing to stop the use of the papooose board, mainly used to expedite treatment, in the Small Smiles Dental Centers. In fact Dr. Casamassimo and Dr. Steven Adair, Small Smiles new Director of Clinical Quality Initiatives and Education and asshole buddies as they say, putting on a CE course together in Adair’s home town of Hilton Head, North Carolina.]

"Most people undergoing procedures in a dental office can stand still," he said. "It would be a hysterical child, or one who is too young to understand what is going on who would need the papoose."

At Ohio State University, a resident in one of Casamassimo's programs is working on a thesis project looking at parental attitudes toward papoose boards as well as other techniques like oral sedation, anesthesia and distraction/positive reinforcement.

Thirty years ago, parents would have said they'd rather have their children held down and the job done, Casamassimo said. Now, though, he has seen a 180-degree shift, as parents prefer putting children to sleep for extensive care.

[Is it the parents, Dr. Casamassimo or is it your pocketbook that prefers sedation. I call BS on that 30 years ago crap, 30 years ago no one had ever heard of such a thing. Were you papoosed Dr. C?]

In a previous interview, Dove pointed out that using general anesthesia is much costlier than using the papoose board, which can be a factor for parents struggling financially.

Another shift in dental practices is the increasing movement toward having parents present during care, Casamassimo said. He said the group of dentists who preferred that parents stay out of the room is largely retiring and a new generation wants the family more involved.

[Increased shift toward parents being present??  Would  that be because of this blog and the lashing you’ve taken for the past four years. If not for the force of the Federal Government, Small Smiles would still be keeping parents in the waiting rooms.

[I want to know when the shirt was away from having parents present? Actually, that was something Dr. Casamassimo and some of his colleagues hatched to not let parents know what they were doing to the children back in those rooms. Dr. C is as much a part of this problem as anyone. He’s held various offices at the AAPD for decades!]  

Regardless of whether parents are in a room, they should actively understand the extent of the procedures, the pros and cons, and be comfortable with it, he said.

That's not what Bakersfield parent Kristy Andreas says she experienced when she took her then-3-year-old son, Evan, to see Dove. If she had understood Evan would be papoosed, she would have insisted on staying with him, or at least behind the door, she said.

Evan says he was scolded and hit during his dental procedures, Andreas said. In addition, Andreas found Dove's care faulty. She ended up getting not just a second but a third opinion to prove it, all of which she said she has documented in her dental board complaint.

Attorney setback

Late last year, Colorado attorney Moriarty told The Californian he was poised to represent Bakersfield parents and was planning a visit here to ink the deal. Earlier this year, he said he was having an expert review some of the children's dental records. But last week, he said he had decided not to take the case.

Moriarty's other dental clients have been in the headlines recently for a case against a dental management company. Such management companies, which are often backed by private-equity money, are the subject of a U.S. Senate inquiry.

Moriarty said some private-equity backed dental businesses routinely bilk Medicaid patients, mistreating them in the process. Even though Medicaid reimbursements tend to be very low, the idea is that the businesses can make money if they practice "assembly line medicine."

"They routinely papoose and grossly sedate children, routinely refusing to allow parents to be present," he said. "They do that to keep parents from knowing what they're doing."

Moriarty said he was drawn to the Bakersfield case because of the parents' mobilization efforts. Ultimately, though, there was too much "he said/she said" and it would have required working with another California-licensed attorney since he was out of state, he said. Besides, he specializes in going up against private equity-funded dental businesses. Dove owns his own business.

Moriarty was clear that he still supports the California parents' mission.

"What Chris Cook and the other families did -- banding together, raising hell and bringing attention to the authorities --brings to light" conduct which otherwise would not be brought to life, he said.

That's exactly what local parents hope to accomplish June 9, when they say dental board investigators will interview their children at the Bakersfield Police Department.

If a dental board investigation finds a preponderance of evidence some violation has occurred, the next step is for the case to go before an administrative law judge, said Russ Heimerich, a spokesman for the dental board. He would not comment on any specific details of the Dove case.

But that could take some time. From January to March of this year alone, the dental board received 969 complaints. From the intake of a complaint to disciplinary action -- if it is deemed necessary -- takes about 1,100 days on average.

"I know some people want it wrapped up in an hour, like CSI," Heimerich said. "But these aren't investigations that happen overnight."

Staff writer Jason Kotowski contributed to this report.

Private equity, profits and aggressive dentistry

 

Global Post

Bloomberg has published an article today that you just have to read.

It starts with a mom in Arizona picking up her (sobbing) 4 year old after school, only to learn that a dentist had installed steel crowns on two of his back teeth — "pulpotomies" according to a note in his backpack. Baby root canals.

The mother hadn't even been consulted. "I was absolutely horrified," she said.

No, this wasn't Marathon Man for toddlers. So why this aggressive act of dentistry?

It was about money. Profits. Private equity. And a new plague known as "dental abuse."

Bloomberg explains:

Isaac’s dentist was dispatched to his school by ReachOut Healthcare America, a dental management services company that’s in the portfolio of Morgan Stanley Private Equity, operates in 22 states and has dealt with 1.5 million patients. Management companies are at the center of a US Senate inquiry, and audits, investigations and civil actions in six states over allegations of unnecessary procedures, low-quality treatment and the unlicensed practice of dentistry.

ReachOut, Bloomberg reports, is one of just 25 dental management services "bought or backed by private-equity firms in the last decade." The management services take care of the business side, leaving the dentists to focus on teeth. The trouble started when the profit-driven businesses began seeing opportunity in your tax dollars: Medicaid.

Maybe that's why there's a big cavity in the US government's budget?

A former physician once counseled me that dentists were "a bunch of crooks, out to get rich." At the time, I took that with a grain of salt. Thanks to Bloomberg, I won't even floss without exercising caution.

Click here, and read on. 

And if there's a dentist nearby, keep your mouth closed. 

American’s Dental Health is at Risk: The true crisis in dentistry

As Bloomberg reported today, Private Equity is seen as the driving force behind abusive dentistry and Medicaid fraud. Little Isaac Gagnon, is still suffering from night terror from the abuse he endured while he was supposed to be safe at school.

The Fort Worth Star Telegram followed saying Texas taxpayer are getting hosed for unneeded dental procedures which amounts to Medicaid fraud.

Byron Harris of WFAA in Dallas has been reporting about this for months.

However, it is “We The People” who are picking up the tab and enriching Private Equity firms coffers into the billions of dollars. But that is not the biggest price being paid.

The biggest price of all is the dental health of each and every American!

This is not a Medicaid patient only problem. The same driving force is behind places like Heartland, MidWest, Pacific Dental, BrightNow, Aspen Dental, Affordable Dentures, Comfort Dental and now Wal-Mart is getting in on the action. The list goes on.

It’s not just Texas taxpayers, it’s ALL taxpayers

Texas taxpayers soaked for unneeded dental work

Speaking of Texas teeth, combine devious dentists with dubious private equity firms and what do you get?  

Soaked taxpayers it seems, Bloomberg reports.  

Some private equity firms have figured ways to overcharge Medicaid for dental work, and Texas seems to be a hotbed. The Texas State Board of Dental Examiners is investigating dozens of cases where dentists billed Medicaid for unneeded work or for services they didn't do. A Dallas orthodontist who reviewed Medicaid dental claims for the state told Congress that fraud in Texas is flagrant and that some dental clinics engaged in the illegal practice of dentistry.

Don't credit the state for uncovering the scandal. A series of exposes by Byron Harris of WFAA revealed little oversight of the state Medicaid program. He reported that more than 20,000 Texas children under age 12 received braces in a year's time. One clinic billed Texas Medicaid more than the whole state of Illinois spent on Medicaid dental care.

Chew on that a while if you wonder whether Texas state government is keeping a close watch on spending your tax dollars. 

Read more here: http://blogs.star-telegram.com/investigations/2012/05/speaking-of-texas-teeth-combine-devious-dentists-with-dubious-private-equity-firms-and-what-do-you-get-soaked-taxpayers-ac.html#storylink=cpy

Bloomberg reports rats out Private Equity dental abuses on children in public schools and the public at large

Bloomberg report

Special needs child taken from class and received root canals, stainless steel crowns and excessive X-rays without parents consent or knowledge, while his brother was next to him hearing his screams of pain and fear. 

Dr. Alvin Coon working for ReachOut Healthcare America's Big Smile mobile dental program deliver the horrifying treatment and could be headed to jail. Just two weeks ago a child in California had 4 teeth pulled while at school by the same company.  The company is under investigation in AZ and CA.

Read the shocking story here at Bloomberg

 

Want to see what happens to these children? Watch this!

http://bloomberg.com/news/2012-05-17/dental-abuse-seen-driven-by-private-equity-investments.html

As an after dinner liqueur I suggest this – April 30, 2012

Big Corporations Pony Up Over $1 Million To Oppose Senate Bill 655 in Legislature

Pueblo Small Smiles Dental Center Sold?

Rumor has it, Dr. Andrew Loomis – date of hire May 23, 2011- is purchasing the Small Smiles Dental Clinic in Pueblo, Colorado and the current employees last day is late next week.

Anyone besides me crying foul and not believing that an actual sale is happening?

I find it odd that a guy who has been with the company for less than a year is purchasing the original Small Smiles. You know the DeRose family is not going to allow anyone to control their original clinic. I’m sure it hold a massive amount of sentimental value.

The clinic just so happens to be housed in a building owned by the DeRose-Padula Enterprises. This sounds like North Carolina and DeRose’s fake sale of the Smile Starters Dental Centers to his employee, Raf Rivera, DDS about the time he agreed to pay $10 mil to settle fraud charges.

If I were a dentist purchasing the clinic, where I had been an employee for a year. There was a  full staff with whom I had worked all during that time, I would most likely keep them on, wouldn’t you? Why wouldn’t you? Some of those let go will be bound by non-compete agreements won’t they?

I’m pretty darn sure Michael DeRose, Eddie too, are on the List of Excluded Individuals and Entities and are not to participate in the Medicaid program, directly or indirectly. I guess DeRose Padula Enterprises is not on that list so it can participate? All sounds ridiculous doesn’t it? That’s because it is ridiculous.

Presumably Randall Ellis, DDS owns the place, right? He is one of those “fake” owners for Church Street Health Management. One thing is for sure, if Randy Ellis, DDS actually owns the clinic,as he has filed sworn documents attesting to, then he should have some serious capital gains on that 2012 tax return on his.

However, if you go back and look at the entity documents on file with the Colorado Secretary of State’s website, I’m not sure it ever left the DeRose Family in the first place.

Tax Assessor Office

Pueblo Tax Assessor's Office, report on 1022 Liberty Lane,Pueblo, Colorado, 81001

All Personal Property is billed to Church Street Health Management, LLC in Nashville, assessed at $34,996.

Land and Building belongs to DeRose Padula Enterprises. Assessed value for 2012 is $430,411. (land 77,500 structure $352,911)

So what did Dr. Loomis purchase and from whom did he purchase it? Has this been reported to the Bankruptcy Trustee?

How many papoose boards did he get in the deal? I notice they are not actually listed as being part of Church Street Health Management’s assets, but surely they are part of the $34,996 of “personal property”. Did he get his contract back so he’s not auctioned off like a slave in a human trafficking ring?

Church Street Health Management Personal Property (Form B38)– begins on page 32

Church Street Health Management, LLC Credit Agreement with Garrison Loan Agency, LLC

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.

Small Smiles Dental Centers employees kept in the dark

This letter was received last week from a Small Smiles employee. It is one of two received last week alone. Hopefully any identifying info was scrubbed, if not, oops, sorry.

My job is obviously a nightmare. I have been an employee with the company since March. A lot of funny business goes on. We are a profitable clinic probably when I first started in we were averaging 100 patients a day which is close to $10,000 a day now we see approx. 50.

I  for the last year have been miserable at my job but as a single mom with no child support I struggle to leave and possibly lose my apartment, etc.

It's not so much that i think what we do at my office in unethical most times I do agree on the treatment.  Big changes in the last year obviously after the Medicaid fraud we have a million compliance meetings, the state cracked down on reimbursement for stainless steel crowns. We no longer papoose (for the most part) as I was seeing many in a day we may have one a month..everyone's scared.

[well at least I’ve accomplished something!]

They are acting as if we will stay open and tell us very little.  Always constant changes weekly at small smiles..such as bill out what was before a periapical as an occlusal etc...no more papooses for Dr's etc.

[ so was it fraudulent billing before or now?]

All I really know is when they filed they told all 67 clinics over the phone a big 67 clinic phone conference and we were encouraged to ask questions basically it was that Tori guy who said business as usual...they don't want the company morale to be down so they don't tell us any new news.

Steve Adair told the Dental hygienist's if they see an HIV patient to double glove spray the room and leave it for two hours..who says this???? Exactly the opposite of what I learned in school.

Anyway the anxiety level I have when I get to work and the fear the boss puts in you and the company morale is terrible. They have us going out now doing ten minute marketing in which I have to walk the streets and pass out toothbrushes to passerby's encouraging them to come to Small Smiles.

Well in a city it’s the same damn people everyday. My bosses are acting like nothing is happening but a few of us follow your blog closely. It's the only truth we get. Dr (intentionally removed) is the current lead dentist "owner "of the office I work at, he is (age removed) spinning in circles and about to have a heart attack. I actually feel for this guy he is so going to get thrown under the bus. He does whatever they say no matter what he thinks

[ He is exactly right. He will be, the whole business is designed to protect the quarterback; Corporate Headquarters.]

But it's his own fault I said to him, “you actually own this place and he said no, I paid $100 and they put my name on the building.  I think what he said is BS.

I was venting sorry so basically I was wondering if no one bids on this hellhole by the 11th this Friday could it be the doors are locked Monday?????????? or probably not going to happen until after the 22nd...??????????

Can they possibly prolong the agony and then file chapter 7? I wish I could quit and go collect unemployment and state how horrible stressful and much anxiety this job gives me but I know they would fight it and I would lose and then put my daughter and I in a poor situation...

I wish there was something I can do..we started seeing adults in November 2011. I think they got a huge tax break for that or maybe are just desperate for any patients we can get.

I feel terrible telling these adults go see the oral surgeon get your teeth extracted then come back and we will fit you for dentures and I have no idea if we will be here???? Any thoughts,  any advice????

I thank you for your blog..it's my only knowledge and when they told us in a morning huddle that Lori Steiner-chief compliance officer was going back to her roots and leaving CSHM.  I was silently cracking up thinking about your blog which usually is the topic of our lunch room conversation and her last day (Lori Steiner the compliance officer) is May 31st how convenient.

Another dentist concerned about or lead/owner told me privately that she spoke with our lead/owner, and told him he should get a lawyer since he's the owner. He told her he had corporate lawyers.

The dentist looks at me and laughs and says “he's going to fry....”

[yes he is! so things must still be a bit shady around there, maybe?]

I feel that those of us who read your blog know more than they do. I just wonder if no one buys CHSM are we definitely closing??? Could they possibly only close some clinics and keep some open???  We have had a few people leave  and they are not replacing them.  But they tell us they aren’t replacing them because we have slowed down...everything is a lie.

I’d love to say thanks again for sharing your story Debbie...I just want it to end for me the girls I work with and the patients.

I appreciate your blog. Thank You

[You are welcome!]

Medicaid Dental Patients For Sale

This one blows my mind. This was an ad that landed in many dentists email box on Monday. 1-800-Dentist selling "leads" for prospective new patients on "state aid". Now, I ask you, what medical provider is patient shopping for potential patients in a program most all says reimburses way too little? Only a big dental mill would be willing to pay $25 per lead for 'state aid' patients.

Is 1-800-Dentist selling patient contact information or are they a third party broker and selling the names of patients which would be (assets) of bankrupt dental clinics such as Small Smiles and All Smiles? Someone needs to be asking?

HIPPA violations??  Anyone??  Bueller?

Where did 1-800-Dentist get these names? At the Corporate Dentistry Going Out of Business Sale?

 

 

 

 

 

 

 

 

 

 

 

 

What's really fantastic, is they can sell the same stuff over and over and over and over again. This is really not unlike the paid patient hunters where dental clinics have employees hit the food banks and food stamp office and get paid per head to bring them directly to the dental office. The patients want to come to get their wal-mart gift cards and such!  Win win!

How prepared is your dentist?

How prepared is your dentist?

One local family's mission to keep children safe

How prepared is your dentist?: wavy.com

 

Updated: Monday, 14 May 2012, 6:30 PM EDT
Published : Monday, 14 May 2012, 4:49 PM EDT

• David Culver

CHESAPEAKE, Va. (WAVY) - A trip to the dentist can evoke pain, anxiety or fear. Those feelings generally subside once your appointment is over. But for one Chesapeake family the pain will never end. It's been five years since their traumatic visit.

Today, they want to challenge parents; they want them to question their child's dentist.

On March 9, 2007, the Blanco family took their 8-year-old daughter Raven in for a simple procedure. She would be sedated, worked on, then awakened from her sleep.

But Raven never woke up.

Raven's father, Mario Blanco, often visits Norfolk's Forest Lawn Cemetery ; that's where Raven is buried. He brings a chair and sits a few steps from her headstone. It's time alone with his eldest daughter. He opens up to her.

"I don't hear her talk back, but I feel her presence," Mario said.

There is a picture of her at the burial site and Mario meditates on her sweet smile. The same smile still fills the Blanco's Chesapeake home. There are family pictures in every room.

Raven's mother, Robin Blanco, still finds her young daughter's death hard to accept.

"For me, the longer the time goes by, you learn to cope with it. But the longer the time goes by, I miss her more," Robin said, her voice cracking.

Raven was sedated for a routine dental procedure. While getting the work done, complications arose and her heart stopped. Robin watched as staff members performed CPR on her little girl. Crews rushed the child from the dental office to the hospital emergency room.

"I remember a doctor coming out and telling... you know, that they've done all that they can do," Robin continued tearfully. "And did I want to see her - you know I just couldn't believe it. And I said, 'Yes I want to see her. I want to see her.' I just couldn't believe it. And she was gone."

In Raven’s memory, the family started The Raven Maria Blanco Foundation, Inc. They follow and share the stories of other children who’ve died following complications at the dentist.

By their count, 11 have lost their lives in the past year.

Today they're on a mission to educate parents and they want dentists to be prepared. Raven's cousin, Nicole Cunha, is spearheading those efforts.

"People have to go to the dentist, people have to have these things done, there are children with anxiety that have to be sedated, they have to have the work done on them, so no you can't take that away, you have to know what to do if something goes wrong," Cunha said.

Virginia Beach Oral Surgeon Dr. Scott Goodove puts into practice what Raven’s foundation wants in every dental office. He told us, "If we have an emergency, our assistants are prepared. They have stations to take if we have an emergency from the back to the front."

Each morning he holds a staff meeting and goes through the patient list. They discuss any medical complications that could arise.

Dr. Goodove sedates hundreds of patients each year. That's far more than a general dentist. But he points out that oral surgeons also undergo years of specialty training. His advice for any dental office, whether they sedate or not, be ready for a worst-case scenario.

"What we have here is sort of a more organized central emergency station.... (Our) patients walk in, they feel comfortable, 'Hey ... these guys are prepared.'"

In a corner of his office he has an automated external defibrillator (AED), a tank of oxygen, a range of medications and drugs. There's also an emergency response guide.

CLICK HERE FOR THE RAVEN MARIA BLANCO FOUNDATION'S SIX LINKS OF SURVIVAL

"It's as simple as picking the emergency - someone passes out - and it will give you the step-by-step guide. But you don't want someone reading this for the first time during the emergency itself, so you run through these drills."

And Dr. Goodove holds mock drills every month. For general dentists, not doing deep sedation procedures Virginia dental regulations don’t go nearly that far. That’s where the Blanco’s want the public to help.

"If we get a group of the whole country coming together, and demanding these things, you'll see a big change," Mario said. Mario eventually wants to see these preparedness practices become law - Raven’s law - as he sees it.

Meantime, much of his time is spent sitting across from Raven burial site, as they keep each other company. Her epitaph reads: "'The most beautiful girl in the world a beloved daughter and sister who is missed and loved so much. One day we will all be together again....' And we will."

Raven's parents want you to ask certain questions before you make a dentist appointment for your child. Click here for a list of those six questions.

Click here to watch the portion of our interview in which the Blanco's discuss taking their other children to the dentist for the first time, following Raven's death.

---

After this story aired, I received the following:

 

Kimberly Asercion

Hello,
After going to the link that showed all the children that had lost their lives due to "complications" at the dental office, I felt like I just needed to tell someone briefly what I have experienced as someone "in the field". I live in Va. Beach and was a dental assistant for almost thirteen years. (I left the field in 2004 after working in an adult practice, and since that time I actually work in the cemetery industry as a General Manager at a cemetery in Va. Beach) I worked five of my thirteen years in a pediatric office. (Drs Sundin and Bullock) and about two months after that at Drs Hechtkopf and Cox. (1998) I did not work long at the last office because the unsafe practices that they undertook actually scared me.

When a child had to have a lengthy procedure they were given Chloral Hydrate for the procedure as well as Nitrous Oxide. (and Lidocaine of course) The dental assistant would come out to the waiting room and get their patient and bring them back. Then the assistant would mix the Chloral Hydrate based on the dose prescribed by the Dr. and give it to the child. Within about ten minutes the children would literally just start getting drowsy and then basically pass out. We would then have to hold them until it was time for them to have their work done...if the office was busy that day then sometimes that could be up to 45 minutes. During that time (and this happened A LOT) the children would begin vomiting...while unconscious and we would have to try to hold them upright while this was happening.

When the procedure would start, the child (who was already completely unconscious) was given Nitrous. It was jacked up way over the necessary level (about 70%) and to the point that it would induce nausea and vomiting even in an adult...but especially on a child that was already sedated. While the child was being worked on (with the papoose board) they had a heart monitor on...when their heartbeat would start to increase the Dr. would say, "Okay...get ready...here we go!" (Because the heart rate would increase when they were getting ready to vomit.) They would not reduce the Nitrous strength and we would just have to keep suctioning as they were getting sick.

After the procedure was finished, they would turn on the straight oxygen and start to try to wake the child up. They would still be very groggy when we would carry them back out to their parents, however we were not allowed to tell them that their little child had just spent the last two hours vomiting while unconscious. We did give them precautions for them to eat lightly and to watch them while their mouth was still numb so that they wouldn't bite the inside of their mouth, etc. They never had any idea what had happened back in the office though. That is the part that was so upsetting to me.

I happened to be CPR certified, however this was not a requirement for the job. I was never asked before I was hired if I was. That I know of, none of the assistants were ever shown emergency procedures. I know I was not. This happened on an almost every day basis. Now, when I started the job, I did have eight years of experience and five of those had been in a pediatric office...however the requirements to get a job in Dr. Hechtkopf and Cox's office were very minimal.

I am saddened to hear these stories...I can very easily see how these tragedies could take place. The dentist most of the time very heavily relied on their assistant to have already checked the child's health history without every looking at it themselves. (This was the story in every office I worked at unfortunately.)
I'm truly sorry that this happened and I hope that you sharing these stories will help to regulate the requirements of dentists and their assistants in the future. I just felt like I needed to tell what it was like behind the scenes because I can easily see how this could have happened.
Sincerely,
Kim