Texas Medicaid Orthodontics Mills are abandoning patients–leaving approx. 200,000 children with a mouth full of braces and no one to continue treatment

KIVA-TV El Paso

Big Thumbs Up to Dr. Rick Black for stepping up!

EL PASO, Texas -

Some children are lucky enough to be born with straight, pearly whites, but every year, millions of American families find themselves spending big money on braces.

Braces in El Paso typically run around $5,500 for a three-year orthodontic term.
Medicaid does not pay for cosmetic procedures, but according to Texas Health and Human Services, Texas Medicaid has been paying for cosmetic orthodontics work for years.

Texas Medicaid spent nearly $500 million on orthodontic treatment for children from 2009 to 2010, according to state records.

That is more than all other U.S. states spent on Medicaid orthodontics combined.

The vast majority of the cases paid for by Texas Medicaid were cosmetic cases, an HHSC spokesperson said.

In response to a public outcry and an investigation exposing the spending by WFAA-TV in Dallas, HHSC stopped all payment to some of the highest billers of Texas Medicaid, which a spokeswoman says have committed fraud.

"If they find credible evidence of fraud, where it appears a provider knowingly submitted incorrect information about cases, they can put a payment hold on them," HHSC spokeswoman Stephanie Goodman said. "And that's what they've done in this case.

Medicaid does not pay for cosmetic orthodontics, only for cases where the child cannot eat or chew his food properly.

Such cases would be children with cleft palate, Down syndrome, or cases where the child has had severe facial trauma due to an accident.

Goodman says fraudulent claims were made, making cases appear more severe, so that they would pass through Medicaid's approval process.

This scenario happened so frequently, eventually racking up a bill of nearly half-a-billion dollars in three years, Medicaid now admits its contractor reviewing the cases was negligent.

One local group of orthodontics clinics, currently under investigation, has now stopped treatment for around half of their patients.

"We're in the midst of treatment! You're just going to abandon my kid?" Erika Mendoza, mother of a Sun Orthodontix Medicaid patient said.

Marcos Mendoza, 12, had his braces put on by Sun Orthodontix almost a year ago.

His mother said his crooked teeth made it necessary for him to get braces, and she said a doctor at Sun Orthodontix told her the braces would be paid for by Medicaid.

Now that Sun has discontinued treatment to Marcos, Erika Mendoza says she is scrambling to find another orthodontist to treat him.

Sun Orthodontix, with four locations in El Paso, is among several orthodontia clinics being investigated for fraud by the Office of Investigative Affairs.

Sun's location in Las Cruces is not included because the investigation is limited to the state of Texas.

In a statement provided by the company's attorney, Frank Sheeder, Sun Orthodontix blames the mess on Medicaid for signing off on the treatments in the first place.

"Our orthodontists were required to submit forms, x-rays and photographs of the patient to Texas Medicaid before they were permitted to provide treatment," the statement reads. "These abrupt changes make it impossible for our orthodontists, and for many others, to continue to serve children in the Medicaid program."

In the meantime, patients like Marcos are scrambling to find new orthodontists.

ABC-7 called a number of Medicaid-accepting El Paso orthodontists to see if they are taking Sun Orthodontix transfer patients.

All of them said 'no,' except one orthodontist.

El Paso orthodontist Dr. Rick Black says he is already taking former Sun Orthodontix patients -- reevaluating their cases, and resubmitting their claims to Medicaid.

We asked him what he would do if payment was suddenly cut off from a case he had initiated. "I think, Matt, you kind of get what you ask for -- in other words, even in private practice, even though I'm a Medicaid provider and I had a small amount of Medicaid patients before this happened -- I feel an obligation," Black said. "When you start a patient, regardless of what happens, especially money, you are obligated to finish that patient."

It is a practice that Sun Orthodontix is apparently unwilling to honor in Marcos' case.

Want to hear a real crock? …

By Jim Cross
PHOENIX -- An ABC News investigative report found some states require very little for dentists to be certified to administer sedatives to children and that 12 children have died nationally after being sedated by dentists.

Arizona dentists face some of the toughest standards in the nation. Kevin Earle is executive director of Arizona Dental Association and said if parents have fears make sure their dentist is board certified.

"If you go to a board-certified pediatric dentist you can be certain the individual has had proper training. Where the concern lies is with individuals who have not had that extensive training.

"The use of oral sedatives have become much more common in the past 10 years so if you have a general dentist who graduated more than 10 years ago, there is an obligation to have more extensive training before they proceed with using oral sedatives."

Earle said board-certified dentists are trained to deal with any emergency.

"There's a rigorous permitting process that includes having proper equipment on site in case there is an incident and having proper medication in case there's a reaction. The assistants are trained to react quickly in the case of an incident."

"We're lucky here in Arizona that those have been in place for more than 10 years."

Earle said to the best of his knowledge there has never been an incident involving the administering of oral sedation.

Jim Cross, Reporter

HIV, Hep A, B or Death.. no line not crossed in dentistry out of pure greed.

This blog has spent the last four years trying to drive home the fact that dentistry in the 21st Century is based on greed with little sign of healthcare considered before treatment.  (no, not everyone) but it is becoming the norm. So much so that madness as reported here has become acceptable.  The ADA and most of its members has remained silent.  This is yet another black mark on what was once a noble profession.

There are over 1100 blog posts here about the corners that are being cut and those who are cutting them.  Yet, today I continue to have to report crap like this!  Why? Why does everything lead back to Colorado? This time, Stein's Oral and Facial Surgery and Dr. Stephen Stein.

July 12, 2012
DENVER -- Patients of a Highlands Ranch and Cherry Creek dentist were advised Thursday to be tested for HIV, hepatitis B and/or hepatitis C.

CALL7 Investigator John Ferrugia began asking questions of the state health department early Thursday and the department made its investigation public Thursday afternoon.

The Colorado Department of Public Health and Environment issued the advisory urging anyone who was a patient of Dr. Stephen Stein, who practiced oral surgery at his practice in Highlands Ranch and Cherry Creek, may have been exposed if they received intravenous medications, including sedation, under Stein’s care between September 1999 through June 2011.

The health department said patients may be at risk if they were seen by Stein during the 12-year period and at these locations:

- September 1999 to June 2011 at Stein Oral and Facial Surgery, 8671 S. Quebec St., #230, Highlands Ranch, Colo. 80130

- August 2010 to June 2011 at Stein Oral and Facial Surgery, 3737 E.1st Ave., Suite B, Denver, Colo., 80206. Patients were also seen at this location by Stein under another name, New Image Dental Implant Center.

The health department said there have been no specific infections linked to these offices, so far.

Investigation Found That Injection Needles Were Reused

The department began its investigation following a report of unsafe injection practices. Upon investigation, it was determined syringes and needles used to inject medications through patients’ IV lines were saved and used again to inject medications through other patients’ IV lines. This practice has been shown to transmit infections.

The investigation continues. State health officials are working with health officials at Tri-County Health Department and Denver Public Health due to the locations of Stein’s practices in those counties.

Practice Closed, Stein Not Practicing

Stein Oral and Facial Surgery is closed. Stein entered into an Interim Cessation of Practice Agreement with the Colorado State Board of Dental Examiners at the Department of Regulatory Agencies on June 24, 2011, and currently is not practicing.

In the original action from 2011, the state found “the public health, safety or welfare imperatively requires emergency action.” Because of privacy issues, the state won’t release details about the complaint to Call7.

Maulid Miskell, DORA Program Director, says that the agency continued to investigate Stein’s practice. In April 2012, the agency notified Colorado Public Health about the Stein possibly reusing needles on patients.

"It’s related but unrelated. It’s hard to talk about. I can’t go into detail, but the information provided to them, as soon as we found out about that information, it was timely reported to them," Miskell said.

Under this agreement, Stein can hold a dentistry license, but he cannot practice because no final action has been taken in the 2011 complaint.

The Highlands Ranch office was purchased by another oral surgeon in September 2011. State health officials have determined that the reuse of needles and syringes on multiple patients in Dr. Stein’s offices did not continue past June 2011.

8,000 Letters Sent Out To Former Patients

CALL7 Investigator John Ferrugia reported that 8,000 letters have been sent out to former patients of Dr. Stein. The letters should be received within the next few days, the health department said.

However, records may be incomplete, so any patients who remember receiving IV medications, including sedation, at one of Stein’s offices between the dates listed contact their health care provider to be tested as a precaution.

Patients who are uncertain if they received IV medications should also be tested.

Patients who did not receive IV medications do not need to be tested. Members of the public can call 1-877-462-2911 or visit http://www.cdphe.state.co.us/ for more information.

People infected with viruses such as HIV, hepatitis B and hepatitis C may not have symptoms for many years, so it is possible patients might have been infected and not know it. Even though patients who may have been exposed may not feel ill or remember getting sick, they should get tested. Although testing cannot determine where or how someone was infected (at Stein’s offices or from another exposure), it is important to know so treatment can begin.

Health providers who test Stein’s former patients are being asked to report any tests positive for HIV, hepatitis B or hepatitis C to their county health department or the state health department and to specify the patient was tested as a result of unsafe injection practices at Stein Oral and Facial Surgery. HIV, hepatitis B and hepatitis C are reportable conditions in Colorado, meaning they must be reported to public health authorities.

Former Patient "Angry," Felt "Instant Denial"

Shannon Stamey saw Stein for a dental implant in 2008. She found out about the potential health scare when she read it first on the 7NEWS Facebook page.

"I got on Facebook and saw on 7NEWS that Dr. Stephen Stein's patients should be tested for HIV and Hepatitis," said Stamey. "I immediately, actually, began shaking. I was with my young son. I talked with my husband on the phone. But definitely, instant denial."

Stamey has a weakened immune system and because she receives blood transfusions every three weeks, she already gets tested for HIV and Hepatitis.

"They just tested me in May and said I'm in the clear, most likely, because this was four years ago," said Stamey. "I'm just very angry for everyone else who has to go through this. I definitely can't imagine waiting to go into a doctor's office and get tested and waiting for those results. That would be very stressful."

She also doesn't understand how this could have been going on for 12 years with no one coming forward.

"How could people working in the office not say anything? And I just don't understand why. I mean, I don't know if it was a money thing? I don't think syringes cost that much," said Stamey. "I don't really understand how someone could do that or why you would do that and why no one would speak up for 12 years."

More Info: http://www.cdphe.state.co.us/dc/Epidemiology/dentistFAQs.pdf or call 1-877-462-2911.

In all fairness Malouf did take his business model from the DeRose family in Pueblo, Colorado… and they have their own footballs stadium and city for that matter…

Who said you can’t make any money seeing to the oral health of our nations poor.

WFAA-TV Byron Harris reports:

WFAA

Posted on July 12, 2012 at 10:30 PM

Updated today at 9:37 AM

DALLAS - The Texas Medicaid dental scandal is moving into a new phase. A construction phase.

One of the dentists charged with fraud in billing Texas taxpayers tens of millions of dollars for unneeded braces on children is in a new spurt of expanding his mansion.

He's building a water park on the property.

It's happening out of public sight, among the high-dollar homes on Dallas' glitzy Strait Lane. All the homes are big here, but the home of dentist Richard Malouf, former majority owner of All Smiles Dental Centers, is even bigger.

Plans for the expansion are on file with the Dallas Planning Commission.
"There's going be a gymnasium, a rock climbing wall," said real estate columnist Candy Evans. "There's plans for a bowling alley upstairs. There's going to be exercise rooms."

The complex, which began taking shape six years ago, began with one chateau. Malouf's Medicaid dental empire was expanding, and he sold a major share to a private equity fund.

Now he's sinking his earnings into a new mansion next door, along with a private Schlitternbahn in the back acreage, along with a second swimming pool to match the one at the original mansion.

All this is happening as two suits charge Malouf with massive fraud, brought by the Texas Attorney General and private attorneys under the False Claims Act.
Attorney Jim Moriarty is one of a consortium of attorneys in the action, led by Waters & Craus in Dallas. They say samples of Malouf's records show that 100 percent of his Medicaid claims were false.

"Frankly, it borders on being obscene," Moriarty said of the mansion expansion. "The taxpayers of the State of Texas paid to build that house, and are paying to expand that house for a guy who claims to have made his money treating the people of Texas."

"I think the only other park I know of is in Jupiter, Florida," Candy Evans said.
That one belongs to singer Celine Dion. A comparison of photos of Dion's estate with those of Malouf's, obtained by News 8, show that Malouf's water park may be bigger.

In Texas, a family's home is immune from seizure. But the lawyers in the false claims action against Malouf say his home may be fair game.

"If that home is purchased with stolen money, or that home is based on money that has been earned by falsehood or deceit, then that home is not protected at all," Moriarty said.

Malouf has several groups of attorneys, since his former company, All Smiles, is in bankruptcy in addition to his pending false claims suit. His most recent criminal attorney did not get back to us.

Related:

• Candy's dirt real estate blog
• Texas AG lawsuits spurred by WFAA dental investigation
• All Smiles Dental Center files for bankruptcy following investigation
• Texas Medicaid dental program pays millions for crowns, fillings
• Texas doctor accused of Medicare, Medicaid fraud gives up license
• Medicaid recruiters scramble for Texas dental patients
• Outrage on Capitol Hill follows News 8 Medicaid probe

Who is the new Texas Coalition of Dental Support Organizations?

Five Private Equity firms, who are steadily marking their territory, it’s not a coalitions, it’s a cartel.

 

 

Coalition Launched to Protect Texans' Access to Quality and Affordable Dental Care

PR Newswire

AUSTIN, Texas, July 9, 2012

AUSTIN, Texas, July 9, 2012 /PRNewswire/ --  Leading providers of dental office administrative support services today announced a new group called the Texas Coalition of Dental Support Organizations (TCDSO).

Members of the coalition - known as dental support organizations or DSOs - help increase access and lower the cost of dental care for Texans at a time when access and affordability are a critical challenge for many Texas families: Texas currently ranks among the bottom eight states in the number of dentists per 10,000 residents, according to data from Kaiser State Health Facts.

TCDSO members provide vital business and administrative support services - including facility maintenance, supply management, billing, scheduling, accounting, taxes, payroll and marketing - that simplify the process of running a dentist office and enable dentists to spend more time caring for their patients. 

ABC News - Death, Greed at the Dentist: American Children at Risk

By MEGAN CHUCHMACH (@megcourtney) and BRIAN ROSS (@brianross)

July 12, 2012

Death, Greed at the Dentist: American Children at Risk

American children are being put at risk by inadequately trained dentists who often seek to enhance profits by sedating their young patients for even routine tooth cleaning and cavity treatments, an ABC News investigation has found.

In many cases, even well-trained dentists have been unable or ill-equipped to handle emergencies with young patients.

More than a dozen children have died after being sedated by dentists, according to the Raven Maria Blanco Foundation, which seeks to alert parents to the potential dangers of the increasingly widespread use of oral sedatives on patients as young as 18-months old.

ABC World News and Nightline to air segment on pediatric sedation dentistry–tonight July 12, 2012

I know, I’ve posted this before and ABC pulled the story. However tonight I have faith it will air. GMA had a teaser about it this morning. Check your local listings and set your DVR’s.

Richard J. Malouf, DDS adjoining two homes! One $14-mil home isn’t big enough, I bet something else he has isn’t big enough either… Just saying…

Dr. Richard J. Malouf’s over inflated ego is reflected in his newest home addition. He’s adjoining two homes into one, and it will have a “lazy river” ride. I think it may be for practice for his “up the river” ride. But again I’m just guessing. 

Yes, this is the same Dr. Richard J. Malouf whose company stole millions of tax dollars and who has filed bankruptcy. Also the same one who the Texas Attorney General has filed lawsuits against to recover stolen funds.

Looks like Texas taxpayers may have a new “Six Flags Over Malouf” amusement park soon.

Richard J. Malouf, DDS - Adjoining two homes, to include lazy river ride. Practice for "up the river" ride?

Robin Lockwood, DDS pleads guilty in Medicaid fraud scheme with Chad Hoecker owned Ocean Dental Centers

Dentists who are participating in this scheme, at all the dental mills across the country; I didn’t see anywhere in here where Ocean Dental or Chad Hoecker pled guilty did you? Are you guys smelling what I’m stepping in here?

U.S. Attorney’s Office July 11, 2012

• Western District of Oklahoma (405) 553-8700

OKLAHOMA CITY—Robin R. Lockwood, 44, a dentist from Oklahoma City, pled guilty to committing health care fraud, announced Sanford C. Coats, United States Attorney for the Western District of Oklahoma.

Lockwood is a dentist licensed to practice in the state of Oklahoma and was employed under contract by Ocean Dental at offices located at 1610 Southwest 74th Avenue, Oklahoma City. Ocean Dental’s dentists provided dental care to Medicaid-eligible children. The Medicaid Program is a cooperative program that provides federal and state funds to pay for health care benefits for individuals with insufficient incomes to meet the costs of necessary medical expenses. In Oklahoma, Medicaid is administered as “SoonerCare” by the Oklahoma Health Care Authority (OHCA), a state governmental agency. Ocean Dental submitted claims to the OHCA for reimbursement of dentists’ services based on patient treatment notes created by the dentists. Ocean Dental paid Lockwood a percentage of the funds that OHCA reimbursed to Ocean Dental for services she personally rendered.

More Casamassimo propaganda; he needs more money from Medicaid. He says the same crap year after year, and never is enough ever enough. Kinda of like a drug addict chasing the dragon isn’t it.

I’m so sick of people like Paul Casamassimo, DDS spewing his bullshit. He has a vested monetary incentive to mouth off this crap and people just keep right on publishing it. Amazing! I’m sick of him and the elites like him saying people on public assistance are no show losers. And I’m sick of him trying to say the American taxpayer should pick up the bill for doctors who have missed appointments, or empty chairs as he puts it.  Empty chairs may be a problem. Shit, don’t have 14 chairs you need to fill, Dr. Cass-ass! Think about it, you fool! BTW, are you still on the “advisory board” of that child abusing, scumbag company Small Smiles Dental?? If Cassamassimo would stop helping corporations steal Medicaid dollars to line their pockets there might be more money for us to pay for empty chairs and those missed appointments. Of course, that’s just how I see it… and I’m an idiot…so who cares what I think, right?

 

Dentists, Medicaid don't mix
Dental care for poor faces challenges of culture, funding

Marionstar.com

You're at a job interview, so smile. But if you're missing teeth, you're less likely to get hired.

Ohio's Medicaid-eligible population largely ignores dental health, dental professionals say. This means minor problems turn into big problems, which frequently end up with the dentist yanking out the problematic tooth.