Kool Smiles Vancouver, Washington Complaint

Why on earth Private Equity Firm- American Securities-would even consider contaminating themselves by purchases these shit hole clinics is beyond me.  They must be sadistic bastards is all I can think of, and enjoy torturing America’s low income children.   I would call the review below "glowing” and the child lucky.  After all they didn’t leave with bruises and permanent emotional trauma as most children.  Friedman Fleischer & Lowe are trying to unload these before they go down like ENRON. 

I was just told this week, they had cut staff to the bare minimum to increase the profits getting ready for the big “sale”.   In my opinion, until the staff is cut to zero there are too many employed.

Here is a review from today!

October 25, 2010

I was very excited to take my son to this dental office. The website makes it look so fun and kid centered. From the moment I walked in I did not have a good feeling about it. This was confirmed once we were taken to the dental work room. It was a room with 8 dental chairs all together. The Dr came out to talk with us. He didn't shake my hand or introduce himself to my son or even ask my name. I don't even think he smiled. The other dentists/hygienists were talking badly about one of the other dentist/hygienists every time she would leave the room. There were two other young boys laying back in the chairs and no one was paying any attention to them or talking to them at all. For a business that markets themselves as kid friendly, they really failed at being friendly at all! We sat around for 20 minutes being ignored after the doctor did his exam, just waiting for the fluoride. We're all in the same room and they just ignored us. No one treated my son as a patient or gave him any attention. Then....the only prizes they had for my 5 year old was a rubber lizard or a broken pair of sun glasses. Oh fun. Made my other son an appt elsewhere. We will not be returning.

Unacceptable? You decide

Unacceptable Dental Practices in 2010

1. 1 Dentist seeing an average of 32 patients a day – That is an average of 4 minutes per child.  Same dentist strapped down 100 children and put on 1000 Stainless Steal Crowns.  I bet this dentist did a fine job!  Why is this person not in jail?
2. 1 Clinic (of three dentists) strapping down over 700 children in 88 days – That is almost 7 children papoosed a day in one clinic.  A clinic papoosing 540 is 88 days is not any better, nor is a clinic who papooses 450 in those same 88 days.
3. 1 Dentist tying almost 300 hundred children in 88 days is also unacceptable - That's an average of three a day for 1 dentist.  If I tied up 1 child in 88 days I would be in jail.
4. 17 Dentists all tying up children more than 100 times in 88 days.
5. 1 Child receiving  13 Stainless Steel Crowns, 11 Pulpotomies and 2 fillings in one OR visit.
6. 1 Clinic of 3 dentist clinic strapping down 160 children in 20 days.
7. Approximately 210 dentists doing 7 or more pulpotomies and putting on 7 or more stainless steal crowns on 400 children in 88 days.
8. 200 dentists pulling over 6 teeth at one visit on 100 children in 88 days.
9. One clinic of three dentists seeing 900 patients in one 5 day work week.  - That is 900 patients in 120 hours.  That is an average of 7 minutes per child.
10. No wonder 1000 treatments had to be redone in 88 days, putting children through hell double time.

It should be no surprise many office staff do not know the difference between "filling" and "feeling".
I know I am missing many other outrageous dental practices that have taken place in 2010 but these are on my mind at the present time.

In My Opinion These Are The Top 15 Small Smiles Clinics A Child Is Most Likely To Be Strapped In A Papoose Board

Just an educated guess based on several factors, including parent complaints:

1. Dothan, Alabama
2. South Bend, Indiana
3. Macon, Georgia
4. Savannah, Georgia
5. Youngstown, Ohio
6. Atlanta, Georgia
7. Akron, Ohio
8. Roanoke, Virginia
9. Florence, South Carolina
10. Beaumont, Texas
11. Worchester, Massachusetts
12. Albuquerque, New Mexico
13. Kansas City, Kansas
14. Montgomery, Alabama
15. Oklahoma City, Oklahoma

In 2010, I think Albany, New York (shocker) and Louisville, Kentucky are the clinics your child is the least likely to be tied up in that straight jacket type device.  Not that I recommend ANY of these dental mills! 

Assistant Attorney General Tony West Mentions Small Smiles Fraud and Patient Abuse In Yet Another Speech

October 20, 2010

Assistant AG Tony West delivered the Keynote Address to the Pharmaceutical Regulatory and Compliance Congress and Best Practices Forum today at the Marriott Hotel in Washington, DC.

Read his full statement here

Excerpts:

Since January 2009, we’ve commenced more health care fraud investigations, secured larger fines and judgments, and recovered more taxpayer dollars lost to health care fraud than in any other two-year period.  During that period, our civil fraud attorneys in the Civil Division have used the False Claims Act – a powerful tool that provides for treble damages – to recover about $4.2 billion lost to fraud against government health care programs…

 

…strongly encouraged Civil Division and United States Attorneys throughout the country to be appropriately aggressive in their use of the wide array of affirmative civil enforcement tools at their disposal.  Tools like Civil Investigative Demands, or “CIDs,” which allow law enforcement to speed up civil investigations by obtaining documents and testimony quickly and under oath.  The authority to issue CIDs once rested only with the Attorney General, but amendments to the False Claims Act last year allowed the Attorney General to delegate that authority to me as the Assistant Attorney General for the Civil Division.  I, in turn, have re-delegated much of that authority to U.S. Attorneys around the country so that they will be able to use this powerful investigative tool properly and effectively…

…And then there are those cases we pursue because they cut to the core of protecting both patient safety and the integrity of our public health care programs.  Cases like Small Smiles.  You may have heard about this case.  It involved a nationwide network of dental clinics that provided unnecessary dental services to needy children on Medicaid in order to maximize the company’s Medicaid reimbursements…

…And the stories we learned about during the course of our investigation were horrific:  unnecessary tooth extractions performed on children where healthy teeth were pulled; unnecessary dental surgery such as needless crowns; and excessive baby root canals – one child had 16 root canals in a one sitting…

In that case we not only obtained a $24 million settlement, but more importantly, important reforms to Small Smiles’ practices under new management, as well as the company’s cooperation in our ongoing investigation into individual dentists..

That last point—working cooperatively with companies—is an important one.   To be clear, no company is required to cooperate in the context of a civil or criminal case.  Yet when a company acts responsibly by timely and voluntarily disclosing unlawful conduct, it is the case that the Department may consider such cooperation in deciding whether or how to charge a corporation or to resolve a case, and indeed, it has been my practice to encourage that in appropriate cases.  In addition, when a company cooperates fully with an investigation, the Civil Division typically informs the HHS Inspector General’s office about the assistance the company provided…

It almost sounds like FORBA's Small Smiles clinics are getting a big pat on the back doesn't it.  Since they are "working cooperatively" and all.  They are still using the BIOB (Blame It On Bush) excuse saying all these terrible things happened with the DeRose family owned the clinics.  Never mentioning that one of their top VP's was with the company while under DeRose rule since 2003! 

I bet if they really took a look at the practices of the company just in 2010 they would find 'shocking' things still happening.

As recently as October 5th (yes, 15 days ago) one child received 12 stainless steel crowns 3 fillings and 11 pulopotomies all in one session.  Mom outraged.

On the same day another child received 3 fillings, 3 pulpotomies, 1 seal, 1 extraction and 5 stainless steel crowns. 

The very next day on parent was told their child needed 8 stainless steel crowns and wanted to do them asap.

Looking Like A Fool With Your Pants On The Ground II

That what you will be if you take a job with these dental mills.  Stay away.  Keep your dignity. 

New Small Smiles Clinics Opening Soon:

Muncie Indiana

Washington DC II

Mission, Texas

Don’t bee fool enough to sign any contract and commit yourself for years with any of these dental mills. 

Ad are out all over the Internet looking for employees.  Do Not be a fool.  Don’t do it.

I’m wondering what foolish insurance company is covering these clinics and the dentists and other professionals in them. 

Clinic’s Ownership: Tax Questions

No doubt I have asked this question before.  But I am going to ask it again. 
Since FORBA’s Small Smiles clinics are registered with the Secretary of State’s office as being owned by random dentists I have a few questions:

1.  Does the individual dentist file a tax return on those clinics?  If not, YIKES!
2. Does the individual dentist file a tangible property tax return and pay property tax on all that equipment?  If not, YIKES!
3.  When the dentist in question quits , gets fired or leaves FORBA’s employment, and FORBA is forced to register someone else as owner, how is this “sale” explained?   I’m thinking some major tax revenue is being missed here. 
4.  Why am I the only person asking these questions?
If Dr. Katie (Helen Petersen) does NOT own all those clinics in Indiana, what does Dr. Katie own?  What about Dr. Jodi Kuhn in Kentucky?  What about Dr. Ken Knott in Alabama?  (yes, Dr. Knott is still listed as owner in Alabama, or at least he was on December 31, 2009, because he signed (or someone signed) the annual report. What about Dr. William Nash? 
5.  I wonder if Dr. Ken Knott knows they still have him owning those clinics? 
If any of these dentist have not filed tax returns on the income from these clinics, I’d say there might be a problem.
How would this all be explained in an IRS audit?

Who knows, maybe all those tax forms are sent to Corporate Headquarters in downtown Nashville and someone down there files the tax returns and signs the name of the poor innocent dentists. 

Kool Smiles Said to Have Received Offer of $700 Million Clinics

Oct. 4 (Bloomberg) -- American Securities LLC, a New York- based private-equity firm, is the leading bidder for a U.S. chain of dental clinics owned by Friedman Fleischer & Lowe LLC with an offer of about $700 million, according to people with knowledge of the auction.

Friedman Fleischer owns two companies, NCDR LLC and DPMS Inc., that provide facilities and support staff to dental groups operating under the Kool Smiles brand, according to the San Francisco-based firm’s website. TPG Capital also submitted an offer in the final round of bidding, said the people, who asked not to be identified because the deal hasn’t been completed.

The two companies are not really two companies, it's Kool Smiles and Kool Smiles 2.  KS is the clinics in the East and KS2 are the western most clinics.

Read the full article here: Business Week

However since after time passes and the stinch of a company begins to fill the offices of these PE firms, stories like this seem to vanish from the Internet.  So in case that happens, here is the full story:

By Cristina Alesci, Jeffrey McCracken and Jason Kelly

Oct. 4 (Bloomberg) -- American Securities LLC, a New York- based private-equity firm, is the leading bidder for a U.S. chain of dental clinics owned by Friedman Fleischer & Lowe LLC with an offer of about $700 million, according to people with knowledge of the auction.

Friedman Fleischer owns two companies, NCDR LLC and DPMS Inc., that provide facilities and support staff to dental groups operating under the Kool Smiles brand, according to the San Francisco-based firm’s website. TPG Capital also submitted an offer in the final round of bidding, said the people, who asked not to be identified because the deal hasn’t been completed.

Rajat Duggal, a managing director at Friedman Fleischer, couldn’t be reached for comment. Officials for American Securities and TPG declined to comment.

Private-equity firms have resumed dealmaking after a two- year lull following the global financial crisis that started in mid-2007, freezing credit markets and ending the biggest leveraged-buyout boom in history. There were $59 billion in deals in the third quarter, more than triple the amount a year earlier, according to data compiled by Bloomberg.

American Securities, which was founded in 1947 by a Sears Roebuck & Co. heir, has invested in companies including vacuum- cleaner maker Oreck Corp. and the El Pollo Loco chain of chicken restaurants, according to its website. The firm was a runner-up at the recent sales of Air Medical Group Holdings Inc. and Aspen Dental Management Inc., both owned by private-equity firms, according to a person with knowledge of the sales.

Air Medical, Aspen Dental

Leonard Green & Partners, the Los Angeles-based private- equity firm, is buying Aspen Dental from Ares Management LLC. Bain Capital LLC, the Boston-based leveraged buyout-fund manager, is acquiring Air Medical from Brockway Moran & Partners Inc. and MVP Capital Partners.

Kool Smiles caters to children enrolled in Medicaid, a federal-state health insurance program for the poor, and other state health insurance plans, according to Friedman Fleischer’s website. Some firms that looked at Kool Smiles were concerned that it was too reliant on Medicaid payments as governments face deficits, said one person familiar with the auction.

Private-equity firms are increasingly buying companies from each other as more than half the companies that submitted plans for U.S. IPOs in 2010 have yet to complete them. Sales among buyout firms allow the seller to return cash to investors, while the acquirer is able to deploy unused capital that was raised during the boom. Clients saw distributions last year fall to the lowest level since at least 2000, according to London-based research firm Preqin.

Opening Clinics

Smile Brands Group Inc., a separate dental chain backed by private-equity firm Freeman Spogli & Co., scrapped an initial public offering in May. The company, which relies on patients with private insurance for most of its revenue, is now shopping itself in a sale process that is still in early stages, according to a person with knowledge of the matter.

American Securities plans to expand Kool Smiles’ main business of opening clinics in places where access to dentists and other medical services is limited, the person said.

TPG has been pursuing deals. The Fort Worth, Texas-based firm and Goldman Sachs Group Inc.’s buyout arm agreed in July to purchase Belgian diaper-maker Ontex NV for $1.55 billion from London-based private-equity firm Candover Investments Plc. TPG also acquired a 35 percent stake in Creative Artists Agency for an undisclosed amount in a deal announced Oct. 1.

Friedman Fleischer has more than $2 billion under management, according to its website. Its holdings include Korn/Ferry International, the executive-recruiting firm, and Montpelier Re Holdings Ltd., a Bermuda-based property reinsurance company.

--Editors: Elizabeth Wollman, Larry Edelman
To contact the reporters on this story: Cristina Alesci in New York at Calesci2@bloomberg.net; Jeffrey McCracken in New York at jmccracken3@bloomberg.net; Jason Kelly in New York at jkelly14@bloomberg.net.

Tennessee Case - National Union Fire Insurance of Pittsburgh v. Small Smiles Holding Company Update - September 30, 2010

Case Number 3:10-0743 filed in United States Federal District Court Middle District of Tennessee – Nashville Division

Small Smiles Holding Answer to the Complaint filed by National Union Fire Insurance Company of Pittsburg.  NUFIC is a Subsidiary of disgraced AIG, American International Group.

Judge Joe Brown recused himself; no reason was given.

Order after Judge Brown recused himself, by Judge Juliet Griffin

Small Smiles Corporate Disclosure Statement- It has no parent company and American Capital Strategies, LTD owns more than 10%.  Small Smiles Holding is the parent company of FORBA Holding, LLC.

Joint Case Management Order – This document states an over view of both sides of the case as well as the court's calendar.

 

November 9, 2010 – Deadline for Small Smiles Holding to file a Counterclaim against National Union Fire (AIG)
January 31, 2011 – Deadline for Small Smiles Holding Company to file third-party claims under Federal Rules Of Civil Procedure 13.  Join additional parties under rule 14.  Join additional parties under rule 19 or 20.
January 31, 2011 – Last chance to amend pleadings under Rule 15.

Discovery Schedule:

October 15, 2010– AIG's National Union Fire Insurance Company of Pittsburgh and Small Smiles Holding Company to make initial disclosures of their respective evidence.
February 18, 2011 - Discovery related to motions, except those dealing with "experts"
March 18, 2011 - All Fact Discovery and Discovery related motions are to be completed, except those related to experts. AIG's National Union Fire Insurance Company of Pittsburgh and Small Smiles Holding Company may each serve 50 Interrogatories, which includes all subparts questions.  If they need more, they mutually must agree.
March 30, 2011 – Deadline to ask the court for a Settlement Conference if they decide on an attempt at a settlement in the case (and the FORBA bunch usually settle or dismiss.
April 15, 2011 - AIG's National Union Fire Insurance Company of Pittsburgh  must disclose their expert witnesses and any reports from the experts.
May 16, 2011 – Small Smiles Holding Company has to disclose their expert witnesses and reports from those expert witnesses.
June 30,2011- Depositions of the "experts" must be completed.
July 29, 2011 – Deadline for Motions/Objections to be filed by either party in relation to the depositions taken and the opposing party has 45 days to respond to any Motions/Objections.  Parties have the option to file briefs within 29 days of any response.

Monthly case management conferences are scheduled to address issues National Union Fire Insurance (AIG) and Small Smiles Holding Company are unable to resolve among themselves.

January 9, 2012 – Deadline for parties to file objections to expert testimony and motions in limine.

Trial by Jury Date Set for January 31, 2012 by Judge Todd Campbell; it is slated to last 10-14 days.

 

For Reference – Federal Rules of Civil Procedure (Fed. R. Civ. P.)

Access West Dental, Asheville, NC-Dr. Letitia (Tish) Ballance

I don't know how old or new this ad is but here is an ad for a job listed at ncdental.org for a new graduate dentist and dental assistants and more.

Access West Dental-Asheville, NC-Dr. Tish Ballance, DDS.

Does Letitia (Tish) have her hand in the cookie jar again and looking to physically and mentally abuse more children in North Carolina? If so, as it appears, who is she in bed with this time. I would think she would want to be more than transparent in her new ventures.

I found an article written back a few years, November 2004 I think, talking about how Tish Ballance had been raised in North Carolina, and instead of going into a normal practice as a dentist she wanted to help the poor children in North Carolina by opening her heart and dedicating her life to helping those children of North Carolina, yeah right, Tish. Sounded good at the time didn't it.

From what I can gather it's scheduled to open in July 2008. Interviews were scheduled for these positions on Saturday 4/12/o8 at the Marriott Residence Inn on Biltmore Avenue, according to career builder website.

Now I'm not that educated as most can tell from the half hazard way this site is thrown together but if I had just gotten named and fined with a cohort, Michael DeRose, 10 million dollars, 10 MILLION DOLLARS I don't know that I would still be out trying to do the same thing again with in 2 days! Then again, maybe I'm just a quick study and some people just aren't.

As you can read from the ad, once again it's a newly formed "group", wonder exactly who is involved in the "group".

Is it just me that finds this just amazingly stupid! Change names, change locations, rinse and repeat!

Honestly those with a sense of humor, you gotta just love this one!

ACCESS WEST DENTAL (Asheville, NC) - Great opportunity to live, work, and play in the beautiful mountains of western North Carolina in the progressive Asheville area, earn a great salary with no administration responsibilities, and to dedicate your skills to making a real difference! Join Access West Dental opening soon in Asheville, North Carolina. The newly formed Access West Dental is a private group general dental practice that will concentrate on providing much needed access to quality dental care for the under served children and young adults of western North Carolina. The new state of the art 10,000 sq foot office is presently under construction in west Asheville and will boast a beautiful professionally designed spacious interior, 8 chair fully computerized open hygiene bay, digital radiography throughout with intra-oral cameras, and 10 fully computerized ops to also support the “paperless” office model. In addition, there will be a central sterilization area, 4 private consultation rooms for discreet and informed doctor/patient communications, and a full complement of trained support staff that will consist of 4-5 RDHs, 10 DAs, 5 front desk staff (2 bilingual), plus and office manager and a director of operations. The practice will be open Monday -Thursday, closed a full day on Friday and offers a very competitive guaranteed salary and full benefits package for only a four day work week. New graduates encouraged to apply! Please contact Dr. Tish Ballance at 828-665-4410 or accesswest@gmail.com for more information on this practice opportunity.

Smiles Starters North Carolina Still Delivering Overtreatment to the Underserved via Elysa Bailey de Morias, DDS

Thousands of complaints made on Internet "message" and "review" boards.

Hundreds of legitimate complaints filed. 

At least 8 lawsuits.

Ten Million dollars ($10M) in restitution to the government for fraud. 

Under observation since 2003. 

Under my watchful eye since 2007.

Name changes of the facilities.

North Carolina State Board of Dental Examiners spending hundreds of hours reviewing complaints on former owners, current owners, past employees, current employees. 

Warning after warning issued, Consent Orders for Disciplinary Actions passed out like programs at a school play.

Surprise inspections from state and federal agencies.

It is almost October 2010 and we still we have Elysa Bailey de Morias, DDS.

Elysa may well be a very nice person, there are a lot of people who are stupid and/or crooks. 

 Here is the Compliant and Consent Order for Dr. DeMorias

Highlights

Practicing at Smiles Starters in Greensboro, North Carolina

A three year old girl was seen by Dr. Elysa on November 3, 2008, we will call the child HW.

Dr. Elysa “was unable to conduct an adequate visual clinical exam or take sufficient radiographs to support her treatment plan.

Dr. Elysa decided to develop a treatment plan anyway that consisted of restoration of 6 of HW’s teeth, “with possible stainless steel crowns on three of her teeth.”

Dr. Elysa placed “watches” on six of HW’s other teeth. That should be about all the three year old had in her mouth. Looks like Dr. Elysa was going to get at least ½ of them.

HW’s mother felt this was not right and took her child to a second dentist the very same month.

The second dentist wasn’t able to perform a through examination on HW.

In June 2009, 7 months later, HW’s mom took her to the second opinion dentist again who then was able to perform a full and comprehensive assessment.

All the second dentist found, 7 months after Elysa de Morias of Smile Starters saw this child, was a discoloration on tooth A and a minor fracture in the enamel of tooth N. He found NO decay on ANY of the teeth Dr. Elysa de Morias has supposedly found 7 months earlier.

In November 2009, more than a year after Dr. Elysa de Morias wanted to drill away and put stainless steel crowns on 6 of HW’s teeth, HW was seen by yet a third dentist. Dentist three found the very beginning decay on tooth A which he felt probably was not there a year earlier when Dr. Elysa laid claim to a mouth full of restoration needed, but found no other tooth problems what so ever.

All the Board nailed Dr. Elysa for was “violating the standard of care for dentists licensed to practice dentistry in North Carolina by proposing a definitive treatment plan without having conducted an adequate clinical examination and sufficient radiographs.”

Dr. Elysa de Morias agreed that there was sufficient evidence against her, but did not admit any wrong doing but decided not to oppose the allegations and agreed to whatever the Board decided to hand out as punishment.

Elysa Bailey de Morias, DDS has her dental license suspended for 30 days. For the next 2 years she must:

Not do that anymore

Not direct her employees to do that anymore

Allow random inspections and interviews

Complete continuing education designed especially for her at the North Carolina School of Dentistry

Reimburse the board $650.00 for their time and trouble.

Have her name reported to the National Practitioner Data Bank (which is no big deal these days).  Former owner and rumored to be current financier, Dr. Michael DeRose was put on that list many years ago and kept his licenses until 2009!  As did his partner in crime, Dr. Tish Ballance-she is still practicing.

Dr. Elysa Bailey de Morias has been in operation in North Carolina since September 2007!  Imagine the number of underserved she has overserved.

The Possibilities

I'm sure I've missed some billing codes and this isn't exact, but it sure is close.

North Carolina Reimbursement rates:

D0150 – Comp oral evaluation - $44.61
D1120 Prophylaxis (aka cleaning)- $27.21
D0210 Intraoral-complete series w/bitewings $71.79
D1203 Fluoride $16.04
D3220 Therapeutic pulpotomy - $81.09
D3220 Therapeutic pulpotomy - $81.09
D3220 Therapeutic pulpotomy - $81.09
D3220 Therapeutic pulpotomy - $81.09
D3220 Therapeutic pulpotomy - $81.09
D3220 Therapeutic pulpotomy - $81.09
D2950 Core Buildup, including pins $98.25
D2950 Core Buildup, including pins $98.25
D2950 Core Buildup, including pins $98.25
D2950 Core Buildup, including pins $98.25
D2950 Core Buildup, including pins $98.25
D2950 Core Buildup, including pins $98.25
D2950 Core Buildup, including pins $98.25
D2930 Prefab stainless steel crowns –primary tooth $144.28
D2930 Prefab stainless steel crowns –primary tooth $144.28
D2930 Prefab stainless steel crowns –primary tooth $144.28
D2930 Prefab stainless steel crowns –primary tooth $144.28
D2930 Prefab stainless steel crowns –primary tooth $144.28
D2930 Prefab stainless steel crowns –primary tooth $144.28
D2940 Sedative filling $39.77
D2940 Sedative filling $39.77
D2940 Sedative filling $39.77
D2940 Sedative filling $39.77
D2940 Sedative filling $39.77
D2940 Sedative filling $39.77

Total - $2339.99

If the procedures was upcoded to the D3230/D3240 it would be an additional $50 per tooth totaling just over $2600.00.

It's not uncommon to upcode the pulpotomies (D3220) to pulpal therapy (D3230/D3240).

D3220 - Pulpotomies are performed on vital teeth, while pulpal therapy (D3230/D3240) is performed on necrotic primary teeth, with resorbable medicament placed down the canals.

Conclusion

The only conclusion I can come to is Dr. Elysa de Morias  unnecessarily tortures and mutilates children, defrauds the medicaid system and got caught this one time. 

However, all that happened was a slap on the greedy little hand and back to work. 

Nothing was mentioned about the full extent of her attempts, just the actions; “violating the standard of care for dentists licensed to practice dentistry in North Carolina by proposing a definitive treatment plan without having conducted an adequate clinical examination and sufficient radiographs.

Questions

As with all of these cases, we have to ask what caused a person who spent thousands of dollars for her education to attempt not only fraud, but needless suffering of a 3 year old child, and to do it as casually as taking her next breath.

How many patients does she see in a week, a month, that she tries and succeeds in this exact scam?

Why are dentist caught doing this not prosecuted?  Doing an investigation, slapping a seeming large fine on them, but letting them keep right on is doing nothing to stop it.  So I have to assume the powers that be support.

Why do support staff not report this? 

Does it make those in the office who turn their head just as guilty?