What that settlement is remains unknown. Here is the latest entry on the court docket, dated June 3, 2014.
ORDER: The court has been notified that this case has settled. It is hereby ORDERED that a stipulation of dismissal or other settlement document shall be filed within thirty (30) days of the entry of this Order.
The preliminary injunction hearing set for June 5, 2014, and the initial case management conference set for June 6, 2011, are CANCELLED.
Revisiting 2009 MassHealth Independent Audit Report; not much has changed.
With corporate dentistry taking over the world, it’s good to remember Allcare who closed it’s doors overnight in January 2011 leaving patients without care or recourse, and dental boards scratching their..uh.…heads.
A class action lawsuit was filed and just like the Allcare’s doors, patients were left lock-jawed.
Allcare Dental Class Action Lawsuit
The Allcare companies filed for bankruptcy in the Western District of New York (Buffalo), Bankruptcy Petition #: 1-11-13848-CLB. Those proceedings terminated in 2013 with a report of no distribution. As such, there are no available assets from these entities for unsecured creditors.
You may have individual claims. Once the class action claims are dismissed, the statute of limitations for your claims will continue to run. You should contact an individual attorney in your state if you desire individual representation. Failure to file within the applicable statute of limitations will forever bar your claims. We are not handling these claims given the no-distribution report.
Allcare patient speaks about ordeal in 2012.
http://www.abc57.com/home/top-stories/ALLCARE-DENTAL--162156285.html
In an Affidavit filed this week in the Bahr brothers (CDMO & CDET) v. Rick Kushner and Comfort Dental lawsuit reveals the abuse and threats that reign down from Kushner and other Comfort Dental executives.
Louisville, Colorado Comfort Dental subfranchisees were berated, threatened and assessed $50,000 penalty for failing to use Budget Dental Lab dba Premier Dental Lab owned by Rick Kushner—owner of Comfort Dental, Inc.—and his brother, Barry Kushner, along with Roy Martin, C. Michael Bloss, Bruce Irick and Neil Norton.
“We would order an appliance from the non-Comfort Dental lab because quality was much higher and much more reliable.”
“In some cases costs were higher when using a non-Comfort Dental lab, but we felt it necessary to serve our patients’ best interest.”
“Comfort Dental assessed a $50,000b out-o-system lab referral penalty on us.”
“…after having been summoned by Rick Kushner, at a meeting at the Comfort Dental headquarters in Lakewood, CO… we (the partners of Louisville (CO) office were admonished by Rick Kushner and about the franchise violation, use of an outside lab. Immediately thereafter, Rick Kushner announced that a $50,000 fine was being imposed on our office/partnership. The entire sum due and payable in 2 weeks.”
One of Dr. Miranda Smith’s patient had perfect teeth, yet in Smith’s treatment plan she pulled every tooth and fit the patient with ill-fitting 
Other’s were children, sedated, for dental treatment they didn’t need.
Her husband blames the whole mess on “two disgruntled and racist employees”. And says, “She’s been fighting this for three years, nine employees and their families are out of work because of this”.
Christopher Torres, her attorney, says many of the charges have been disproved on an “administrative level” and believes the criminal charges won’t hold up.
Apparently the Feds think otherwise and have a 21-page affidavit to back it up with $140,000 in Medicaid fraud charges.
It’s not the disgruntled employees that concern me, it’s the ones who are happy at their job working for dentists like these.
Smiles and Giggles Dentistry for Children and Adults is located in Spring Hill, Florida.
Florida AG Press Release:
Attorney General Pam Bondi News Release
May 23, 2014
Media Contact: Jenn Meale
Phone: (850) 245-0150Attorney General Pam Bondi’s Medicaid Fraud Control Unit and the Pasco County Sheriff’s Office Arrest a Tampa Bay Dentist
TALLAHASSEE, Fla. –Attorney General Pam Bondi’s Medicaid Fraud Control Unit, with the assistance of the Pasco County Sheriff’s Office, arrested Pasco County Dentist Dr. Miranda Smith on charges of Medicaid Provider fraud.
Dr. Smith, owner of Smiles and Giggles Dentistry for Children and Adults in Pasco County, allegedly billed Florida’s Medicaid program more than $140,000 in dental services which were either unauthorized or not provided.
The Attorney General’s Medicaid Fraud Control Unit initiated its investigation of Smith and her dental practice after receiving complaints about suspicious billing from parents and patients. According to the investigation, Smith billed Medicaid for x-rays, anesthesia, and other dental procedures that were not performed. Additionally, former patients alleged that Smith’s employees provided dental care, even though these employees were not licensed dentists.
According to the investigation, at least one minor patient's parent was told her child had eight cavities and would need to be sedated to perform urgent dental work. The parent received a second opinion from a dentist with more than two decades of experience. The dentist performed her own examination and found that the child had no cavities.
Investigators also found that Dr. Smith and staff exhibited a pattern of pulling healthy teeth in an effort to sell patients dentures and make larger Medicaid claims.
Smith is being charged with two counts of Medicaid Fraud. If convicted, she could face up to 10 years in prison and up to $10,000 in fines. The Attorney General’s Office of Statewide Prosecution will prosecute this case.
The Florida Department of Health’s Board of Dentistry voted on May 16, 2014, to suspend the license of Miranda W. Smith, D.D.S., in case number 2011-12390. This suspension will become a Final Order of the board within the next few business days.
I couldn’t help but compare the two pictures above! LOL
Never mind…
For those who think the Texas State Board of Dental Examiners can’t take swift action, you are dead wrong.
Bryan, Texas creepy dentist and dental board member, Dr. William Reagan Birdwell was arrested Wednesday, May 21, 2014 after caught filming an employee changing in his office bathroom.
At lightening speed the board took harsh action by removing any mention of him on their board member page.
So there!
Birdwell was appointed by Governor Rick Perry in 2009 for a term ending in 2015. I guess his term ended early.
Wednesday May 21, 2014 TSBDE Board Members
Two days later, poof, he’s gone!
The Hearing scheduled for May 14, 2014 to hear arguments on the Temporary Restraining Order and Injunction was rescheduled until after June 5, 2014 apparently to allow time for discovery such as a deposition of Jodi Kuhn. (see Joint Motion to Reschedule)
(Waist high boots will not be nearly high enough; so I’m thinking a full diving getup will be needed.)
May 6, 2014 Kuhn filed her Response to CSHM’s Complaint, which I thought odd. Usually at least 2 extensions are asked for before those are ever filed.
Reading the Response will make your head spin, but don’t be alarmed. It’s suppose to make the judge’s head spin, and frankly after reading the Complaint and the Response my sympathy is with any judge who finds this mess on his docket.
I find the Complaint and Response something conjured up in a witch’s cauldron. Hardly a sentence in either has the actual truth of the matter at hand. I wonder how she squares up everything in her Response with the clinics she has her name slapped all over in Ohio and Kentucky. (you will see what I mean when you read it) .
If Kuhn’s lies hold, then every clinic is up for grabs in more than just Small Smiles!
She goes into great depth about how CSHM was the one Excluded from Medicaid and not her Colorado clinics. She even attaches the Joint Report by Senators Baucus and Grassley, talking about what terrible treatment children receive at Small Smiles clinics.
Since she contends HHS-OIG has serious problems with CSHM, and not Small Smiles clinics, I wonder why the clinics, staff and treatment received at the clinics were under such scrutiny; CSHM wasn’t treating these sweet children.
Anyone think HHS-OIG had problems with the way Kuhn’s paycheck was being printed or something? Further she didn’t mind one bit to hand over every dime “her” clinics made to CSHM until the Exclusion was announced.
Frankly, I would have been pissed long before now they were taking all the money I was making straight out of my bank account. Plus, I’d be pissed they were still taking it out of my Ohio and Kentucky clinics. She doesn’t mention those clinics. Hmmm….
Related Documents:
CSHM v Jodi Kuhn Complaint, April 21, 2014
CSHM v Jodi Kuhn Response, May 6, 2014
Thornton Small Smiles Purchase Agreement, May 6, 2014
Thornton Small Smiles Stock Pledge Agreement, May 6, 2014
Joint Motion To Reschedule TRO Hearing, May 12, 2014
What’s in a name? A brand.
Anyone besides me think the DGPA has gotten such a bad reputation over recent years, it needed a name change? Does it matter? Not really. They are who they are, not matter what they call themselves.
“Association of Dental Support Organizations” Unveiled as New Trade Association Name
(May 13, 2014) – NAME CHANGE REFLECTS EVOLUTION IN THE DENTAL PROFESSION AND ASSOCIATION’S FOCUS
DENVER, May 13, 2014The Dental Group Practice Association (DGPA), a nonprofit industry association representing more than 30 dental support organizations (DSOs), announced today that the organization has changed its name to the Association of Dental Support Organizations (ADSO).
“It’s important that our organization’s name clearly reflects our mission to support DSOs and all they do to ensure the delivery of innovative, high quality and cost effective care,” said Dr. Quinn Dufurrena, Executive Director of ADSO. “Our mission is to provide world-class business and technology support services to dentists, a partnership that lets dentists focus on what they do best, which is serving their patients.”
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
In an article on Dentaltown, dated October 2012 Comfort Dental founder, Rick Kushner said: -
“Corporate dentistry scares the hell out of me for two reasons: first, whether they get their money from the public or from private equity, corporate dentistry will always have only one priority: demonstrate more profit. (By the way, Comfort Dental has only one original money source: me. Oh and a couple of local banks. Of course, every single Comfort partner is equity invested in his/her own Comfort partnership.) And secondly, as a dental “chain” we are unfairly lumped together with corporate dentistry by ignorant dentists including DSIs (dental school instructors) and of course, some patients. Structurally and philosophically we at Comfort are as far from corporate dentistry as traditional private practice. Had the profession listened to me instead of attacked me over the past few decades, the professional landscape would be saturated with Lean & Mean group type practices so prosperous that there would have been neither need nor room for corporate dentistry. So again, how did corporate dentistry happen? It’s dentists’ fault. It’s DSIs (dental school instructors) fault. It’s not my fault; it’s their fault. Dental practices were so bad for so long with their 80 percent overheads and their hygiene-heavy practices that businessmen in business suits looked at them and instinctively knew they could do better and keep the difference in profits. And guess what? They were right. Businessmen in business suits looked at dental practice and knew they could handle our business better than dentists. So they did. Not my fault. I warned dentists but they were smarter than me. Graduates laden with debt and corporate dentistry are a match made in heaven. “
I would agree with 90% of that statement.
However a Complaint filed March 25, 2014 in Colorado US District Court accuses Comfort Dental of “exerting excessive and improper control over medical decisions and judgment of dentists practicing in Missouri, Kentucky and Indiana” appears to indicate Comfort Dental is more “corporate” than Mr. Kushner likes to think.
A Brief filed with the Compliant, seeing an Injunction against Comfort Dental states:
“Comfort Dental’s illegal conduct exposes Plaintiffs to immediate and irreparable harm. Comfort Dental’s demands that the Plaintiffs participate in the MLRP (Mandatory Lab Referral Program) and sell the Gold Plan (unregistered discount medical plan) force Plaintiffs to make an impossible choice: lose their 25 year franchise or violate the laws of multiple jurisdictions.…it impermissibly interferes with, and exerts control over, dentists’ independent medical judgment and forces Comfort Dental dentists to place the financial interests of Comfort Dental’ s owners over the best interest of their dental patients…threatens irreparable harm by threatening to terminate Plaintiff’s franchise, and by demanding that they engage in potently illegal conduct which could expose them to penalties, professional licensure actions and damage to their patients relationships and reputations. “
I read this to say, instead of dentists being fired, their Subfranchisee Agreement can be terminated without notice or opportunity to correct problems that may arise.This sounds a whole lot like more like “corporate dentistry” than independent franchise owners to me. As always I could be wrong.
However, before getting into what meticulously laid out in the Complaint and other pleadings, you need to know the players:
Dr. Li Lou Skelton, current dental license status is Active/Probation.
Agreed Settlement Order that began in June 2008; all related to Dr. Skelton’s dental treatment of 8 patients fell below the acceptable standard of care on 2004 and March 2008.
August 2010 Agreed Settlement Order dated August 2010, over substandard care of 17 additional patients. In addition to restitution to patients Skelton agreed to pay the Texas State Board of Dental Examiners $20,000 over the next 4 years in $5,000 installments.
Five Malpractices cases were filed against her in 2013 and between February and April of 2014, 3 additional cases have been filed.
This woman as 7 pending malpractice suits!!
Where is the Texas State Board of Dental Examiners?
| Case No. | Date Filed | Case Status | |
| 1 | 2011CI09803 | 06-14-2011 | DISPOSED |
| 2 | 2011CI15583 | 09-23-2011 | DISPOSED |
| 3 | 2013CI00047 | 01-02-2013 | PENDING |
| 4 | 2013CI05704 | 04-04-2013 | DISPOSED |
| 5 | 2013CI08156 | 05-14-2013 | PENDING |
| 6 | 2013CI08796 | 05-23-2013 | PENDING |
| 7 | 2013CI20502 | 12-18-2013 | PENDING |
| 8 | 2014CI02109 | 02-12-2014 | PENDING |
| 9 | 2014CI05424 | 04-03-2014 | PENDING |
| 10 | 2014CI05500 | 04-04-2014 | PENDING |
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 
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
CSHM, LLC/Small Smiles Dental Centers/”fill in the blank” Youth Dental Center” was granted a Temporary Restraining Order against one of its fake “owner dentists” in US District Court last week.(April 25, 2014) The Order was granted after a Complaint was filed against Dr. Jodi Kuhn for allegedly breaching her various Management Service Agreements (MSA’s) with CSHM, LLC.
The Complaint states in January 2013 Dr. Jodi Kuhn Kuhn purchased 4 clinics in Colorado for $100 each from Randall W. Ellis, DDS—the prior fake owner dentist. Ellis purchased from Robert Andrus, DDS, the prior prior fake owner.
(That’s a damn good deal! But I don’t believe it to be true; not much of of anything in these documents is actually true. Kuhn’s name doesn’t’ appear until December 2013. If she purchased the clinics in January 2013, why is CSHM’s Linda Zoeller name still plaster all over the 2013 annual reports. After all Jodi did it herself in December of 2013.)
How the people at CSHM keep it straight as to when they own the Small Smiles clinics and when they don’t is beyond me; since it always depends on who they are communicating as to whether they own them or not. Of course, the truth is they do own them, and Sen. Grassley’s report provided that evidence.
Church Street Health Management (CSHM) f/k/a FORBA had to divest in the Manassa, Virginia clinic in March of 2012. HHS-OIG sent them a Notice to Exclude. Here is the HHS-OIG agreement sent to Sheila Sawyer, General Counsel and Chief Administrative Officer of CSHM at the time.
On April 30, 2012, the sham owner of the Small Smiles of Manassas, Gillian Robinson-Warner supposedly signed a Termination Agreement with CSHM. The Termination Agreement states Small Smiles of Manassas, LLC, a Virginia limited liability company, “owns and operates a dental practice in a dental office at 9012 Mathis Avenue, Manassas, Virginia 20110”. Apparently the Manassas clinic was the worst of the worst of the Small Smiles clinics. However, all clinics have been under a Quality of Care Corporate Integrity Agreement since January 2010.
As the Manassas Termination Agreement reads one would assume Small Smiles of Manassas, LLC is a living breathing human-being. Gillian Robinson-Warner signed as President of Small Smiles of Manassas, LLC and agreed to pay CSHM $80,000 to CSHM if they would terminate the said MSA.
The very next day—May 1, 2012—two Motions were filed seeking the Bankruptcy Court’s approval to terminate the contracts.
Motions? Contracts? More than one, you ask?
Yes, there were two!
The same day the Manassas Motion was filed in Tennessee Bankruptcy Court, so was a Motion seeking the courts approval to terminate the Management Services Agreement between CSHM and the Pueblo clinic. The Pueblo clinic is the flagship clinic of the DeRose-Padula family; the ones who created this monster. Isn’t that odd? The Pueblo clinic agreed to pay CSHM $300,000 to terminate their imaginary agreement. Dr. Randall W. Ellis supposed signed as president of the Pueblo clinic.
We know, the Small Smiles of Manassas, LLC is just a shell corporation, like all the others; each clinic has its own LLC or PC designation. Each controlled and operated by the people at CSHM and backers. Those are facts that have been proven over and over.
Despite that being common knowledge; CSHM will tell you the grass is purple while you are standing there looking at it and know its green; maybe they have lived in the fantasy world of “we only provide support services to dentist owned dental clinics land” for so long, they believe their own BS.
It is understandable where all of this might lead to an identity crisis for anyone working at CSHM or any of their Small Smiles clinics; particularly troublesome for Linda Zoeller. She isn’t even sure of her title at the various, LLC’s or PC’s. Here are 4 different titles she gave herself at just one of the Indiana clinics. Stop laughing!
Reading over both Motions and Termination Agreements, I had to laugh out loud a couple of times. (Ok, I’ll be honest, it was more than a couple, and it was more like a couple in “I’ve only had a couple of drinks” kind of way.)
Besides all the stated facts in the document being anything but factual, I had to laugh at the language.
More than once “abundance of caution” was used. By my very favorite was “The Termination Agreement reflects the product of extensive arm’s length negotiations”. I’ll admit I blew coffee across the room when I read that one. I don’t know how a PC or LLC verbalizes its intent in negotiations; sign language?
So you want to sell the dental practice you worked years to establish instead of just retiring and closing the doors? Were you offered, a “too good to be true” deal by Heartland Dental, or some other Dental Practice Management organization?
Do yourself and your patients a favor and decline. Take the lesson’s learned by Dr. Salisbury and don’t be swayed with visions of riches offered by Rick Workman. Otherwise be ready to become the slave of white collar suits sitting in a Canadian board room. Why? Because you will have to hit their production goals in order to receive the your final installment payments. (Read the lawsuit below).
By Tony Edwards, Editor in Chief
DrBicuspid.com talked with Dr. Shah about what drove him to found Dental Equities, what he believes are the advantages of private practice, and where group practices may go wrong.
DrBicuspid.com: How did you go from a thriving private practice to founding a firm to help other dentists in private practice?
Kianor Shah, DMD.
Dr. Shah: Throughout dental school I was interested in the concept of delegating tasks within a practice to enable my colleagues to be more focused on the patient. I graduated from dental school, associated with a doctor, and learned so much from him. After six months, I purchased my first practice with the help of that other doctor and a conventional bank loan.
After you built your practice, you became a practice management consultant, working with group practices. But now you have founded an organization that works to strengthen private practices. Why is that?
Over the course of these last eight years, I have worked with a dozen members of the largest dental management services organizations and members of the Dental Group Practice Association and have observed their operations very thoroughly…
Praise for prosecutors: Ind. attorney general sets high standard
By Michael W. Davis, DDS, DrBicuspid.com contributing writer
April 9, 2014 -- On April 1, 2014, the Office of the Indiana Attorney General filed criminal charges against principles and employees of Anderson Dental Center. Defendants are alleged to have engaged in variety of criminal conduct, including dental Medicaid fraud, forgery of documents, money laundering, theft, corrupt business influence (racketeering), prescription drug fraud, and practicing dentistry without a license. All defendants are presumed innocent until or unless found guilty beyond a reasonable doubt by a court of law.
Several elements make this case very special. First, in the spirit of governmental full disclosure and transparency, the complete investigative report of Diane Hedges, the state investigator for the Indiana Medicaid Fraud Control Unit (MFCU), was posted on the Office of the Indiana Attorney General's website. This report and investigation, assisted by Sheila Green of the U.S. Health and Human Services Office of Inspector General (HHS-OIG) and Neal Freeman of the FBI, was exemplary in its thoroughness and detail. This type of evidence and report is the solid backbone of a criminal case for any state or federal criminal prosecutor. Good governmental investigators such as these are not paid nearly enough, nor appreciated enough by the public. Their work deserves great praise.
Too frequently, criminal charges are not brought forth in prosecution of dental Medicaid scams. Often, only civil charges are rendered, and cases are usually settled for pennies on the dollar, with no admission of guilt. Prosecutors are allowed to close a case. Nondentist owners who may be pulling all the criminal strings are rarely indicted. The crooks go back to business as usual, poor children are hurt, and taxpayers are ripped off once again. The cycle continues. Perhaps this time a chain was broken?
Heads up all you others out there! Round of applause to Indiana AG, however, this is small peas, you have much bigger ones doing the same. Time to put some corporation executives in there with Ms. Metzner.
Anderson Dental Center Busted for Alleged Medicaid Fraud
By Mike Corbin - mcorbin@wibc.com | @WIBC_MikeCorbin
The Indiana Attorney General's office says the unlicensed owner of Anderson Dental Center, three dentists and four employees all face charges they bilked Medicaid of at least $300,000. Authorities say owner Sally Metzner and others submitted false and inflated claims to the Indiana Medicaid program for dental service payments. They say some of the documents were forged to get higher reimbursements than they were due.
The dentists 73-year-old Paul Pangallo, 69-year-old Jeffrey Rich and 46-year-old Thomas Dubois are also charged with money laundering, Medicaid fraud and theft. The four office workers are charged with corrupt business influence. A fifth worker is charged with prescription drug fraud. An affidavit alleges the fraudulent billing continued even after authorities executed search warrants at the office.
How fitting it was signed on April Fool’s Day.
OIG Excludes Pediatric Dental Management Chain From Participation in Federal Health Care Programs
April 3, 2014
Related InformationCSHM, LLC, formerly known as FORBA Holdings and Church Street Health Management (CSHM), signed an Exclusion Agreement that bars CSHM from participating in Medicare, Medicaid, and all other Federal health care programs for a period of 5 years, Daniel R. Levinson, Inspector General of the U.S. Department of Health and Human Services, announced today. The exclusion is based on CSHM's alleged material breaches of its Corporate Integrity Agreement (CIA) with the Office of Inspector General (OIG). CSHM manages and operates the national chain of Small Smiles Dental Centers, which provides services primarily to children on Medicaid. CSHM's corporate predecessor entered into the CIA in 2010, as part of the resolution of a False Claims Act case involving allegations that the company had provided dental services to children on Medicaid that were medically unnecessary or failed to meet professionally recognized standards of care.
To minimize immediate disruption of care to the hundreds of thousands of children treated at CSHM clinics and to enable an orderly, controlled shutdown of the company or divestiture of its assets, the exclusion will be effective on September 30, 2014. CSHM waived its right to appeal this exclusion in any judicial forum.
"CSHM has committed repeated and flagrant violations of its obligations under the CIA—violations that put quality of care and young patients' health and safety at risk," said Inspector General Levinson. "This exclusion underscores our commitment to enforcing our integrity agreements designed to promote quality of care and protect patients in Federal health care programs." Mr. Levinson said that this exclusion "makes clear to the provider community that OIG closely monitors our CIAs, critically evaluates providers' representations and certifications, and will pursue exclusion actions against providers that fail to abide by their integrity agreement obligations."
On March 7, 2014, OIG issued a Notice of Exclusion to CSHM based upon numerous material breaches of its obligations under the CIA. CSHM failed to report serious quality-of-care reportable events, take corrective action, or make appropriate notifications of those events to the State dental boards as required by the CIA, OIG found. CSHM also failed to implement and maintain key quality-related policies and procedures, comply with internal quality and compliance review requirements, properly maintain a log of compliance disclosures, and perform training as required by the CIA. Finally, CSHM submitted a false certification from its Compliance Officer regarding its compliance with CIA obligations.
This exclusion marks the culmination of a series of alleged failures by CSHM and its corporate predecessors to comply with its CIA. Under the CIA, an independent quality monitor conducted more than 90 site visits and reviews to monitor CSHM's compliance. Since the 2010 settlement, OIG repeatedly cited CSHM and took actions to address those violations, promote improved compliance, and maintain access to care for an underserved population. These actions included imposing financial penalties and forcing the divestiture of one of the company's clinics.
Despite these actions, CSHM remained in material breach of its CIA and OIG issued Notices of Intent to Exclude to the company in December 2013 and January 2014. In such cases, providers have the opportunity to demonstrate to OIG that they have cured, or are in the process of curing, the material breaches. CSHM represented to OIG that it would cure the material breaches. However, through meetings with CSHM and its Board of Directors and review of its written submissions, OIG determined that CSHM had failed to cure the material breaches and proceeded with the exclusion.
Until the exclusion goes into effect on September 30, 2014, an independent monitor will continue to monitor the quality of care being provided to patients at CSHM clinics. CSHM is required to inform patients at least 30 days before closing a clinic. CSHM is also required to keep State Medicaid agencies abreast of developments and provide monthly status reports to OIG. Any divestiture of assets by CSHM must be through bona fide, arms-length transactions to an entity that is not related to or affiliated with CSHM.
The Inspector General credited Special Agents from OIG's Office of Investigations, Miami Regional and Nashville Field Offices, with assisting in this investigation. OIG was represented in the investigation and litigation of this matter by Senior Counsel Felicia E. Heimer, Maame A. Gyamfi, Robert M. Penezic, and Tamara T. Forys, with assistance from Paralegal Mariel Filtz.
CSHM disputed OIG's determination that it was in material breach of the CIA.
(Clip taken from interview on why they hired ADP to help them with the UnAffordable Care Act.)
This same study could be done in any state these private equity owned dental clinics operate and the results would be the same, if not worse. All of this has been reported right here since 2007, it’s 2014! Just saying…
Questionable Billing For Medicaid Pediatric Dental Services in New York - March 2014
BY Glenn Blain NEW YORK DAILY NEWS ALBANY BUREAU|Wednesday, March 26, 2014, 12:20 AM
The state’s Medicaid program paid through the teeth for questionable billings by shady dentists and orthodontists, a new federal report charges.
One dentist claimed to have provided one child 42 tooth fillings in a single visit.
Another dentist averaged 16 procedures per child, compared with a statewide average of five, according to the report, which is being released Wednesday.
They were among 23 pediatric dentists and six orthodontists in the state who pocketed $13.2 million in Medicaid payments in 2012 for services that appeared unnecessary or may not have been performed at all, according to the report by the Department of Health and Human Services inspector general.
“We found one orthodontist who treated almost 5,000 children in a single year,” said Lucia Fort, an analyst in the inspector general’s office.
“That’s about 10 times higher than the state average for orthodontists.”
Read the complete NY Daily News Story here.
CSHM/Small Smiles Dental has been changing the business entity names on file with the Secretary of State in Kentucky and Ohio. Small Smiles of Akron, LLC – Michael Crites, DDS has been changed to Akron Smiles Youth Dentistry, LLC – Michael Crites, DDS. (if you would like a look at the many name changes in Ohio, search the Secretary of State site here using “Prior Business Name”)
Small Smiles of Louisville, PSC was changed to Louisville Smiles Youth Dentistry, PCS on November 27, 2013. Since at least June of 2013,
CSHM has also been changing information contained in their dentists National Provider Identifier (NPI) records on file with the Federal government. The mailing address has also been changed in the individual clinic records. The business mailing address has been changed to a US Postal Service sub-station post office box:16 Arcade Unit 198747, Nashville, TN 37219-1994.
The “manager of licensing and credentialing, Ms. Jenell Stringer is making the changes. I’m sure at the direction of someone at CSHM headquarters.
For instance, on June 11, 2013, Ms. Jenell Stringer, Manager of Licensing and Credentialing changed the mailing address in the NPI record of Small Smiles of Worcester, LLC d/b/a Straight Smiles of Worcester-(NPI number 1487943635) to:
16 Arcade Unit 198747
Nashville, TN 37219-1994
615-750-0343
You can see for yourself by searching the NPI number here.
They did the same thing in May of 2010, just 4 months after the Corporate Integrity Agreement was put into place. At that time I believe they used a US Postal Service sub-station at 208 W. 8th Street, Ste 810,Pueblo, Colorado, 81003-3038
If you would like to check out the dentist records, click here. Below are a few names and NPI numbers:
Interview with Gary Iocco, President,
National Association of Dental Laboratories
March 2014
By: Michael W Davis, DDS
NADL Website http://www.nadl.org/home-page.cfm
National Board of Certification in Dental Laboratory Technology http:///www.nbccert.org
The Foundation for Dental Laboratory Technology http://www.dentallabfoundation.org
NADL What’s in Your Mouth http://www.whatsinyourmouth.us
Dr. Davis: Many in the general public may not know the vital role of the dental technician, within the dental team. From my perspective as a restorative dentist, a dental technician can make me look like a superstar, or a nitwit. What exactly does a dental technician do, and why is that so critical in successful clinical results for patients?
Mr. Iocco: As dental laboratory technology professionals we transform the dentist’s directions from the prescription or work order and create the actual treatment option that the dentist has chosen to provide their patient. Quality dental laboratory professionals employ knowledge of modern materials and available technologies to provide our dentist clients with a restoration that is consistent with the high standard of care and esthetics that our dentists expect to provide for their patients.
This is only possible if there is sufficient communication and understanding and a mutual knowledge of and commitment to what is required for a quality outcome.
While good communication is always important, the more complex or involved a case is the earlier in the planning process a dentist should bring their dental laboratory technology professional into the conversation.
Highly skilled and experienced dentists will tell you that to provide the standard of care and esthetics that they seek for their patients restorations, they work closely with a quality dental laboratory.
If anyone is looking for CSHM and Small Smiles press release after the media exposed the fact they will be excluded from Medicaid in 30 days, you won’t find it on their website any longer. No need to put out an “All Points Bulletin”, it can be found below.
President and CEO David R. Wilson, released a memo to payors on March 12, it has since disappeared from their website as well. But never fear,it’s still here.
The whole media statement, from start to finish, basically gave the finger to HHS-OIG and every person who has investigated them since 2007; in addition to making highly misleading—if not down right lying—to staff and employees.
Seems their Facebook page has disappeared as well. I imagine they don’t want any comments or questions, don’t you?
Below is the press release.
March 11, 2014
CSHM, LLC & OIG NOTICE OF EXCLUSION
In a letter dated March 7, 2014, CSHM, LLC (“CSHM”) received a notice of exclusion from federal health care programs from the Office of Inspector General of the Department of Health and Human Services (OIG). The notice of exclusion does not apply to any individual employee or the Dental Centers and Practice Owners, but to the CSHM, LLC corporate entity only. If the exclusion should go into effect, it means that CSHM may not continue with some or all of its current responsibilities under its Management Service Agreement (MSA) and this may affect administrative services related to Center operations.
The exclusion notice is based on the OIG’s determination that CSHM has violated some terms of the Corporate Integrity Agreement (CIA) that has been in place for the management company and its predecessors since January 2010. CSHM assumed the CIA in June 2012 and it is well known that it has implemented the CIA provisions within the Centers and generally since that time. Many Center owners and employees have met the Independent Quality Monitor (IQM) and CSHM’s compliance staff over the last 18 months as the company was implementing the CIA’s provisions. Generally, the alleged violations related to certain delayed reporting of a few adverse clinical events, failure to undertake certain training in 2012 before CSHM assumed the CIA, and the omission of two adverse events on the CIA disclosure log, though over 1,200 events were successfully place on the disclosure log for processing.
CSHM believes strongly that it has substantially and in good faith implemented the CIA at a great cost in resources and with the important cooperation of the Centers and its health care professionals, particularly on the enhancing dental clinical standards. The OIG’s proposed determination to exclude CSHM for some non-compliance with its CIA is an unduly harsh and an unprecedented response to expected and common difficulties in implementing a very complex CIA that has a novel and innovative administrative, process and clinical requirements.
CSHM intends to appeal the notice of exclusion and file a request for hearing with the Department Appeals Board. During the appeals process, the exclusion will be stayed and we will continue to provide business, administrative and support services to 53 associated dental centers in 19 states and the District of Columbia, pursuant to our management services agreements. The legal process will take an indeterminate period of time. In the interim, CSHM will continue to perform normal operations and will continue to provide our internal and external constituents with up-to-date information. Should you have questions regarding this matter, please contact a member of our communications team at Lovell Communications:
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You have to check out CSHM-Small Smiles “Quality and Compliance” webpage. Past the list of the overseers, you will find a link that says“For more information, please visit: www.smallsmiles.com/compliance.
Go ahead, click it.
MARCH 12, 2014 - A company that manages a chain of dental clinics once accused of subjecting children to painful and unnecessary procedures and bilking the government for millions of dollars has been notified it will no longer be eligible for reimbursement from federal health care programs like Medicaid, its principal source of revenue.
The company, CSHM, manages 53 clinics nationwide, most of which operate under the name Small Smiles. The clinics treat mostly low-income children in areas where access to dental care is limited.
The Office of the Inspector General of the Department Health and Human Services sent a letter to CSHM on Friday citing multiple breaches to a compliance agreement, which mandates quality of care measures. The breaches included failing to report incidents involving patients at Small Smiles clinics in Tulsa, Okla., and Mattapan, Mass.
The OIG declined to provide further detail on the specific breaches that led to the exclusion.
Sen. Chuck Grassley, R-Iowa, who last year published a report on corporate dental management companies along with former Sen. Max Baucus, D-Mont., said Monday that the CSHM exclusion notice “will protect both taxpayers and vulnerable children receiving dental care in the Medicaid program.”
Related:
Check out the uptick in legal, conference and lobbying expenses. I’m not sure how you can spend that much in a year and not work more than 8 hours a week.
Management fees have also skyrocketed.
CSHM and Small Smiles have been dodging media phone calls for days. They have finally issued a statement; begrudgingly I'm sure.
They say they will appeal. I hear they won't. Hell, they have been appealing since 2010; dang near quarterly.
They have received at least 2 earlier threats to be excluded; maybe three. The report issued last year by Senator Grassley's office basically asked, "how bad do these folks have to be before excluding them. They may appeal just to keep the revenue flowing. But I would think they should be on a Credible Allegation of Fraud pay hold.
CSHM Small Smiles Dental Media Statement 03-11-2014 by Dentist The Menace
In a letter (see below) to Inspector General Daniel R. Levinson, Rep. Michael Burgess (R-TX) and Rep. Diana DeGette (D-CO) express their continued concerns about “deceptive practices of dental management service companies (DMSOs)”.
They further call on HHS OIG to exclude any corporate dental companies from participating in the Medicaid program, saying, “Based on the report by the Senate Committees and the prior findings of HHS OIG, we concur with our Senate colleagues and recommend that HHS OIG should consider excluding any corporate entity that employs deceptive business practices that result in substandard care, from the Medicaid program.”
Burgess and DeGette are also concerned about the length of time it has taken to bring one of these companies—Small Smiles Dental Centers—to justice.
The letter recounts the history of the Small Smiles investigation, starting with the “2008 investigative news report” by WJLA in Washington. That report actually aired in November 2007; so it’s even worse, right?
The 3 page letter also states:
Grassley: Notice from Inspector General is a Victory for Accountability
March 10, 2014
WASHINGTON – Senator Chuck Grassley, senior member and former Chairman of the Senate Committee on Finance, said the decision of the Inspector General for the Department of Health and Human Services to disqualify CSHM, LLC from the Medicaid program “will protect both taxpayers and vulnerable children receiving dental care in the Medicaid program.”
The Inspector General delivered a Notice of Exclusion (click here to read the Notice) following a year-long investigation by Grassley and then-Chairman Max Baucus of Montana into allegations of abusive treatment of children in clinics controlled by corporate investors rather than dentists. The senators issued a report and recommendations last July and urged the administration to ban dental clinics from participating in the Medicaid program if the dental clinics circumvent state laws designed to ensure only licensed dentists own dental practices to prevent substandard care.
“Our oversight found that when states can’t hold owners accountable, then clinics are more likely to fail to meet standards that protect the children who should be helped,” Grassley said. “The actions of some dental practices strained the Medicaid program and put low-income children in traumatic, highly questionable situations.”
OMG! OMG! OMG!
After 7 long years of persistence, it’s finally happened! Small Smiles Dental Centers are excluded from participation in Medicare, Medicaid and all Federal Health Care Programs!
Small Smiles Dental Centers - CSHM Exclusion Letter by Dentist The Menace
Let us not forget, the dental centers Quality and Compliance was overseen by:
Dr. Paul Casamassimo
Dr. Arthur Nowak
Dr. Joe Bernat
Dr. Anupama Tate
Dr. Steve Adair
Quality & Compliance - Dental Centers - CSHM by Dentist The Menace
I can’t woo hoo and OMG enough—I’m shaking from head to toe with glee!!!!!
Now, where can I locate a bottle of the “good stuff” Champaign!
Let’s say you own your patient’s charts, do you own your dental practice?
Since the Antoine Dental Center's favorable ruling was overturned last week, TDMR, is calling for a Federal investigation into the judge. (God, I hate linking to these people! I think this is a ploy to get me to send them web traffic! LOL Don’t enter a password, it’s a phishing expedition.)
Yes, they want a Federal Investigation into the judge! Talk about cry babies! These guys simply can’t stand defeat. I bet they all got trophies for participation when they were kids.
However, to read about their game plan, you need a password. That’s right, a password. They have this big headline, then tell you to read it, you need their permission. Maybe it’s only a headline? Think?
I'd say an investigation should look at the previous decision of the administrative judges, but I try to give them a break that they just didn’t know what they didn’t know.
Frankly, the more Federal investigations into this the better. What's really odd, is this particular case is over some $400,000. Who spends $2-5 million in attorney fees to recoup that amount? Yeah, this is much bigger than Antoine Dental Centers.
One thing that crosses my mind, is how Dr. James Orr and Bob Anderton trained these dentists how to cheat the system—in Anderton’s own private law office—and now Orr is the “expert” witness for the dentists and Anderton is their attorney. Talk about conflict of interest! Geez! This seems to be more about Orr and Anderton covering their own butts, than it is about Antoine Dental Center’s pay hold.
Currently Orr and Anderton are touring, teaching dentists about—of all things—record keeping!
There is just no way that this is sliced where the attorneys representing Antoine Dental Center and Dr. Nazari have their clients best interest ahead of their own. I almost feel sorry for Nazari. He could have, reached some settlement, taken his slap on the wrist, paid a little fine, and gone on about his business. At worse, a few months jail time; he would have gotten more sleep there than I bet he’s getting these days. I believe he is being coerced. Pure craziness.
Where’s the popcorn?
Analysis of ADC vs. Texas Health and Human Services Commission
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.
In the Welcome Letter from Dr. R. Quinn Dufurrena as posted on the Dental Group Practice Association (DGPA) and the DGPA’s press release, I think it’s clear what the plan is for the group; more “creative” dentistry —i.e. teledentistry (whatever the hell that is)—and changing state dental practice acts to be more revenue generating friendly, despite any loss in patient quality of care. After reading excerpts of several articles and interviews with Dufurrena published over the years, it appears he’s wishy washy on many issues, other than teledentistry. Other than that, he will be whatever they need him to me. Of course, I could be wrong.
From Dufurrena’s Welcome Letter at the DGPA:
From the March 3, 2014 DGPA Press Release:
Doug Brown is president of Affordable Care, Inc. Steve Thorne is president of Pacific Dental Services. Neither are dentists.
Dr. Richard Quinn Dufurrena hasn’t been interested in the actual practice of dentistry in years; if ever. But he has been interested in the business of dentistry. So he is going to fit right in the DGPA and the DSO business modeling they promote.
From the June 2008 article about Dr. Dufurrena’s Hillibrand Fellowship and him taking the position as Executive Director of the Idaho State Dental Association:
