May 30, 2012 1:00 pm
Financial Times:
Western Dental mandates Jefferies for sale process
Websites:
Wednesday, May 30, 2012
Federal Trade Commission implies Private Equity Executives deciding dental treatment will give North Carolina citizens lower costs.
North Carolina Representative Stephen LaRoque called in the FTC when it looked like SB655/HB698 might pass. Is Representative Stephen LaRoque bought and paid for by Corporate CEO’s? Appears so.
Where has the Federal Trade Commission been all these years if this is such a huge issue? Nowhere to be seen, not until brought in by Private Equity and Representative LaRouque.
FTC Staff: Proposed North Carolina Dental Services Law Would Likely Reduce the Benefits of Competition for Consumers
Federal Trade Commission Documents and Publications
May 29, 2012FTC Staff: Proposed North Carolina Dental Services Law Would Likely Reduce the Benefits of Competition for Consumers
Federal Trade Commission staff, in response to a request from North Carolina Representative Stephen LaRoque, stated that a bill proposed in the North Carolina legislature (http://www.ftc.gov/os/2012/05/1205ncdental.pdf) would likely deny consumers seeking dental services in North Carolina the benefits of competition, including the potential for lower prices, expanded access to dental services, and greater choice.
North Carolina House Bill 698 would give the North Carolina Board of Dental Examiners significant new regulatory and oversight authority over Dental Service Organizations (DSOs), which contract with dentists to perform non-clinical, business management functions, allowing dentists to focus more on patient care and less on administrative tasks. According to the FTC staff letter, the Bill would prohibit currently-used DSO management agreement provisions and give the Board exclusive authority to review and approve all DSO management agreements in North Carolina. The Board could apply these new restrictions and oversight powers to prevent DSOs from entering the state, and to dismantle DSOs now operating in the state by refusing to approve management agreements when they come up for renewal.
"Given that the Board already oversees health and safety issues as part of the licensure regime that governs all dentists in the state, and given that DSOs focus solely on non-clinical aspects of dental practice, it does not appear that the Bill would enhance the Board's ability to ensure patient safety," the FTC staff comment stated, noting that underserved communities, including 78 of the state's 100 counties, may be particularly affected if DSO efficiencies cannot be realized. "Therefore, we urge you to consider whether the Bill's restrictions and grants of regulatory power to the North Carolina Board of Dental Examiners are necessary to protect consumers" or whether they risk "merely protecting those dentists who do not choose to use DSOs against competition from those who do."
"In the absence of DSO-specific safety concerns," FTC staff urged the North Carolina legislature to consider the potential anticompetitive effects of H.B. 698 and reject the Bill.
The comment is part of the FTC's ongoing efforts to promote competition in the health care sector, which benefits consumers through lower costs, better care, and more innovation.
The Commission vote approving the staff comment was 5-0. It was sent to North Carolina Representative Stephen LaRoque on May 28, 2012. A copy of the letter can be found on the FTC's website and as a link to this press release. (FTC File No. V120007; the staff contact is Patricia Schultheiss, Office of Policy Planning, 202-326-2877.)
The FTC's Bureau of Competition works with the Bureau of Economics to investigate alleged anticompetitive business practices and, when appropriate, recommends that the Commission take law enforcement action. To inform the Bureau about particular business practices, call 202-326-3300, send an e-mail to antitrust@ftc.gov, or write to the Office of Policy and Coordination, Bureau of Competition, Federal Trade Commission, 601 New Jersey Ave., Room 7117, Washington, DC 20580. To learn more about the Bureau of Competition, read Competition Counts (http://www.ftc.gov/competitioncounts).
MEDIA CONTACT:
Office of Public Affairs
202-326-2180
Copyright 2012 Federal Information and News Dispatch, Inc.
Federal Trade Commission Documents and Publications
Private equity invests in dentists to pull poor kids' teeth for Medicaid dollars - North Carolina Battle Ground
Private equity firms have found a profit center in the teeth of poor children, which the firms are getting to by buying or backing dental management firms and getting their dentists aggressively into the business of over-treating kids on Medicaid.
Just as Mitt Romney's work at Bain Capital was about creating investor profit, not jobs (whatever he may claim now), this is about creating investor profit, not healthy teeth. For instance:
On May 2, All Smiles Dental Center Inc., a management company owned by Chicago-based Valor Equity Partners, filed for bankruptcy protection. Its hand was forced in part by a Texas Medicaid action cutting off payment to some of its clinics because of allegedly “excessive” and “inappropriate” orthodontic care, according to an All Smiles executive’s affidavit included in the filing. All Smiles was part of a state audit in which 90 percent of Medicaid claims for orthodontic braces were found to be invalid because they weren’t medically needed, according to Christine Ellis, one of the auditors.In some cases, the braces may have been put on children's baby teeth. Another dental management services company, ReachOut Healthcare America, which is owned by Morgan Stanley Private Equity, specializes in going into schools and treating kids in bulk. And when quantity is the priority, well, you make some mistakes. Like the case where six-year-old Sabrina Martinez's teeth were drilled "even after the student’s mother, Valerie Davila, told the company she was seeing a family dentist and didn’t need any work." But, see, there was another student named Sabrina Martinez, and if you're just trying to get through the most procedures you can on the most kids you can, you don't necessarily take time to tell one Sabrina Martinez from another. In another case:
When ReachOut called Stacey Gagnon to tell her the mobile dentist was coming to Isaac’s school, she said she explained that he had seizures and other serious medical conditions. ReachOut was told he could have a cleaning and oral hygiene education, nothing else, according to Gagnon.After that call, ReachOut dentists held Isaac Gagnon down and gave him two steel crowns, two pulpotomies and 10 X-rays.
Cases like this obviously require individual dentists to suck, both as dentists and as human beings. But if it's just about individuals, such stories don't happen to scale. That takes big money—things like private equity involvement pushing dental management services companies to expand the scope of what they do from providing services like billing and scheduling to coming closer to directing actual medical decisions, something that is potentially in violation of "State laws [that] broadly say only licensed dentists or firms they own can practice dentistry."
Some states are cracking down, and the U.S. Senate is investigating possible overbilling by several firms. But while regulating these abuses is an important first step, private equity firms will find the next under-regulated point of entry into profiting off of the massive inequality that leaves poor families vulnerable to such abuses and creates no meaningful disincentives to rich investors doing things like this again and again.
Ain't it the truth! Again and again and some more agains. North Carolina seems to be the battle ground, with Senate Bill 655/House Bill 698.
Private Equity firms are going all out to STOP North Carolina Dental board from enforcing the laws there. If you are a state lawmaker in North Carolina, I wouldn't be shocked if you got a call from beyond the grave from the likes of Leona Helmsley or Kenneth Lay.
The News Observer reports - Big buck in dentistry's ownership - "Who should make decisions about your dental care: you and your dentist – or a big, out-of-state corporation owned by Wall Street private equity funds? That’s the issue in the fight over Senate Bill 655 in the North Carolina legislature."
Orthodontics Offices Closing in Texas
Looks like the spin has started in Texas. I’m hearing many Orthodontic clinics will close up shop on July 1, 2012.
In the piece below, Dr. Michael Newman's says, "...about 5 percent of them would meet the requirements now."
Fact is, about 5% qualified EVER! Only thing that is changing is maybe, just maybe, stricter enforcement of standards already in place.
Surely Dr. Newman really meant to say, "about 5% is all we can bill for and not get nailed for Medicaid Fraud, now"
TIMES RECORD NEWS - Wichita Falls, Texas
Orthodontist office braces for closurePractice was only one in area taking Medicaid
Wichita Falls, TX May 26, 2012 -The only orthodontic office accepting Medicaid payments in Wichita Falls has stopped seeing patients and has locked its doors.
Red River Orthodontics set up shop on Euerka Circle in mid-2010. A sign in the door of the vacated Wichita Falls practice directs patients to an office in Fort Worth.
Representatives of Red River Orthodontics declined to comment, and referred questions to an attorney who could not be reached Friday.
The business was registered in the Wichita County Clerk's office under the title John Gremmels, Grill Repair, PA. The address given was in the 3300 block of Monterra Crest Drive in Fort Worth.
Last year Texas paid out $184 million in Medicare for orthodontics. That's more than every other state combined.
Dr. Bill Hendrickson, of Hendrickson Heetland Orthodontics, said he suspects Red River Orthodontics bolted for the door when they realized the Medicaid money was drying up.
"Their words were, 'It's a good investment,'" said Hendrickson, who visited the office personally. "They said, 'This is a very lucrative business.'"
Hendrickson now is in talks with state officials. He said he's trying to take on the patients who were displaced when Red River Orthodontics jumped ship.
Technically, at least one dental office that offers orthodontic services still accepts Medicaid, but is actually kept from doing so because of more stringent, state-mandated requirements.
In 2005 about 80 percent of dentist Dr. Michael Newman's patients were on Medicare. Newman, who operates Texas Orthodontics in Wichita Falls with his wife Denise, practices orthodontics as well as other dental procedures. Until October 2011 he was able to treat most of the patients who needed Medicaid to pay for his services.
But stricter enforcement of Medicaid standards mean that most of them, even patients who have already been fitted with braces, won't receive his care.
"I would say about 5 percent of them would meet the requirements now," Newman said.
In fact, only one of his potential patients received the go-ahead from the state for treatment. Newman wasn't allowed to treat that patient because he isn't a specialist.
A few factors have contributed to this, he said.
One is that some orthodontists have been accused of taking advantage of Medicaid funds. One case, detailing taxpayer money given to All Smiles Dental Centers in Dallas, has drawn significant media attention.
Another factor is the splitting of the third-party entity that paid Medicaid funds to orthodontists, the Texas Medical and Healthcare Partnership. About a year ago, he said, the company was divided into three new agencies, DentaQuest, Delta Dental, and Managed Care of North America. Newman said it hasn't been the same since.
He said the companies have drawn up constricting new rules that makes it virtually impossible to get a patient approved for payment.
"They started cutting back so that we couldn't get the cases approved," he said.
One rule that's being more strictly enforced is that an orthodontist must prove that a procedure is "medically necessarily" to maintain a patient's health. Newman said this is laughable.
"There is no patient I have ever seen who is going to die because of their teeth," said Newman, an officer of the American Orthodontic Society.
Friday, May 25, 2012
America's ToothFairy forms partnership to help at-risk children
America's ToothFairy forms partnership to help at-risk children
May 25, 2012
In an effort to expand oral health services for children, My Kid’s Dentist/Every Kid’s Dentist (MKD/EKD) announced a partnership with National Children’s Oral Health Foundation: America’s ToothFairy (NCOHF) through the Students United for America’s ToothFairy (SUAT) Pediatric Dental Residency Program. As a result of this alliance, NCOHF will become the primary charitable partner for the Pacific Dental Services-affiliated MKD/EKD offices.
Designed to provide critical oral health educational and preventive services for at-risk children, this new program also cultivates interest in the oral health field and unites future dental professionals in a concerted effort to break the cycle of pediatric dental disease in their communities. Guiding chapter activities, members of the SUAT Pediatric Dental Residency Program will serve as mentors for dental, pre-dental, dental hygiene, dental assisting and high school student volunteers.
“We are proud to partner with My Kid’s Dentist/Every Kid’s Dentist through this exciting program and applaud their commitment to children’s oral health,” said Fern Ingber, NCOHF President and CEO. “Their support will enable NCOHF to mobilize graduate, undergraduate and high school students throughout the country in an effort to reach thousands of underserved children with the resources, services and education necessary to prevent pediatric dental disease.”
Stephen Thorne, Founder, President and CEO of Pacific Dental Services, will also join the NCOHF Board of Directors. The NCOHF Board of Directors consists of highly respected and dedicated leaders of national and international organizations, universities and corporations concerned with children’s oral health and elimination of oral health disparities.
“I’m honored to be joining the NCOHF Board of Directors,” said Stephen Thorne, Founder, President and CEO of Pacific Dental Services. “NCOHF provides unparalleled oral health care education and support services for at-risk children and I’m looking forward to working with my fellow board members to shed light on pediatric dental disease and to help break its cycle.”
Dental Center Manager Gets Green Light For Sale To Lenders
Nothing really new here…
Law360, New York (May 25, 2012, 12:36 PM ET) -- A Tennessee bankruptcy judge on Thursday approved a credit bid to sell dental center manager Church Street Health Management LLC to a group of its lenders for $25 million plus their debt, just a few months after fallout from Medicaid fraud claims pushed the company into bankruptcy.
U.S. Bankruptcy Judge Keith M. Lundin agreed to the sale to CSHM LLC, an entity owned by some of Church Street's lenders including CIT Healthcare LLC, after no other bids were received at an auction.
Connecticut attorney general to seek restitution from Winsted dentist over billing practices
I’d say if your are a corrupt dentist in Connecticut and have your name on a PC or PLLC you might be a dumbass. Here is what happened to Dr. Doug Macko. So, if you are in a dental clinic there, and pacing the floor with worry, then you know you are doing criminal acts, right? Get your nitro pills ready. (You know who you are)
HARTFORD –Published: Thursday, May 24, 2012
Attorney General George Jepsen said in a statement that he is seeking restitution from a Winsted dentist and his practice for “allegedly violating the Connecticut Unfair Trade Practices Act by illegally billing the Connecticut Medical Assistance Program from April 2002 through October 2009.”
“The state Department of Social Services administers the Connecticut Medical Assistance Program, which includes Medicaid and other programs that pay for medical benefits for certain low-income and disabled Connecticut residents. DSS terminated the provider agreement for (Dr.) Douglas J. Macko ... and on Oct. 26, 2010, suspended him from the program for 10 years,” the statement said.
Macko and his professional corporation, Douglas J. Macko, D.M.D, P.C., in Southington, “had unlicensed dental assistants perform cleanings and other dental services, which may only be performed by licensed dental professionals, and then billed the state as if Macko had performed the services,” the statement said. “Alleged illegal billings were also made for services that were never provided.”
The complaint also alleges that “the acts, practices and course of wrongful conduct by Macko violated public policies against larceny, vendor fraud, health insurance fraud and against a medical provider violating licensing requirements.”
“This action is being brought to seek restitution, civil penalties and other relief authorized by law,” Jepsen said, also in the statement. “It should also send a clear message to other providers that Connecticut will not ignore fraudulent billing and other illegal practices and will vigorously pursue restoration of taxpayer dollars lost as a result.”
Susan E. Kinsman, director of communications for Jepsen's office said Thursday that the action brought by the attorney general is a civil one and, "It is our understanding that criminal charges have not been brought at this time."
Thursday, May 24, 2012
Mom takes 6-year-old out of dental chair to protect him
These places are so corrupt they don’t even care to change their ways during the middle of massive lawsuits or Federal Investigations.
Mom takes 6-year-old out of dental chair to protect him
San Antonio Headlines Examiner
When Karla Cardenas took her 6-year-old son Steven to a San Antonio dentist office on Friday, May 18, 2012, little did she know that she would have to take her son off the dental chair and refuse the treatment to protect him.
“They wanted to put him in a straight jacket type papoose while he was still screaming in pain from the shots they were giving him in his gum,” Cardenas said. ”They were trying to rush it and they heavily sedated him.”
The single mother of four took her son to The Smile Center Family Dentistry on Blanco Road after getting the approval and direction from Medicaid.
“I had no choice but to take Steven to that center,” Cardenas said. “Medicaid required it.”
“I told them to stop, you are not going to do this while he is in this much pain,” Cardenas said as she grabbed her son out of the chair.
Cardenas now said she is glad she followed her instinct because she has since learned that this dental care chain has been under scrutiny by the news media.
Chantel Brewer said “they did the same thing to my daughter “but “she kept getting out of the papoose so they wanted to send us home with her teeth all shaved down without the caps on.”
It was so bad that “even the assistant had scratches all over her face from my daughter kicking her in the face, neck, arms and even kicked her in the eye because she was in that much pain.”
“How can the Medicaid office send us to that office when there is this much bad news about them,” Cardenas asks. “It looks like they are herding children in and out as fast as they can with little concern about the pain.”
Earlier this year, Brian Collister of WOAI news issued several reports regarding similar concerns from other parents. According to WOAI, the dental chain has earned $23 million from Medicaid since 2007.
One San Antonio law firm, The Crosley Law Firm, P.C. is representing patients against this chain of dental centers who believe their children “have been victims of substandard dental care leading to injuries and requiring additional treatment.”
According to the Crosley Law Firm website, “many of these parents were approached in parking lots and lured into Smile Center with the promise of dental exams for their children at no out-of-pocket cost to them.”
“In most cases we have seen, the children were covered by Medicaid, and Smile Center would bill Medicaid directly,” the website stated. “ Often the dental care consisted of pulpotomies and the placement of stainless steel crowns.”
Crosley says that for some of their clients “the dental work may have been unnecessary, and resulted in a large bill to Medicaid” and in some cases “the injuries caused from the dental care necessitated visits to the emergency room and/or hospitalization.”
Cardenas, who has been a nursing student, indicated she “didn’t see any kind of resuscitation or life saving equipment or a ‘crash cart’ available” in the event of an emergency.
“This doesn’t mean they don’t have any (life saving equipment),” Cardenas explained. “I’m just saying I didn’t see any there.”
Hey, dental office managers, you too can be arrested, face felony charges, and jail time.
I have to ask is it worth it? Is playing along with the fraud worth giving up your life and family?
Office managers out there, know exactly what is happening with all the Medicaid fraud, children being abused and sit on their asses. Why?
Yeah, I’ve heard it, over and over and over again. “I need to feed my family”. Don’t mean to be so cold, but I’m so over hearing it.
OM’s at the dental mills are paid well, very well, too well in many cases. $50 to $60 thousand dollars a year is over the top to manage an office for a dental clinic. The paycheck is meant to hold them hostage as well keep them gagged and handcuffed.
Several times a week I find folks coming to this blog looking for the answer to their question on whether they- office managers, dental assistants, etc.-can be arrested or held liable in criminal fraud or malpractice behavior they see in their offices. They answer is a big fat YES. Ask Claudia Ventura.
CA Dentist Arrested for Insurance Fraud
Insurance Fraud — By Trace America on May 14, 2012 at 4:48 PMBeverly Hills often brings up images of huge mansions with beautiful sparkling swimming pools, gorgeously landscaped lawns, and several fancy cars in a large driveway. It often does not bring up images of insurance fraud; but one Beverly Hills dentist to the stars may be changing that.
According to the Beverly Hills Patch and the District Attorney’s Office, Tom K. Kalili, 57, was arrested on May 4th and accused of insurance fraud, grand theft of personal property and filing a false tax return. He was charged in a criminal complaint with 101 felony counts.
Kalili is the owner and operator of Beverly Hills Medical Suites.
It is reported that Kalili and his partners have several celebrity clients, including Jim Carrey, Kathy Ireland, Adam Sandler, Keanu Reeves and Vin Diesel.
Kalili’s office manager and biller, Claudia Ventura, 38, is also being charged, if only with 10 felony counts, including insurance fraud and accessory after the fact.
These charges all come out of a multi-year investigation by the California Department of Insurance, the California Dental Board and the California Franchise Board.
According to DrBicuspid, Kalili directed Ventura to submit fraudulent billing statements to four different insurers for a total of $339,799.99.
Prosecutors are asking for Kalili’s bail to be set at $500,000 and Ventura’s at $25,000.
If Kalili is convicted, he could face over 50 years in state prison, while Ventura could only receive up to seven.
Errol Gillis, DDS v California Board of Dentistry–Appeals Court Decision–Gillis lost on many levels.
Dr. Gillis worked at Sears Dental and things did not go well for him. He fought the law, and the law won. He lost his licenses for "gross negligent and incompetent" professional treatment. He appealed that decision to an Administrative Law Judge. The Dental Board took it to the First Appellate District Division One in California. The Dental Board won. Errol M. Gillis, DDS v California Board of Dentistry - Appeals Court Decision and Order Case CPF-10-510174 Jot this down: After a five-day hearing spanning days in June, July, and September 2009, an ALJ issued a proposed decision on December 3, 2009. The decision found the facts as set forth above and concluded Gillis was both grossly negligent and incompetent under Business and Professions Code section 16702 for overfilling James J.‟s tooth (paragraph 5E), both grossly negligent and engaging in unprofessional conduct under section 1670 for failing to respond to the wife‟s calls (paragraph 5G), and repeatedly negligent under section 1670 for failing to maintain complete patient records and failing to note the overfill or advise James J. about it (paragraphs 5A and 5F). The ALJ found the Board had not proved the other allegations of the accusation.