Buying and Selling of Your Medical Charts: Is this legal?

This post is a bit off topic but thought it deserved some space on my blog.

Recently I was reading a message board and a discussion came up relating to 'buying charts'.

It was about a young dental practice wanting to know how much they should pay per chart if they purchased them from a retiring dentist. (which means there was an offer from the retiring dentist to sell them in the first place right?)

Now something about that just bothers me. I thought my medical charts (dental or otherwise) were somehow a bit more protected than that. The idea that they can be bought and sold really burns my butt not to mention all the HIPPA issues I see that could arise.

Imagine your dentist retiring, soon you get another dentist peddling his services via your mail box or home phone from the info he just bought from your retired dentist.

During this conversation another professional came back and said that you can't really buy charts but you can take over custodianship of them. He advised not paying a dime for them but to offer the retired dentist to take over the charts saving the retiring dentist from having to store, make copies to send to his old patients, sorting them all out etc.

Does the fact that your private medical information, of any kind, can and is bought, sold or traded? Of course I don't guess this is much different than if a professional sold his practice is it? In selling that practice wouldn't the buyer get your charts?

Two Doral Dental Opinions: Both raise questions

When asked about signing up to be a Doral Dental Provider here are a few of the responses:

mc2001 says: I have mostly good things to say in Virginia. The rates are reasonable (reimburse at approximately 60-70% of my practice fees depending on the codes). I collected $2.8 million last year with 8 chairs running 5 days a week.

I get a $30,000-$45,000 check every 9-12 business days, very few claims get denied and they cover most ADA codes that a pedodontist uses. Additionally, I am a participating provider with Delta and once the participating provider adjustment is done, I often find that Medicaid reimburses at a higher rate than Delta.

Sounds like to me this guy (or gal) is saying they get more money from Doral Dental and it's Medicaid reimbursements, then through private pay Delta Dental. Do other dentists know about this, since they argue they won't take medicaid patients due to the low reimbursement rates?

Of course I did take note that is was all about the 'coding' used. Wonder what coding one uses to get that high of a percentage of reimbursement? Creative Coding maybe? Like coding on Oral Hygiene instruction which is telling a two year old to brush his teeth twice a day, (can't tell his parents, they are locked in the waiting room at many clinics) wonder how much that pays?

Of course there are two sides to the flattest pancake so here is another opinion from nanham22:

Run away AS FAST AS YOU CAN. Doral manages Kansas Medicaid and it is the reason we absolutely refuse to see Medicaid patients - we don't get paid on time - MAYBE six months later, if we are lucky; and then, minimal reimbursement.
You can never get anyone to help you with claims. Finally, we had to call the governor's office and our state rep to get claims paid that were over a year old.
Pitiful.

Adventure Dental and Vision, yep vision too

Before going any further, I want to warn you that the owner of these clinics worked for and was trained by FORBA and Drs. Michael and Ed DeRose and Dan DeRose as well as Michael Roump of the infamous Small Smiles clinics that mistreat and abuse children and have been accused of medicaid fraud.

Looks like there's yet another dental clinic on the rise catering to low income Medicaid children only this one is going to take care of eye care as well. (I bet FORBA hates they hadn't thought about this new cash cow!)

Adventure Kids Dental and Vision (yes vision is being added I suppose unless there is something about seeing with ones teeth that I'm not aware of).

This place started out in Colorado Springs, CO (yep, Colorado again) as Academy Kids Dental and is the brain child of Ronald (Dr. Ron) Brandon Montano once again another former Small Smiles dentist, like Dr. Tran and Dr. Pham of Kool Smiles being former Small Smiles (Ed and Michael DeRose trained) dentists.

As of right now there is a clinic in Colorado Springs, Colorado another in Greenley, Colorado and one on the east coast in Brockton, Massachusetts and two in the DC area.

This clinics theme is cartoon action hero with the main character being "Captain Smiles". see captainsmiles.com

And the 'management company' for Adventure Kids Dental, sometimes referred to as Adventure Dental, is Hero Management. (an email address on one of the websites is cathy@hero-management.com)

So what's the deal with every dental clinic needing it's own personal management company anyway?

Another of it's websites is: adventuredentalandvision.com

The staff at the Colorado Springs clinics includes Drs. Ron Mantano, Mario Montanez, Melissa Montano and Steven Gould.

The Greenley dentist is Dr. Amy Jorgensen

No one is listed in the Brockton office so it might not be open yet, who knows.

Anyway there are two now opening in the Washington, DC hotbed:

1253 West Pratt Street
Baltimore, MD
410-727-4746

and

1305 Rhode Island Avenue NE
Washington, DC 20018
202-269-4746

..both 4746 wonder what special meaning those numbers have to Dr. Ron?

We can only hope that complaints don't come flying in for Adventure Dental. Hopefully Dr. Ron learned what NOT to do while working at Small Smiles in Colorado Springs. I heard he was let go, so that's a good sign since Small Smiles/FORBA doesn't keep dentists who are patient and nice to children.

Time will tell.

Anyway it's looking like the Washington DC, Maryland, Virginia area of the country needs it's own fully staffed task force, complete with a SWAT team to keep a close eye on all the dental clinics for the poor.

Dr. Kenneth Knott: Owner or Front Man?

Recently I checked out a Small Smiles yellow page ad in a city to be named later.

They ad read in part:

Care Provided by OH Licensed General Dentists
-Dr. Kenneth E. Knott & Dr. Robert Andrus, Owners

I just don't believe that is true.

They do not provide the care as it would lead you to believe and they don't 'own' the clinic either. Neither of these dentists have touched a mouth full of teeth in years.

Dr. Kenneth Knott is listed as FORBA's Senior Vice President-Central Region according to their internal employee list.

Dr. Knott has licenses in Kentucky, Ohio, Nebraska, New Hampshire, Oklahoma, South Carolina, Virginia and others. Dr. Robert Andrus is licensed in all these states as well.

So is being a 'senior vp for FORBA really mean, you go from state to state in your region, take some tests if any, hopefully pass them, apply for and obtain licenses so that we can hang them in the rogue clinics. So I guess that makes one a "professional licenses obtainer", right?

Doral Dental Execs Would Invoke 5th In John Ford Trial.

From My Fox Memphis

Defense Rests in John Ford's Corruption Trial

Judge: Key Ford Witness Doesn't Have to Testify

Last Edited: Wednesday, 16 Jul 2008, 2:58 PM CDT

Created: Wednesday, 16 Jul 2008, 1:16 PM CDT

NASHVILLE, Tenn. (WHBQ FOX13 myfoxmemphis.com) -- The defense rested in the John Ford corruption trial after a federal judge shot down attempts to get two crucial witnesses to testify on behalf of the former state lawmaker.
U.S. District Judge Todd Campbell on Wednesday said the former CEOs of two TennCare contractors have the right not to incriminate themselves on the witness stand.

Campbell's ruling left Ford without the benefit of testimony from Osbie Howard, former CEO of Memphis-based OmniCare, and Craig Kasten, co-founder and former CEO of Doral Dental, based in Mequon, Wis.

It is not clear whether the two could also be charged in the case.

(They darn well should be along with Dan DeRose and Todd Curse who no doubt paid Doral Dental to let Small Smiles open up shop in Tennessee)

Ford, 66, is accused of taking more than $800,000 to use his position as a senator to advance the interests of the two companies. Ford has maintained he was being paid for work he did outside the state of Tennessee.

Ford's attorney, Isaiah "Skip" Gant, has said Kasten made sworn statements in a deposition that would vindicate Ford.

Kasten took the witness stand Wednesday without the jury in the courtroom. Asked whether he would be willing to answer questions about the business dealings between Doral and Ford, Kasten said, "I would refuse to answer on the grounds that my answer might tend to incriminate me."

(Incriminate him and a few others I propose)

Previous testimony has shown that Doral paid Ford's consulting group about $1.2 million.

Last week, Gant asked the government to grant Kasten immunity from prosecution in exchange for his testimony.

In considering the request, Campbell asked prosecutors whether the government intended to charge Kasten and if he was the target of a probe.

The prosecution's answer to Campbell's questions was filed under seal and Campbell denied the request for immunity.
Howard, the former OmniCare CEO, took the stand after Campbell advised him to get a lawyer before testifying.

With Nashville attorney Jodie Bell by his side, Howard repeatedly invoked his Fifth Amendment right not to answer Gant's questions.

Gant told Howard he wanted to ask about his personal and business relationship with Ford. He also asked if Howard would answer questions about Managed Care Services Group, a consulting group that Ford and Howard were in together.
"If I were to ask you questions in that regard, would you answer those questions?" Gant asked.

"No," Howard said. "I would invoke my Fifth Amendment rights."
In ruling Howard should not be compelled to testify, Campbell said Howard's concerns about incriminating himself were "substantial and real."

(Substantial and Real, well you bet it is!)

Closing arguments were set to begin Wednesday afternoon.
Ford is serving a 5 1/2-year prison sentence for a bribery conviction in the unrelated Tennessee Waltz sting.

Remember Doral Dental is the company saying it's doing an investigation in Maryland concerning the barbaric treatment of children by Small Smiles/FORBA Dentists.

Dentist Able To Treat Patients Too Soon

It just amazes me how easily a person can attend dental school, graduate and immediately be given the opportunity to tear into a person's mouth, especially a child's.

No wonder so many go to dental school instead of medical school or take the time to attend another couple of years of college to actually become a pediatric dentist.  And explains why dentistry has become such a joke, which it shouldn't be since oral health is so important.

In medical school it's years before you are allowed to attack the care of a patient on your own, to become a dentist and treat patients is a piece of cake in comparison.  No, I'm not saying it's easy by any means nor do I think I could do it, however from what I've heard many Small Smiles dentist are doing I'm not so sure my 5 years old grandchild might not do a bit better job.

What bothers me is the fact these dentist pass a test, (yes they actually do have to do some work on actual teeth before graduation but so does a cosmetologist so that doesn't mean a whole heck of a lot) then left to roam from state to state simply applying for a licenses to practice and after a few questions from state dental boards are granted those licenses.  And unless there are complaints (and a whole lot of them and sometimes this mean little) they are left to run loose.  This is why filing complaint is so important!  If not you, then who? 

I know from doing all my research into this very few dentists licenses are actually revoked and in most instances one state will slap them on the wrist, maybe even two slaps, the next state knows this but will grant them a licenses anyway as if there is some dentist shortage or something.

This just seems wrong to me.  There is a bit of oversight of dentists.  But nothing near enough when looking at how places like Small Smiles, Kool Smiles and the like have been allowed to open renegade dental offices.  Many of these clinics have licenses hanging in their offices of dentists the staff have never seen or heard of, let alone any of them actually working on patients.

Of course many of the staff don't understand why these licenses are hanging there (it's to skirt the laws of particular states) but I encourage them to report this behavior to your state dental boards.  If there is a dentist licenses hanging in your office and you've never seen this dentist this should raise some red flags and I hope that you ask yourself why.

Anyway, states need to be taking a much closer look at their dental laws, rules and regulation and put a high powered microscope on their dental boards.  It's time for individuals to take some action here and let your law makers know there is a python in the wood pile and clean up this mess.

That is one thing I can thank companies like Small Smiles for, their tyranny bringing to light much that is wrong and what needs to be cleaned up and I don't mean tomorrow, I mean last week.

Another Child Abused At The Hands of Dental Staff.

This is Ginny's story:

Recently I took my 5 y/o son to a Pediatric Dentist in Overland Park, KS. I begged for something before hand for him, knowing that he would be very scared.

They called in Valium 10mg, 30 min before his appt. He was needing 2 fillings that were side by side. They also advised me before hand that Nitrous gas was going to be used.

Once the gas started, he began to get a combative, screaming, and kicking. He begged for me to help him. It felt like a dagger to the heart.

They said that they would need to use a papoose board, with my permission, so that they didn't drill into his cheek or gum. I advised them that he was a little claustrophobic and wouldn't like it.

They said they needed to finish the procedure. He was screaming no no no and was asking them to wait because he had to tell me something, ("kids try using all tactics", is what I was told).

I kept talking calmly to him telling him it would be over soon, and it was ok and mom was here. When they turned it into a safety issue, you think you are doing the right thing.

Watching your child be strapped down, with a 130-140# tech laying over them, screaming, nearly throwing up, you feel like a criminal & a failure as a parent.

He kept saying he couldn't breath, and the tech kept telling him that if he was crying he was breathing. I am a RN, and would never treat my patients like this. You are trained safety first, but he is my child and I knew that they couldn't leave his procedure half done.

I asked several times if they had used lidocaine, they said that he wasn't hurting he was just mad. He was never given local anesthesia.

I was told by a tech that if I felt that it would help they could try it but it may interact with the Valium, and cause a worse issue than what we had.

I try not to let office staff know when I go somewhere what my profession is because then they seem to treat you differently. When it was all over almost 45 minutes later, he was soaked in sweat from his head to his socks.

The doctor was calm during all of this and never raised her voice once. The techs though had this look on their faces like they were going to control this child, the first one yelled out the door for help then two more came in.

Over all there was the dentist, and 4 techs in the room. He is very very strong and kept getting his hands out of the restraint and pinched them. He was asked not to pinch because it wasn't nice. I wanted to tell them put yourself in his shoes, I would be scratching your eyeballs out of your head if you were holding me down, so get over it!

Never again will anything like that happen again to any of my children. My daughter went 1 1/2 years ago and had a baby eye tooth pulled that wasn't ready to come out but because all of her perm teeth were being twisted, had to be pulled. That was a different doctor same facility.

I fired that doctor from seeing my children because of her treatment. It took me over a year of talking and reassuring my daughter that the next experience would be better, for her to return to the dentist.

And after my sons appt. and not using lidocaine, I was discussing it with my husband and I truly do not think that she was ever given lidocaine or any other anesthesia except for nitrous gas.. I am appalled.

I am calling Monday morning to ask what her anesthesia was for that appt. She is 9 and is to start braces in 2 months at this facility. If I find that she wasn't given local when they pulled her tooth, I will make a decision to turn them in to the ADA and also to transfer care.

It is up to us to protect our children and I have failed both of them in this department. If anyone feels that it is wrong, it probably is and they need to remove their child from the situation.

I will never be afraid to cause waves again. If we don't protect them who will?

Dr. Robert F. Andrus-Still Small Smiles Front Man?

According to Beta Health Association Complete Specialists Directory (not dated so I don't know how "updated" this actually is) Dr. Robert F. Andrus's specialty is Pedodontics (children's dentistry). Of course as with anything to do with Small Smiles, this simply isn't the case. His current Colorado licenses lists him as a General Dentist.

Of course I knew this was probably BS since this same list has Michael DeRose's Specialty as Pedodontics as well and we know that simply 'ain't so'.

Why do I mention Dr. Robert F. Andrus, DDS you might be asking yourself? Well, on this same list it says that Dr. Andrus works in the Michael DeRose office located at 1022 Liberty Lane, Pueblo, Colorado along with Drs. Ed DeRose, Michael DeRose, Jim Mobley, Randy Ellis, Hate Haerr.

Of course there are hundreds of dentist associated with Small Smiles/FORBA and Michael DeRose but this guy seems to stand out a bit since he's applied for and received dental licenses in Kentucky, Nebraska, New Hampshire, South Carolina, Virginia and Kansas just to name a few.

So how does this associate him with Small Smiles? Well, there is an article on glsennca.org called "Small Smiles defies traditional system". In this article it says that Terry Dickinson was wary of corporate dentistry coming to the state of Virginia and would be keeping an eye on Small Smiles.

It also says that Todd Cruse, chief development officer for FORBA would be managing a Small Smiles clinic owned by a Colorado dentist, Dr. Robert Andrus. This same article says a Dr. David Jones, DDS (not of the Monkees fame) closed his private practice to come to work for Small Smiles in Roanoke (bet he regrets this move by now).

Anyway I don't know if Dr. Andrus still is fronting for Small Smiles, using his name on licenses and such but he sure did at one time and he's all but held hands with Micheal DeRose and I'm not sure they've not done that as well.

After the first Small Smiles Report

Over the course of a few months, after Roberta's first report, there were a lot of follow-ups and communications between a lot of organization and state agencies and FORBA, now known as Church Street Health Care Management.
November 2007:
At that time, Maryland had 3 companies that managed their dental program.

1. Amerigroup who contracted out to Doral who contracted with FORBA (this drives me insane!)
2. United Healthcare - Mid-Atlantic Medicaid Plan (United Medicaid/UHCMA) who contracted with Dental Benefit Providers, Inc.
3. JAI Medical Systems

All these companies started investigating Small Smiles clinics Nov. 9 and Nov. 12, 2007.

November 9, 2007 Mike Lindley tells employees there would be audits that they estimate may take 30-45 days and during which time they could not seek reimbursement, but they had made the decision to continue to treat patients.  (because they felt so strongly about taking care of the underprivileged, all services would be "at no charge". 

[Am I the only one who doesn't think they knew how things would end and they could float these clinics for a couple of months, no problem]

Oh What A Tangled Web

Doral Dental is a Third Party Administrator (TPA) of Government Medicaid Dental Programs according to answers.com.

My first question is why in the world does any agency (Medicaid) need a THIRD party anything. Wouldn’t first party or second party at most be plenty?

Amerigroup is a Medicaid Managed Care Organization (MCO) but following along the thinking of Doral's designation, I guess Amerigroup would be considered a Second Party Administrator.

Your state Medicaid services would be the first tier I suppose.

So your state gets your hard earned, and taken away from you, tax dollars allocated to them to spend on the poor and those in need for medical treatment, called Medicaid. (In some states they give it a local name such as in Massachusetts it’s called MassHealth, in Tennessee it’s called TennCare, but it’s just Medicaid.)

Evidently the states don’t know what to do with the money, they need experts to distribute it so they hire companies like Amerigroup to spend your tax dollars for them.

In Maryland they have hired 7 of these companies, one isn’t enough I suppose. Amerigroup is one, AmeriChoice, Coventry Diamond Plan, Helix Family Choice, Jai Medical, Maryland Physicians Care, and Priority Partners are the others.

All of these companies then find it overwhelming to do the job so they hire Third Party Administrators such as Doral Dental. Doral Dental then goes out and gets contracts and hires the actual providers, your dentists and dental clinics such as Small Smiles.

Some of the Second Tier companies such as Jai Medical contract directly with the providers, Small Smiles, so I guess hats should be off to them for by passing those Third Party Administrators. Getting rid of the middle middle men I suppose. (more money for them to keep right)

However even the Third Tier companies like Doral find it overwhelming to spend all that money and will hire companies to help them decide where to spend it as they did in Tennessee by hiring Managed Care Services, a company who just happened to be owned by a state senator, John Ford, now on trial. (Amazing how many “consulting” firms are needed to decide where to spend all those Medicaid dollars isn’t it.)

Honestly, we have management companies managing management companies who hire consulting firms to help manage the management.

Well, evidently the rival firm of Doral, FORBA which just happens to own Small Smiles that are Doral Dental providers in other states wanted to sue Doral for Doral not letting them in on the TennCare Medicaid dental pie. This brought to light Senator Ford’s involvement and everything hit the fan and federal charges were filed but so far only against Senator John Ford, why no charges are being filed against FORBA and Doral for offering the bribe money is beyond me. I mean aren’t the ‘johns’ of hookers also charged?

Well anyway this brings me to Doral overseeing Small Smiles clinics in Virginia, Maryland, Ohio, Kentucky and a host of other states for those Second Tier Administrators like Amerigroup.

Doral says it’s conducting internal investigation of all the allegations on the mistreatment of children and fraudulent Medicaid billing, but what good is that exactly. I mean Doral sends it’s patients to Small Smiles in several states, yet is in competition with Small Smiles own management, FORBA in other states. (Head spinning yet? Mine sure is.) And the icing on the cake, Doral who is looking into these allegations is in deep doo doo in Tennessee for bribing a state senator! Don't think any kind of 'clean bill of health' Doral was to give Small Smiles would mean a whole lot, what do you think?

When pressed Doral will just throw the responsibility back to Amerigroup, saying they are the ones who push for all these children to be mistreated, (clearing throat) I mean money to be made, Amerigroup says it’s Small Smiles, and Small Smiles throws up it’s hands and says they don’t know anything about children being mistreated or Medicaid being ripped off.

And do you think the states know, well heck no. They don’t even seem to be smart enough to manage the Medicaid dollars in the first place and they have hired a umpteen packs of Foxes to watch one hen house.

But when all said and done there really is no competition or rivalry. They are all in the same bed, using the same horrible methods to steal millions and millions of your dollars and mistreating and abusing innocent children to get the job done and sending at least some of the huge profits to an Islamic bank is Bahrain that must not be making enough money of oil prices.

And let us not forget this same scenario is happening with United American Healthcare and it’s Third Tier Management group Omnicare. (As Doral Dental is to Amerigroup, Omnicare is to United American) FORBA/Small Smiles is also a dental provider for Medicaid enrollees of United American Healthcare in various states just like they are for Doral Dental and Jai Medical.

United American Healthcare, through it’s OmniCare company was paying Senator John Ford $8500 a month for his services in getting key legislation through the Tennessee assembly. Legislation that would greatly benefit FORBA/Small Smiles as well as it’s own interests. (You can read about this at various places on the net, so I’m not getting into all of those allegations here)

Point is United American Healthcare did nothing to curtail Small Smiles treatment of children in Maryland. Doral Dental terminated 4 individual dentists and is ‘investigating’ (chocking on that word) Small Smiles practices before it sends more of it’s enrollees to Small Smiles and in November Jai Medical Systems sent a letter directly to Todd Cruse putting Small Smiles on probation and requiring Small Smiles to allow parents to go back with their children, make sure all personnel are licensed BEFORE they treat children, not go to school while practicing, and were going to do surprise visits and random patient surveys.

In light of the recent allegations of United Healthcare and Doral Dental being in hot water up to their eyeballs for bribing a state senator, I don’t think either of these companies should be ‘overseeing’ or ‘investigating’ wrong doing of Small Smiles or any other company, do you?