Saturday, September 29, 2012
Employee complaint about dental office sanitation
http://news.com.au/national/dentist-clinic-operates-without-steriliser/story-fndo4ckr-1226483364907
Judge stops case where dentist sues patient for Yelp review
http://www.kval.com/news/local/Dentist-who-sued-patient-over-Yelp--171840671.html?m=y&smobile=y
Thursday, September 27, 2012
Whistleblowers, we should all be one!
Whistleblowers Help Texas In Medicaid Fraud Cases
- by Becca Aaronson
- September 27, 2012
“When I’ve spoken with a couple of other states, they definitely recognize Texas as a leader in enforcing pharmaceutical fraud,” said Dr. Sammy Almashat, one of the report's authors.
Texas has recovered at least $354 million in Medicaid fraud settlements from pharmaceutical companies since 1991 with the help of private whistleblowers, according to the report. Almashat said that’s because under Texas law, whistleblowers can receive between 15 to 25 percent of the financial penalties of a Medicaid fraud settlement for bringing the case forward.
Although 13 states have similar laws, “Texas is a unique case, because other states haven’t been nearly as active as Texas in taking advantage of whistleblower revelations in prosecuting,” civil Medicaid fraud, said Almashat.
“A whistleblower brings unique underlying knowledge about the fraud that was perpetrated by the defendant in the case,” said Daniel Hodge, first assistant attorney general. In all civil Medicaid fraud cases — including those against pharmaceutical companies and many others — in the last 10 years, Texas has recovered $880 million, said Hodge, and $373 million of that went to the state treasury.
The whistleblower cases are entirely responsible for that $880 million, Hodge said, explaining that although the Inspector General at the Texas Health and Human Services Commission referred 12,000 criminal Medicaid fraud cases to the AG's office since 2002, during that same time, that agency only referred three civil Medicaid fraud cases.
Currently, a top priority at the AG’s Office is to pursue orthodontic and dental fraud in the Medicaid Program, said Hodge. The office has assembled the Orthodontic and Dental Fraud Task Force to combine resources at various agencies, including the Office of Inspector General at the HHSC. At least one case being pursued by the task force was referred by a whistleblower.
Given the significant portion of the state budget that goes to Medicaid, “it’s more critical than ever for the taxpayers that we aggressively pursue any actors that defraud the taxpayers and recover those dollars,” Hodge said. “We’re thrilled that Texas has been recognized for [Attorney] General Abbott’s efforts to prioritize uncovering and recovering waste, fraud and abuse in the Medicaid program.”
Wednesday, September 26, 2012
Sun Orthodontix raided by FBI–Life in dental fraud is not as rosy as it used to be, is it?
We’re getting there…
by BYRON HARRIS
WFAA-TV
Posted on September 26, 2012 at 5:58 PM
Updated today at 6:18 PM
Story TimelineClick to open timeline
Related:
NEWS 8 INVESTIGATES
In the largest action to date, the FBI, state investigators and the attorney general have raided the offices of Sun Orthodontix.
Sun doesn't have locations in North Texas, but it was the second largest biller for braces under Medicaid in 2010.
Part of its huge growth in Texas is linked to Medicaid dental bills. News 8 found Texas dentists were charging taxpayers for putting braces on kids who didn't qualify for them under Medicaid.
Sun collected more than $9.6 million in 2010, according to state records.
FBI agents were part of Monday's raids at Sun offices, which stretch from El Paso to Corpus Christi.
"The FBI doesn't show up when they think you've committed a crime... they know you've committed a crime long before they show up," said Houston attorney Jim Moriarty, who is part of a whistle-blower case against Dallas-based All Smiles Dental Centers.
The joint raid is the largest action so far against a dental firm in Texas.
"I think you may see tens or hundreds of dentists who end up with civil or criminal charges against them," Moriarty said. "I think there is a tsunami of criminal action against crooked orthodontists in Texas."
No criminal charges have been filed against Sun or its dentists. But the company has been in a dispute with Medicaid. The state quit paying Sun Orthodontix earlier this year, questioning its practices.
Sun has taken the state to court for money it says it is owed.
E-mail bharris@wfaa.com
Ohio State Dental Board Compliance Manual
Remember the stories last week about state not inspecting dental offices for sanitation.
Mohamed El Deeb continues to have Minnesota dental license suspended.
Mohamed El Deeb, license number D9508, is no stranger to the Minnesota Dental Board:
November 6, 2008 - Stipulation and Order for Conditional License after a complaint that was serious enough to be referred to the Attorney General. (I guess the Minnesota dental board knows the right person to contact at the AG’s office there, unlike Texas, where they haven’t a clue)
The incident occurred in January 2004. They found “record keeping violations” – a great catchall, like “improper equipment for us motorists” – substandard care and “incorrect billing” – aka “fraud” as it related to three patients. Evidently it related to conscious sedation, as the board called in an expert for a report.
In 2005 there was another complaint. It too was referred to the AG. Somewhere along they reviewed 5 years of his records and found several items worthy of sanctions.
September 24, 2010 Dr. Deeb petition the dental board to have his license reinstated. They did so, with no conditions attached.
September 7, 2012 – The board issued an order of a Temporary Suspension during a closed session.
September 17, 2012 – The board continued its Temporary Suspension
Don’t’ miss WFAA–TV–Byron Harris Report
I hear there was a raid by the FBI at a Texas Orthodontic clinic. Watch for Byron’s report.
Think “Sun”shine!
Tuesday, September 25, 2012
Here’s a challenge -
Here is the Laffer Associates Study that says DSO’s (Kool Smiles, Small Smiles, etc) perform less procedures per patient than private dentists. It also says they steal less than money per patient than private dentists. Ok, it doesn’t use the word steal… but still….
You can find a link to the raw data at the bottom of page 5 of Laffer’s study. Or at their dropbox here. Or this dropbox here.
WARNING – if you have a copy saved as an .xls file instead of a .xlxs your speadsheet does NOT contain all the data!
Here is the challenge – Debunk it!
According to the study they found 35 Texas Providers Identifiers for Kool Smiles in Texas. Considering Small Smiles used at a minimum 25 provider numbers for 4 of their dental centers in 2010, I betting there were a whole lot more than 35 numbers used for Kool Smiles and their many clinics in 2011. Hell, there are at least 55 “providers” in the Indiana Kool Smiles centers. It might have been 35 that could be identified, for Texas in 2011, but that’s the point, isn’t it?
Laffer says this about the data:
Data and Methodology
We were provided Medicaid claims paid data for the fiscal year 2011 by Kool Smiles, who had received these data from the Texas Medicaid Program via a Freedom of Information Act request. We did nothing to verify the authenticity or accuracy of these data.
Before going into the results of our analysis, let me provide a few definitions. In Texas, Medicaid covers children in families from no income up to 185% of the federal poverty level for children up to 1 year old, up to 133% of the federal poverty level for children from 1 year old to 5 years old, and up to 100% of the federal poverty level from children 6 years old to 19 years old.Thus, the data contain all Medicaid claims arising from children aged zero through 19 years, 11 months in families with income up to the applicable multiple of the federal poverty level (the federal poverty level is an annual income of
$18,530 or less for a family of three as of 1/1/12), regardless of what type of dental provider treated the child.
We counted as a procedure every separate dental activity that was charged to Medicaid with a Medicaid billing code.
Unfortunately, the data did not contain a separate total count of patients accessing dental services. Instead, unique patient counts were provided for each Medicaid billing code. To derive an estimate of the total number of patients, we added the number of patients treated via each code for a prophylaxis cleaning and used that count as our number of unique patients.
We used this procedure for all DSOs and all non-DSOs as well.
Prophylaxis cleanings, or “prophies”, are the standard dental cleanings that every patient receives as part of a routine dental visit.24 These dental cleanings, which are typically billed under the same code each visit, provide a more reliable method for this patient count than other routine services, such as exams, which might be billed under different codes and lead to double counting. There are three codes for prophylaxis cleaning, each based on age: D1110 for patients 13 to 20 years old, D1120 for patients 6 months to 12 years old, and D0145, 25 a code specific to the Texas Health Steps program, for children under 3 years old.
The Medicaid data we received contained a count of clients who received the procedure associated with each Medicaid billing code, broken out by location of dental service (see below). Summing the number of clients receiving each prophylaxis procedure thus provides a proxy for the total number of unique patients treated under Medicaid in Texas in 2011.
Accordingly, we use “prophies,” a routine procedure administered with regularity, as the count for unique patients, or “patients,” as we’ll refer to them in this analysis.
Additionally, the data quite naturally did not explicitly identify which dentists were associated with DSOs. The amount of reimbursement doesn’t differ for DSO dentists and non-DSO dentists. In order to receive reimbursements for treatment
performed on Medicaid patients, however, a dentist must apply for and be assigned a Medicaid Texas Provider Identifier (TPI) number. We made a list of all of the DSOs we could identify that do business in Texas, and any TPI that filed a claim using an identified DSO address was counted as being a DSO dentist (see Appendix A for a full listing of all DSOs included in our calculations). All other TPIs were counted as non-DSO dentists. In the process, we dropped the claims data for any TPI that filed with Texas Medicaid but was associated with an address that was not within or immediately bordering Texas.
An important caveat is that the total population of DSOs within the data represents office locations, and not individual dentists. In going through the data, we were unable to find multiple dentists working at the same DSO office billing
separately. With few exceptions for non-DSOs, it seems a rule that most group practitioners bill under a single base (7-digit) TPI instead of their unique and individual 9-digit TPI.
Basically, I read this to say “GIGO” – Garbage In – Garbage Out. So someone spent a hell of a lot of money for a report that means nothing and I mean nothing. Goes to show you though, tell a company what you need it to say, and they can get the data to make it so.
As well, these DSO’s work very hard to hide the fact they are operating as a DSO, since it’s illegal, so the number of non-DSO dentists numbers have to be distorted, right? Like I said, GIGO!
Monday, September 24, 2012
Civil trial begins for Dr. Brain Seastrunk - accused in child death. Dr. Seastrunk is blaming nurse, Cynthia Jones.
Civil trial begins for doc accused in child death
By Craig Kapitan
Updated 10:57 p.m., Thursday, September 20, 2012
When 22-month-old Maddoux Cordova woke up from a routine outpatient dental procedure three years ago crying, thrashing and trying to remove his intravenous line, Dr. Brian Seastrunk approved two doses of morphine instead of Advil.
The anesthesiologist's decision, along with his failure to closely monitor the boy after the narcotic was administered, led to the child's death, attorneys for Cordova's parents told a civil court jury Thursday as testimony began in a malpractice trial.
Seastrunk's attorneys have countered that the nurse who requested and administered the drug — and therefore the hospital that hired her — instead is to blame. The hospital also has been sued but is not a party in the trial.
“As a doctor, the rule is you don't expose your patient to needless risk,” plaintiff's attorney Beth Janicek said during an opening statement in 37th state District Court. “That's what they live by. It was needless to order such a powerful drug.”
Cordova was found not breathing by his grandmother the afternoon of Dec. 11, 2009, about five hours after he was discharged from Village Specialty Surgical Center, according to court documents. He was revived by emergency responders but was brain dead, and on the day after Christmas the decision was made to take him off life support.
Gun toting dentist, Dr. Conrad Jim Kusel Jr. uses lethal weapon to keep staff under control during meeting. Lawsuit filed.
All the illegal dentistry happening in Florida, used to stay in Florida. Seldom did news come out about dentists arrests, going mad, or illegal corporate practice of dentistry. But boy, oh, boy, has that changed in the last two weeks!
LAWSUIT: Port St. Lucie dentist terrified worker with staff meeting gunplay
LAWSUIT: Port St. Lucie dentist terrified worker with staff meeting gunplay
Imagine if Dr. Thomas Floyd had a gun in his office !!! He would have shot children instead of jabbing them in the mouth with pliers and beating them in the stomach.PORT ST. LUCIE, Fla. -- A lawsuit filed by a former employee claims a Port St. Lucie dentist waved a gun around at a staff meeting, telling staff to "sit down and stay in line."
Everyone agrees the dentist had a gun at work that day.Police reports show six detailed accounts of the same meeting. But the State Attorney's office here never pursued charges against the dentist -- Dr. Conrad Jim Kusel Jr. of the Kusel Dentistry practice in Port St. Lucie.
Lawyers for former receptionist Sunday Sack, a 13-year employee there, say she suffered post-traumatic stress disorder from the February incident in which she and others allege Kusel pulled the gun in an angry tone and said "everyone is going to sit down now and and I'm sure everyone is going to stay in line during the meeting, right?"
Sunday Sack: "That morning that gun was pointed and cocked it, and started to talk, I saw that vein, I saw that vein popping..I literally froze and basically fell down into my chair..I was like paralyzed."
Kusel's brother Brian Kusel is also a dentist there. The suit also names him for not intervening in the situation.
The lawsuit does not specify damages, but Sack says she planned to work there for the rest of her life and is seeking money for lost wages and distress. She's been attending counseling since the incident in February and says she was so affected, she spent months hiding in her own closet fearing for her life.
Sack is now on Social Security disability for her diagnosed trauma. In police reports, Kusel defended his actions by saying the gun was bought with money the staff had given him for the holidays, and he was showing off what he'd purchased. Since the gun-waving incident, three other employees have left the practice.