By Deepa Bharath | dbharath@scng.com | Orange County Register
PUBLISHED: January 16, 2019 at 6:11 pm | UPDATED: January 18, 2019 at 2:19 pm
IRVINE — Sixty-five families whose children were infected by rare bacteria when they underwent pulpotomies, or “baby root canals,” at an Anaheim clinic two years ago filed a lawsuit Wednesday, Jan. 16, naming the clinic, its operators, the company that installs and maintains water filtration systems, and several dentists.
The lawsuit, which was filed in Orange County Superior Court in Santa Ana, alleges that Children’s Dental Group and dentists who provided services there performed hundreds if not thousands of unnecessary pulpotomies on children. Potentially deadly Mycobacterium abscesses was found in several samples the county’s Health Care Agency took from the clinic’s water system.
The children, ages 3 to 9, all underwent pulpotomies at the clinic between April and July 2016. In all, 500 children underwent the procedure during that time.
Children’s Dental Group has since become part of Western Dental. The clinic in question on East Lincoln Avenue is not owned or operated by Western Dental, but has changed hands.
So far, 150 families have filed lawsuits against the clinic and the number is expected to grow, said Dan Hodes, Irvine-based medical malpractice lawyer who is representing the children and their families.
A new complaint was filed against a local pediatric dental chain, Smiles 4 Kids. The chain is managed by Dr. Justin VanBibber and owned by Lone Peak Management.
The latest complaint was filed by the Washington State Dental Association with the Department of Health and the Dental Quality Assurance Commission. The complaint alleges the dental offices in the chain, only refer patients to their other practices for oral surgery or orthodontia.
Dr. Chris Delecki is the president of the Washington State Dental Association.
"They're failing to disclose the fact the patient has other options besides their self-referrals to their own managed practices," said Dr. Chris Delecki, President of the Washington State Dental Association.
"Patients are often being asked to travel from Tumwater to Tacoma for their orthodontic care and these are Medicaid patients and for many of them transportation is one of the biggest things they face.
he complaint includes an email apparently sent by the Smiles for Kids Regional manager to office managers.
"Patients in your offices should NOT be given options as to where they would like to go for their wisdom teeth extractions -- referring patients anywhere else is sending OUR business and money away and is therefore, unacceptable."
LOCAL DENTAL CLINICS OPERATED BY LONE PEAK MANAGEMENT
ENGAGED IN DANGEROUS AND DECEPTIVE PRACTICES, COMPLAINTS ALLEGE
Practice at Smiles 4 Kids, Kids Dental, Family Orthodontics Put Patients at Risk
and Cost Low-Income Families
TACOMA – November 13, 2018 – The Washington State Dental Association (WSDA) has filed a new complaint with the Washington State Department of Health, alleging dental clinics operated by Lone Peak Management Group, LLC (Lone Peak) are engaging in dangerous and deceptive practices.
The WSDA complaint is just the latest complaint against Lone Peak, which operates more than a dozen clinics in Washington state, specializes in pediatric dentistry, and serves a high percentage of low-income, Medicaid-eligible patients.
The WSDA complaint was filed after research into Lone Peak practices. It alleges that the chain arranged a kickback scheme that generated nearly $170 for Lone Peak every time a patient was administered general anesthesia. Disguised as a “facility use fee” charged to the anesthesia provider, these payments far exceeded fair market value of the record-keeping Lone Peak provided the anesthesia provider, generating substantial additional profit for Lone Peak.
Dentists and staff in Lone Peak offices also were directed to engage in a system of self-referral to affiliated clinics for specialty dental services like oral surgery and orthodontia. This system ignored patient preferences and in many cases resulted in families traveling significant distances to affiliated clinics when other qualified providers were nearby.
Internal Lone Peak documents cited in the complaint clearly demonstrate the profit motive behind this policy: “Patients in your office should NOT be given options as to where they would like to go for their wisdom teeth extractions,” reads one email. “Regardless of how near/far the office … referring patients anywhere else is sending OUR business and money away and is therefore unacceptable.”
Previously, Seattle’s KIRO 7 TV reported on another whistleblower complaint against Lone Peak, filed by a former office manager who left the company after refusing to follow directives from company managers to re-use dental mouthpieces that are intended for single-use only.
Internal company emails cited in the whistleblower complaint show Lone Peak putting profits ahead of patient safety. In one email regarding the reuse of mouthpieces, a Lone Peak executive lamented the fact that “our expenses would go through the roof if we didn’t find a way around” the single-use requirement.
The emails also describe how Lone Peak ignored concerns raised by at least one clinic dentist about the reuse of single-use mouthpieces. Lone Peak agents directed dental office staff to deceive that dentist: “We should probably hide our open Isolites (mouthpieces) on the days we know she is coming in,” wrote a Lone Peak agent. “In the meantime, just make her happy when she is around, and then go back to business as usual when she leaves.”
“The concerns brought forward by the whistleblower and uncovered by our team are deeply troubling and represent a dangerous corporate intrusion in the doctor-patient relationship,” said Dr. Chris Delecki, president of the Washington State Dental Association. “This speaks to what can happen when corporations are allowed to directly or indirectly own dental practices. In this environment, corporations can direct, question and over-rule the decisions dentists make in how to best treat their patients. This is why our association has consistently advocated for state laws to prohibit this type of interference and why we have engaged in bringing these practices to light.”
Washington law prohibits corporations, including dental service organizations (DSOs), from practicing dentistry, which includes directing a dentist’s treatment plan; limiting or imposing requirements on how a dentists uses equipment or materials in the provision of treatment; or limiting or imposing requirements on the materials, supplies, instruments or equipment a dentist deems necessary to provide diagnoses or treatments consistent with the standard of care.
Lone Peak is a DSO headquartered in Colorado that manages approximately 50 dental clinics in 12 states, including Washington. Lone Peak is owned by Tailwind Capital, a private equity firm whose stated mission is to transition businesses to become “larger, more profitable enterprises.”
Documents received by WSDA indicate that certain executives of Lone Peak may also have been involved with the Small Smiles dental chain DSO, and a number of Lone Peak dental offices formerly may have been Small Smiles dental offices. Small Smiles was included in a scathing 2013 US Senate report that found the chain performed unnecessary services and that its business model deceptively gave managers rather than dentists control over the clinics. The report also recommended that Small Smiles be excluded from participating in the federal Medicaid program.
Small Smiles and its parent company, Church Street Health Management (CHSM) have faced litigation before. In 2012, Small Smiles paid $24 million to settle allegations of Medicaid fraud brought by the U.S. Department of Justice. And in 2015, Small Smiles agreed to pay nearly $39 million in claims for alleged “unnecessary, inappropriate, unsafe, and excessive dental procedures.” Church Street Health Management has since declared bankruptcy.
The most recent complaints here in Washington also name Justin VanBibber, a Utah-based dentist who serves as the nominal head of the clinics engaged in the kickbacks and the mouthpiece reuse practice. He is listed as a practicing dentist on Lone Peak clinic websites in Washington, but the profile for his South Jordan, Utah practice lists him as a resident of Utah.
The Washington State Department of Health has opened active investigations into Lone Peak’s and VanBibber’s practices.
About the WSDA The Washington State Dental Association’s 4,400 member dentists are committed to solutions that prevent disease and ensure quality oral health for all Washingtonians. WSDA empowers its members to advocate for and provide optimal oral health care.
HOUSTON, Nov. 2, 2018 /PRNewswire/ -- Samson Dental Partners, LLC and ImmediaDent of Indiana, LLC agreed to pay $5.1 million to the federal government, the State of Indiana, and a whistleblower dentist to resolve a qui tam case with fraud allegations, according to the legal team for the dentist.
A settlement agreement was entered into among the U.S. Department of Justice (on behalf of the Office of Inspector General of the U.S. Department of Health and Human Services), the Medicaid Fraud Control Unit of the Office of the Indiana Attorney General, and Jihaad Abdul-Majid, DDS.
The qui tam complaint alleged that the defendants engaged in illegal corporate practice of dentistry and various types of fraud, including fraudulent billing, excessive and unnecessary treatments of excessive patients, and a sustained pressure by non-dentists in management positions to place corporate profits over patient care by exerting undue influence on dental care decisions.
Dr. Abdul-Majid, who will receive $925,000 plus expenses, attorneys' fees and costs, is represented by Charles S. Siegel, of Waters & Kraus, LLP, of Dallas; Daniel Hargrove, of The Hargrove Law Firm, P.C., of San Antonio; James R. Moriarty, of the Law Offices of James R. Moriarty, of Houston; and Joseph D. Satterly and Paul Kelley of Satterly & Kelley, PLLC, of Louisville, Ky.
According to the settlement, the federal government and the state of Indiana contend that they have certain civil claims against Samson Dental Partners, LLC and ImmediaDent arising from the submission of false claims for payment to Medicaid during the period from Jan. 1, 2009, through Sept. 30, 2013, for the following conduct:
Samson Dental Partners, LLC engaged in the corporate practice of dentistry in violation of Indiana state law by exerting obtrusive influences over ImmediaDent's medical professionals and staff by rewarding production and disciplining for not meeting production objectives and directing personnel in a manner which compromised clinical judgment;
Samson Dental Partners, LLC and ImmediaDent upcoded simple tooth extractions and improperly billed them as surgical extractions; and
Samson Dental Partners, LLC and ImmediaDent improperly billed for scale and root planing (deep cleaning) when they were either not performed or not medically necessary.
ImmediaDent operates nine dental care practices in Indiana. Samson Dental Partners, LLC, headquartered in Kansas City, Mo., provides administrative and other support services to ImmediaDent.
The case is "United States ex rel. Jihaad Abdul-Majid, et al. v. ImmediaDent Specialty, P.C., et al.," Civil Action No. 3:13-cv-222-CRS in the U.S. District Court for the Western District of Kentucky. The case was originally filed on Feb. 20, 2013 by Dr. Abdul-Majid. The federal government and the state of Indiana intervened in the case in September 2018.
The lawsuit alleged violations Federal False Claims Act, 31 U.S.C. § 3730(b), and the Indiana False Claims and Whistleblower Protection Act, Indiana Code 5-11-5.5-4.
The settlement agreement is neither an admission of liability by SDP and ImmediaDent nor a concession by the federal government and the state of Indiana that their claims are not well founded.
Smiles 4 Kids is “managed” by Lone Peak Management Group (LPMG), located in Colorado. Tailwind Capital. In January 2017, Tailwind Capital purchased a controlling interest in LPMG for $55M. Waller Law Group represented LPMG. In press releases at the time, it was stated LPMG had nearly 50 clinics in 12 states. As of March 2018 I counted 59 clinics and 73 known business entities. But as always, I could be wrong. (smile)
Let me just say this is only the tip of the iceberg about this company.
Below is the excellent report, by Alison Grande, that aired October 25, 2018 on KIRO7 News.
Whistleblower: Local pediatric dental chain reusing disposable tools
By: Alison Grande
Updated: Oct 26, 2018 - 6:19 AM
The Washington State Dental Quality Assurance Commission is investigating after a whistleblower complaint accused a local pediatric dental chain of re-using dental tools.
Lisa Walker quit her job as the office manager at the Smiles 4 Kids at Allenmore Hospital in Tacoma after she says the dentist overseeing the businesses, Dr. Justin VanBibber, told her to re-use disposable Isolite mouthpieces.
"That we re-use the Isolites, he asked that I put them in the cold sterile and re-use them on patients and I refused," said Lisa Walker.
The Isolite Mouthpiece package is clearly labeled "Disposable. Do not re-use. Re-use can result in the transmission of infections, pathogens."
Isolite mouthpieces are used to keep the airway clear during a dental procedure. "It suctions out the blood, the saliva, pus, tooth decay, you name it -it keeps the airway free of debris," described Walker.
"The worry for my kids and it was my worry for all kids is that, I mean we have hepatitis B, hepatitis C, there's HIV, I mean there's numerous numerous diseases and long-term illnesses that can be contracted through blood."
Most dentists in the United States have not heard of the Massachusetts Dentists Alliance for Quality Care. We are a group of dentists who are passionate about private practice and maintaining an excellent standard of care in our profession and for our patients.
In recent years, many of us have felt that organized dentistry’s advocacy for private practice has declined. In all fairness, not every dentist is in private practice. Many are working for dental service organizations (DSOs), academia, insurance companies, and other fields. The ADA and state organizations represent all dentists, not just one special interest group.
Last year, several dentists in Massachusetts decided to seek legal advice and petition our Attorney General in response to a contract received from Delta Dental of MA (currently called Total Choice PPO). Not only did we raise enough money to file a formal petition with the Attorney General, but we also formed a group that has grown to more than 60 members today.
In July, we voiced our concerns to the Division of Insurance at a hearing regarding a “new fee methodology” proposed by Delta Dental that would automatically decrease reimbursements to the entire network of Premier providers in the state. To date, we continue to educate our legislators and advocate for private practice dentists, as well as mentor students and recent graduates.
Although Delta Dental’s new for-profit Total Choice PPO was approved in our state, Delta continues to sell the non-profit Premier plan (96% of dentists in Massachusetts are Premier providers). In June of this year, it was announced that our state dental society decided to make a deal with Delta Dental of MA to cut all of the Premier dentists’ reimbursements by 10%.
This 10% “recalibration,” a euphemism for lower reimbursements, will affect that 96% of dentists in our state. Conversely, the Total Choice plan that offers a larger 30% discount has not been less popular with employers in Massachusetts and has far fewer contracted participating dentists.
Many dentists in our state understand these subtleties and were extremely upset by the decision of the leadership of the Massachusetts Dental Society, while other dentists may not be paying attention to these small details or fear retribution for getting involved.
Now is not the time to sit back and let others figure out the details that affect the future of our profession. Do you recall what has happened to primary care physicians? Not only have they been forced to work increasingly faster by insurance companies, but the quality of patient care also has suffered as a result. This is especially important for the younger generation of dentists to understand, as they will need to work faster and longer hours to try to make a living with ever decreasing reimbursements and huge amounts of student loan debt.
It is our hope that organized dentistry in our country will learn from the mistakes of the American Medical Association and try to slow the corporatization of dentistry and the reliance on dental benefit companies. We would like to see more support for the private practitioner members who, in fact, serve most patients in our country.
The Massachusetts Dentists Alliance for Quality Care is continuing its work on behalf of our profession. We believe that by educating our legislators, we will have a stronger voice in our state government. We also believe there is hope for our future and welcome as many dentists who are interested in becoming part of this movement to join our group.
Stand up, fellow dentists. It is time to make your voice heard. The time to make a difference is now!
Dr. Tanzi, a graduate of the University of Maryland School of Dentistry, has more than 18 years of private practice experience. She started The Dentist at Hopkinton in Hopkinton, Mass, 15 years ago near the starting line of the Boston Marathon. Passionate about issues facing dentists and private practice, she is also a founding member of the MA Dentists Alliance for Quality Care, which advocates for private practice dentistry and high quality dental care for patients. She can be reached at jilltanzidds@hopdent.com.
Szewczyk was first accused of illegally performing dental procedures in 2012. The District Attorney at the time decide not to pursue charges citing a conflict of interest since her husband was a Deputy Sheriff in Paulding.
Apparently, Szewczyk posed as a dentist through her mini-DSO, County Dental Providers. She also is reported to have performed dental procedures in the homes of patients.
At least one patient was sent to the hospital due to an abscess in his throat the size of a tennis ball.
In an interview with Atlanta TV station WGCL, Szewczyk said: “It’s definitely a personal vendetta” by the prosecutor. She added, “Sad situation … and I’m confident it will be handled in a timely manner.”
The investigation into Szewczyk dates to 2013, when the Georgia Board of Dentistry alerted the district attorney’s office to complaints about Szewczyk, who ran a business called County Dental Providers starting in 2011 that contracted with independent licensed dentists to come in and work on patients, Donovan says.
The state board’s 2013 alert prompted a criminal investigation at the time that led to a single charge in Paulding County accusing Szewczyk of performing dental services without a license, the district attorney says. But on the DA’s recommendation, Szewczyk was enrolled in a pretrial diversion program that did not require her to enter a plea, and instead allowed for the charge to be dropped if she successfully completed the program.
“This was the only instance of which we were aware at the time, so we just said, ‘Don’t do this anymore,'” says Donovan. “I got a notice saying she had completed the program about the same time I heard from the Board of Dentistry that she was back at it again.”
There are indications Szewczyk is associated with Heartland Dental on her LinkedIn page which has been removed. Additionally her picture appears on Group Dentistry Now blog.
B.A.D. is the acronym for Boycott Aspen Dental. We are a cause that primarily seeks to give a voice to the Aspen Dental victims who are not strong enough to speak out on their own. Alone we are faceless along with all the other Aspen Dental victims, but as a group we have a BEAUTIFUL face of courage with a BOLD name. We desire to help victims of Aspen Dental because we too are a handful of victims that have been hurt; some of us worse than others.
Why has B.A.D. been created?
B.A.D. was created after experiencing my own personal Aspen Dental horror story, and after reading endless so it seems, online negative reviews about similar Aspen Dental experiences. I saw a need to create a centralized website so people can see the magnitude of thousands of voices screaming out the injustices of Aspen Dental; people who have never had their dental horror story told much less appropriately addressed by the company who caused the damage (ADM). B.A.D. is not about one individual; B.A.D. is a cause that seeks to bring Aspen Dental Victims together. We are one voice and one face: Boycott Aspen Dental.
How did you hear about Aspen Dental?
My insurance had limited options, and Aspen Dental was one of them. I searched the actual dentist for negative reviews, and couldn’t find any. Dr Mark Habermeyer was new at Aspen Dental, but he had several years of prior experience. It was just a simple crown replacement, so I made the appointment asking myself, “How could I go wrong?”
Unfortunately that one visit will cost $5000 to fix the errors made by the staff that day.
I’m still getting treated for this issue that was caused April/May of 2017, so I’m not sure if more will be added to that figure later.
Did Aspen Dental attempt to compensate for your pain and trouble?
They refused to refund my money at the time of the incident, which was when www.twothirtydentalcaution.org was created. Not a word was heard from Aspen Dental
until June of this year when I received a call from a staff member at Aspen Dental to say they’ve decided to refund my money. What? Over a year later they are doing this? So I get the check for $408, and then another call comes in a few weeks later to offer a settlement. Unfortunately they chose a figure I put out there a year ago, and which no longer covered all that I had gone through. Aspen Dental knew B.A.D. was soon to be revealed, and this apparently was their first vain attempt to stop it.
What do you mean by “vain attempt”?
They showed absolutely no concern whatsoever for all the pain I’ve endured. They attempted to entice me with a low ball offer, but what they failed to consider is I already had concluded and accepted that I wouldn’t be getting any money from Aspen Dental. The plans for B.A.D. were in place (March 2017 is when the idea was conceived), so I was very suspicious when I received the first call that came a year afterthe incident with no previous attempts on record made by Aspen Dental to rectify this.
After they realized I wasn’t going to take the bait of the second call with the low ball offer, three ladies from Aspen Dental Management Corp offices in Syracuse, NY called me again to attempt to convince me to take the low ball offer. When that didn’t work, they hired an attorney with threats to close us down, and yes that low ball offer was included once more.
What about the threat of a lawsuit?
The day Aspen Dental sues its victim is the day the world will know that Aspen Dental is guilty of all they are accused of doing and more. This victim will never shut up. They don’t have the power to destroy B.A.D. like they would like us to believe. For example, if by chance they were able to have our websites removed with their money, well there was a day we didn’t have the Internet and word still traveled about upcoming events. We will revert back to sending telegrams if we have to, but B.A.D. will be around for months, years and decades to come. Aspen Dental we are not going away until you stop hurting innocent people.
Does Boycott Aspen Dental have an attorney?
We are suiting up for battle, let’s leave it at that.
What is on the agenda of B.A.D. for the short term?
Please visit our website www.boycottaspendental.com to learn of our current goals as we are planning our grand opening October 6, 2018. That’s when we will reveal our first fundraiser for an Aspen Dental victim to be chosen by member voting. We will also have our first Aspen Dental picket on that day (locations to be announced).
What is on the agenda of B.A.D. for the long term?
To tell as many people who will listen, Stay Safe; Stay AWAY from Aspen Dental!
To have an annual picket at every Aspen Dental location until Aspen Dental STOPS preying on innocent people, often times low income seniors, people with disabilities and children of low income families. If you are an Aspen Dental Victim or know someone who is, please consider joining B.A.D. today!
August 16, 2018 AUSTIN (KXAN) — A lawsuit filed within Travis County details allegations against Dr. Clinton Herzog from FLOSS Dental, including that he is not a licensed dentist.
Plaintiffs claim Herzog collected hundreds of thousands of dollars from investors to open multiple locations for his dentistry in Austin, then never bought them and left the city. They also say the State Board of Dental Examiners suspended his license in 2015, but allowed him to practice under certain conditions.
In 2016, Herzog voluntarily surrendered his license to practice, which the plaintiffs said they were not aware of. According to Texas State Board of Dental Examiners records, Herzog was accused of advertising that his offices had multiple "elite" providers forInvisalign services, but he was the only "elite" provider. Herzog is also accused of advertising dental services that "were free or discounted without disclosing the prices of associated services," according to his non-disciplinary remedial plan.
FLOSS Dental workers on Fifth Street in Austin told KXAN Herzog "left town" and they could not get a hold of him…
*Penality Group 1(usually Heroin, Meth or Cocain) Possession of less than one gram is a State Jail Felony which may result in confinement in a Texas State Jail Facility for a minimum of 180 days and maximum of 24 months along with a fine up to $10,000.
August 7, 2018 Boston — A
Quincy-based dentist who was banned from the state’s Medicaid program
has been indicted in connection with an alleged scheme to fraudulently
bill MassHealth under another dentist’s name, Attorney General Maura
Healey announced today.
Dr. Shahrzad Haghayegh-Askarian, age 43, of Norwell, was
indicted by a Statewide Grand Jury on charges of Medicaid False Claims
(2 counts) and Larceny over $1,200 (2 counts). Haghayegh-Askarian’s
company, Dazzling Smile Care PC, located in Quincy, was also indicted on
the same charges.
An audit by the State Auditor’s Office
uncovered Medicaid fraud committed by Dr. Haghayegh-Askarian. Following
that audit, Dr. Haghayegh-Askarian agreed to a $300,000 settlement with
the AG’s Office in 2015 and was terminated from participating in the
MassHealth program. The settlement stipulated that she could only
re-enroll with MassHealth if she met standards of compliance and
instituted a monitoring program mutually agreed upon by Dr.
Haghayegh-Askarian and the AG’s Medicaid Fraud Division.
The AG’s office alleges that, despite her termination
from MassHealth, from April 2014 to December 2017, Dr.
Haghayegh-Askarian continued to treat MassHealth patients and billed
those services under the name and identification number of another
dentist, without his knowledge or authorization. That dentist contacted
the Office of the State Auditor to report this alleged fraudulent
activity when he learned of it in September 2017.
“I commend my staff and the staff of Attorney General
Healey for their work to bring charges against Dr. Haghayegh-Askarian,”
said State Auditor Suzanne Bump. “Her license should be immediately
revoked, and her continued, brazen abuse of MassHealth should be
punished.”
“This matter illustrates the commitment of all agencies
to combat medical billing fraud which affects all citizens,” said
Anthony DiPaolo, Chief of Investigations at the Insurance Fraud Bureau
of Massachusetts. “The IFB places a high priority on fighting this type
of insurance fraud. The collaboration in this matter is unprecedented.”
All of these charges are allegations and defendants are presumed innocent until proven guilty. The matter was investigated by Assistant
Attorneys General Jay McCormack and Kevin Lownds, Investigations
Supervisor Lisa Bailey and Investigators April Waterhouse and Deborah
ElMajdoubi, all of Attorney General Maura Healey’s Medicaid Fraud
Division, with assistance from MassHealth, the Insurance Fraud Bureau of
Massachusetts, the State Auditor’s Office, and Massachusetts State
Police assigned to the AG’s Office.
Benevis/Kool Smiles Response to CBS Report:
Dr. Greenwald and Dr. Rai blew the whistle on Kool Smiles after they say they witnessed unnecessary dental procedures performed on children. CBS reached out to the company for a comment and they provided the following statements:
Statement from Kool Smiles:
"Our patients and their safety are our top priority and we will continue to work toward our mission of ensuring every child in America has a dental home. The settlement reached in December 2017 addressed treatment provided between 2009 and 2011, and was unrelated to the quality of dental care provided to patients. The company's compliance and quality assurance programs lead the dental industry and we continue to implement ongoing measures to ensure every patient receives the best care."
This past December, 2-year-old Zion Gastelum died four days after visiting the Kool Smiles office in Yuma, Arizona. Zion's death occurred just days after the Whistleblower suit was settled. The case had been in litigation for almost a decade.
Statement from Kool Smiles regarding death of Zion Gastelum:
"Kool Smiles treatment protocols follow the guidelines and best practices established by the American Dental Association and the American Academy of Pediatric Dentistry. Treatment is provided only after conducting a consultation and obtaining the informed, written consent of the patient's parent or guardian. Our dedicated dentists, anesthesiologists and the rest of our Kool Smiles family mourn this tragic loss."
Despite all the claims, counter-claims, third, forth and fith party claims, here is the the short version:
Texas withheld reimbursement from several dentists due to a high suspicion of Medicaid fraud. Dr. Nazari, his clinic Antoine Dental and others argued they needed and deserved their money for all the honest and much needed work they had done on so many children with terrible orthodontic deformities and rotten baby teeth. They were the saving grace to the underserved population as they saw it.
Being royally pissed, Nazari suesTexas and Xerox (NYSE:XRX) (ACS) demanding his money.
The Feds (that is us, the US taxpayers) says “Hey Texas, we pay 50% of all you spend on Medicaid, and we want our money back!
Texas says, “We really have that kind of cash to hand back, we spent it already. But we will try to get it from Xerox. They ran the show down here for years. In fact we knew nothing about this until Byron Harris did a series of reports for WFAA in Dallas. We learned about it on the local evening news!”
Texas sues Xerox, under whatever name Xerox was using at the time. The suit ends up at the Texas Supreme Court.
Texas tells the Texas Supreme Court justices, it was no seeking actual damages from Xerox in a civil Medicaid fraud suit in a civil Medicaid fraud suit accusing the company of signing off on $1.1 billion in claims for orthodontic services without properly vetting them, and therefore the remedies it has sought aren't subject to proportionate responsibility calculations.
Xerox says that it is wrongly facing sole liability in the matter, despite the fact it trained paid employees to basically rubber stamp “Approvals” as fast as they could. Additionally, in early testimony it was learned they trained the dentists how to game the systems.
Small business dentistry is increasingly establishing advocacy groups designed to address specific issues. Areas of concern range from protecting the doctor/patient relationship against the intrusion of the insurance industry and corporate dentistry to honest evaluation and solutions for the public’s “access to care.”
These associations are springing up in a variety of different states. Because of their distinctive smaller sizes, they are highly attuned to specific predicaments unique to a given state. Larger national groups may have multiple and conflicting agendas, which too often grind effectiveness to a standstill. These smaller spearhead organizations often serve as the initial testing ground for addressing and solving challenges. Many times, state dental associations will later pick up the banner and carry forth with their added weight and power of membership.
Three organizations that exemplify this movement are the Concerned Dentists of Texas (CDoT), the Concerned Dentists of Washington State (CDWS), and the Massachusetts Dentists Alliance for Quality Care (MDAQC). Each of these relatively small associations is free to examine problems unique to its specific state and discover optimal mechanisms for local problem solving. They aren’t handicapped by the political or economic motivations of a faraway distanced leadership. They aren’t bogged down by neverending and do-nothing committee meetings. And, they lack multiple layers of leadership hierarchy, which often hinders effective action…
Deloitte Advises Southern Dental Alliance on Sale to Pouschine Cook
Deloitte Corporate Finance acted as exclusive financial advisor to Atlanta-based VSM Management d/b/a Southern Dental Alliance on its sale to Pouschine Cook Capital Management and its co-investor group.
Southern Dental is a multi-specialty dental service organization in the Southeastern U.S. with 32 clinic locations across eight brands.
“DCF’s assistance was indispensable for us throughout the transaction process, offering both expertise in the space and extensive resources. We are excited about our future growth prospects and the new partnership with Pouschine Cook,” said Mark Lakis, CEO of Southern Dental.
Tom Harbin, managing partner at Source Capital, echoed the sentiment, “DCF’s deep knowledge of the dental space was invaluable and helped lead to a successful transaction. We could not be more pleased with the outcome.”
So far only 2 states have released their share of the $23,900,000 Benevis/Kool Smiles Dental Fraud Settlement that covers a 3 year period of Jan. 2009 to Dec. 2011.
Arkansas - $478,500 Massachusetts – $1+M (the state is to receive $1,700,000 with a portion of that going back to the Federal Government)
They started their business model of “Abuse Children; Collect Medicaid $” in June of 2002 with Drs. Frick (Tu Tran) and Frack (Thein Pham) and Kool Smiles still at it today; it will soon be 16 years!
One must never forget Dr. Tu M. Tran and Dr. Thien Chi Pham were dentists working at Smile High Dentistry in Colorado. Smiles High Dentistry is part of the Small Smiles Dental chain in 2001.
That leaves 13 years of the same fraud and abuse that has gone unchecked.
"This is a story of an enormous company defrauding Medicaid and pushing unnecessary procedures onto kids. We investigated and reached a settlement. Now millions will be returned and this company will change its practices forever."
ARE YOU KIDDING ME!
First, that statement left out the fact these unnecessary procedures were accomplished whereby small children, even babies, were tied up and tortured for speedy traumatic and painful procedures.
This has been going on in state for over 15 years. MassHealth state auditors noted in a published report Kool Smiles and it's cousin Small Smiles had a high incident of crowns back in 2005 or 2006. I have that report somewhere, I’ll find it and post it for you.
Question Attorney General Maura Healey: How much did Mass get in 2010 when Small Smiles was sanctioned $24M? Did they change their business practices? Uh...no! Actually, they doubled down! Small Smiles even signed a 5 year Quality of Care Corporate Integrity Agreement.
Imagine the millions of dollars pillaged and the number of children abused by this “enormous company”.
This is state-sanctioned child abuse, you just can't paint it any other way.
As I’ve pointed out before, as far back as 2009 Kool Smiles has had representative on the Virginia Department of Medical Assistance (DMAS) Dental Advisory Board (DAC). First David Strange, the Paul Walker. Small Smiles had representitives as well.
Small Smiles even went to far as to signed a 5 year Quality of Care Corporate Integrity Agreement and agreed to pay nearly $24M (nearly $27M when you add in the separate amount for the state of New York.) plus interest.
They simply sold a few clinics to Kool Smiles, Adventure Dental (also root with Small Smiles) and DentaQuest, also operated by former Small Smiles executives and kept a few for themselves, esepcially in Georgia and South Carolina.
They simply believe the laws don’t apply to them. Ad from the Kentucky Dental Association Website.
Benevis, (formerly NCDR, LLC) is owned by FFL Partners and operates Medicaid dental clinics under the name Kool Smiles Dental, focused on children (perferably under the age of 5 from the looks of things). However they operate a disturbing non-Medicaid division under the corporate umbrella of PSBB, PC, Inc. with Dale Mayfield CFO, Secretary and CFO. Mayfield is the Chief Dental Officer at Kool Smiles. In 2016, Mayfield was appointed to the Georgia Board of Dentistry by Governor Nathan Deal. (try not to puke if you read this link)
This is for the period of January 1, 2009 through December 31, 2011.
That is 3 years.
They have been in business with this exact same business model since 2002, when FFL Partners found Dr. Tran and Dr. Pham at the Denver Small Smiles Dental Clinic and offered them an opportunity of a lifetime; to start their very own Medical Mill and become “owner dentists”.
It’s now January 2018.
So, 15 years, right? This settlement covers 3 of 15 years.
The way I see it, they should pony up an additional $286,800,000.00.
I don’t see any Corporate Integrity Agreement; let’s hope that is a seperate Agreement yet to be released.
A mother is speaking out following the death of two children who visited a dental office in Yuma.
Nearly six years later, Elva Aranda is sharing her experience at Kool Smiles, who claims her daughter was being choked by a dental assistant in Summer 2012.
"It was a horrible experience, a horrible experience because when you see someone else hurting your child, you feel helpless," said Aranda.
Aranda says while her daughter was getting her regular checkup, the dental assistant was acting aggressively towards her daughter during the procedure. She claims the dental assistant was adding pressure to her daughter's neck as if she was choking her without realizing it.
"You know the suction tool, she started putting that into my daughter's mouth, and that was making her "gag". I'm here looking at my daughter, and I'm seeing her gag because that tool was shoved in her mouth and I started comforting here saying "it's okay, you're going to be okay" but I did not see that this lady had her whole hand shoved into my daughter's neck choking her."
Two children, one dentist's office, each meeting the same tragic fate. An Arizona mother is suing Kool Smiles in Yuma after her 4-year-old daughter died days after she visited the dentist's office in January 2016.
Francisca Lares said she is heartbroken, because she was only trying to do the right thing in getting care for her daughter, KNXV reports.
But when little Liseth Lares developed a fever, family attorney Marco Mercaldo said the dentist sent the girl home after a "relatively cursory exam."
"Told the mom essentially there is nothing to worry about, she'll be fine," Mercaldo said. "Unfortunately, the infection spread and she died of the infection."
Mercaldo argues Liseth could have survived the infection if Kool Smiles had given her the proper treatment.
YUMA, AZ - An Arizona family is left confused, devastated and looking for answers about just what happened during a young boy's dental appointment.
The family of Zion Jay Gastelum said the 2-year-old died after a dentist appointment in Yuma last month. Zion's uncle told ABC15 the child's parents took him to Kool Smiles Dentist on December 16 for a crown and filling, and somehow either during or after the process, it appears Zion stopped breathing.
According to family, Zion was transported to Yuma Regional Medical Center and then flown to Maricopa County, where he died several days later.
YUMA, AZ - An Arizona family is left confused, devastated and looking for answers about just what happened during a young boy's dental appointment.