Friday, October 19, 2012
Thursday, October 18, 2012
Class Action Filed Against Aspen Dental–They operate illegally.
Brian S. Cohen, Esq.
COHEN LAW GROUP, P.C.
2 Greenwich Office Park - Suite 300
Greenwich, CT 06831
Phone: 203-485-7525
Fax: 203-485-7526
10 East 40th Street - 46th Floor
New York, NY 10016
Phone: 212-967-2879
Fax: 646-349-2567
Email: brian@cohenlg.com
Web: www.cohenlg.com
Aspen is not alone, most, if not all of these are operating illegally as well:
Affordable Care, Inc – American Capital
Allied Dental Practices
American Dental Partners
Aspen Dental Management, Inc
BrightNow!
Children’s Dental Group
ClearChoice Dental Associates
Dental Care Alliance
DentalOne Partners, Inc . – MSD Capital – Michael Dell
Dentistry For Children
Gentle Dental Group / Northwestern Management Services – Linden Capital
Gentle Dental of New England/Gentle Dental Associates
Gentle Dental/InterDent, Inc
Great Expressions Dental Centers
Heartland Dental Care – Code Hennessy & Simmons, LLC
ImmediaDent - James Ferrell – Samson Capital
Kool Smiles – FFL Partners
Lumino The Dentists
Midwest Dental – FFL Partners
Monarch
Mountain Dental
Ocean Dental
Pacific Dental Services, Inc – Scott A Beck and Jeff Butler
Perfect Teeth – Birner Dental Management
ReachOut Healthcare America – Morgan Stanley
Refresh Dental
ImmediaDent – James Ferrell – Samson Capital
Small Smiles – Garrison Investment
Smile Brands, Inc – Welsh, Carson, Anderson & Stowe
TownCare Dental Partnership, Inc - FL. State Representative Michael Bileca
West Coast Dental Services, Inc
Western Dental Centers
Texas expands Medicaid dental fraud estimates to $154 million
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by BYRON HARRIS Bio | Email WFAA-TV Posted on October 17, 2012 at 10:03 PM Updated today at 12:01 PM Story
In a House hearing on Monday, News 8's investigations of Medicaid dental fraud were praised by state representatives. "I have to tip my hat to WFAA in Dallas for doing what they've done," said Rep. Lois Kolkhorst (R-Brenham), chairwoman of the Public Health Committee.
The state has suspended payments to 26 orthodontic organizations under a policy called Credible Allegation of Fraud (CAF). The state can hold money back from Medicaid providers if it suspects it was billed fraudulently. Texas estimates that $229 million in Medicaid payments to put braces on kids' teeth may have been improper.
Audits show as many as nine out of 10 payments may have been fraudulent. For general dentistry, more than $154 million may have been overpaid. Expert analysis shows half the bills checked were erroneous. Eighty-nine dental providers have had payments withheld under CAF.
The OIG told a the public health committee of the Texas House that more manpower, more interest in fraud, and improved software are helping catch more fraud going forward. E-mail
E-mail bharris@wfaa.com
Wednesday, October 17, 2012
What will Harlingen Family Dentistry fight for, and what will they not?
The same Harlingen Family Dentistry that killed ten year old Marcos Tirado in September won a skirmish with the Office Of Inspector General’s (OIG) office yesterday. But that is far from winning this war.Harlingen Family Dentistry is one of the top 25 Medicaid billers in Texas and under investigation by the OIG. The Texas Tribune has Harlingen Family Dentistry rated at number 17 in claims for fiscal year end 2011.
Dr. Juan Villarreal, owner of Harlingen Family Dentistry is a former member of the Texas State Board of Dental Examiners, appointed by Governor Perry in 2001.
As standard practice, while under investigation,Office of Inspector General (OIG), began to withhold 40% of all reimbursement payments.
Not very happy about that, Villarreal appealed OIG’s decision. Despite OIG having evidence that 84 of 85 records reviewed failed to meet requirements necessary.
Harlingen hired their own witness who said he would have approved all but 8 of those 85.
WOW, that’s a HUGE difference!! Too huge to not look a bit suspicious on Villarreal’s part. After all he’s the one wanting “you” money and looks like he’s willing to kill children to get it.
Yesterday, Administrative Law Judge Susan Fekety, agreed to reduce the payment hold from 40% to 4%.
Always the victim, Villarreal said, "I am afraid to say that it appears that honest dentists are being ‘gamed’ rather than the other way around so the state can try to collect back funds its contractor had pre-approved years ago and that they want to claw back regardless of consequences to providers and patients. It just shows how broken Medicaid really has become.”
Would Marco still be alive if Villarreal were not such a greedy man? One thing is clear; what Dr. Juan Villarreal will fight for and what he will not.
Father claims no one tried to save his son
All About Dentistry–Dr. Farahani confronted about kidnapping. One dentist flees the country.
DALLAS — This summer, News 8 discovered some dentists were luring kids to their offices with pizza and pocket change without their parents' permission, then billing Medicaid for dental procedures that were unneeded.
Tiara Truelove said she and six other kids were offered cash on the campus of Dallas Can Academy in March when they were on their lunch break. A dental recruiter then drove them to All About Dentistry on Scyene Road.
After the recruiter fed the students pizza, their teeth were cleaned and they were each given $10, Tiara said.
When her mother, Tiffney Truelove, found out, she went to the office to complain and said she was met with indifference by the staff.
"You picked up my — at the time 16-year-old — and took her to the dentist, and you bribed her, and you basically kidnapped her," Truelove said. "And after you fed her, you supposedly cleaned her teeth. And then you brought her back and you don't think that you did nothing wrong?"
Challenge to recent studies on DSO’s by Laffer, Winegarden and Arduin: Put your mouth where your studies are.
October 15, 2012 Sally Pipes, President of Pacific Research Institute, published an op-ed piece at Forbes.com whereby Wayne Winegarden and Donna Arduin had studied Arthur Laffer’s study and yep, they agreed, dental management services organization are simply scrumptious. [cough]
Here is a chance for each of them to put their mouths where their “studies” are.
Here is the challenge to each; Laffer, Pipes,Winegarden and Arduin:
- Go to your regular dentist for a check-up. Keep any treatment plan you receive or report on the state of your dental health.
- Pick two DSO clinics that treat adults and two that are geared toward children on state insurance programs. I’m sure there are some nearby. It probably won’t cost you a dime, all of them have coupons for free exams and x-rays.
- Go for your appointments. Voice record the entire visit or it doesn’t count.
- Bring back any treatment plans, credit applications and other paperwork you receive.
- Next grab one of your toddlers, better yet, a grandchild, preferably under the age of 5 years old.
- Take them to their regular dentist for a check-up. Keep any treatment plans you receive or report on their dental health.
- Run them down to each DSO Medicaid clinic you chose for a check-up.
- Here too, you must record each visit. Don’t be scared. if you are brave enough to put your name on these “studies”, you should balls enough to send you “child of choice” back there alone.
- You must get copies of their treatment plans as well, if any. I say that since chances are good the treatment will already be completed when you get your child back.
- Interview the child after each visit.
When you’re done, each of you should have 6 reports, 3 for you and 3 for the “child of choice”.
Now, you have some real life data!
Tell us how it went.
Monday, October 15, 2012
Student denied dental degree after failing to meet production quota at New York University College of Dentistry in 2009, gets her degree in 2012
There are hoards of evidence that dentists and employees of dental chains owned and operated by Wall Street fat cats have production quotas to meet. Some chains call a daily “budget” amount, while others call it “goals”, “targets” or “forecasts”. Be it the number of patients or dollar amount the company expects the employee to bill or sell, it’s still a quota.
The pressure to meet these quota’s appears to be the foundation on which the overtreatment, mistreatment, malpractice, and brute force used on children is based.
It’s not just the private equity firms, like Morgan Stanley, or the regionalized dental management organizations like Dental Professionals of Texas (now MB-2) bilking the Medicaid system. It’s also our medical colleges it appears.
A student used to be denied his or her degree because they were short credits. At New York University College of Dentistry (NYUCD), graduating is based on meeting a production goal.
It was because she had failed to meet the $38,000 in production quota at NYU’s David B. Kriser Dental Center.
What does New York University College of Dentistry call its production quota system? It’s called “Practice Model Value” (PMV). It is purportedly to train dentists to treatment real patients for a fee. Well, golly gee, wonder if they had no clue that would happen if they used their skills after graduation?
I wonder if it’s some kind of scoring system to see how much value any particular student can be to a corporate dental chain. That seems to be what the name of the program implies.
We know for sure it is a revenue generating system for the college at the expense of patients health and the taxpayer. NYUCD accepts several Medicaid managed care programs.
I know what you’re thinking, maybe this was some kind of program to aid in payment of her education. That answer is, no. Meeting the $38,000 quota is required by each student in addition to the $70,000 a year tuition.
According to court documents, students were required to meet a quota $38,000 in their last two years of dental school. In the spring of 2009, Dr. Harry Meeker, Katie’s instructor, says he notified Katie about her deficiency. But the earliest records showing any communication to the fact was May 25, 2009.
So, what did Katie do? Again, according to court documents, after hearing of her situation and before she planned to move to Boston in two days, Katie did what others pressured to meet quota’s do. She fabricated patient records. She charted she she provided patients with 16 extractions, and bleaching on one afternoon and ponied up the $2000 herself. The treatments never happened.
Thursday, October 11, 2012
Texas Task Force Hunting Down Medicaid Dental Fraudsters
Texas finally appears serious about the state’s extraordinary Medicaid dental fraud. Hopefully indictments will soon be coming. I hear at least one bunch of merry bandits, are locking doors on some of their clinics and owners are scurrying like the nasty rats they are.
Joint Task Force Tackles Medicaid Dental Fraud
by Becca Aaronson October 10, 2012
Through a new joint task force, the Texas attorney general’s office and the office of the Inspector General at the Health and Human Services Commission have teamed up to strengthen investigations of fraud and abuse in the state’s Medicaid dental program for children. And because the task force allows the agencies to coordinate limited resources, state officials say, the state can advance investigations and recover misused taxpayer funds more quickly.
“The Medicaid and orthodontic fraud task force was convened to ensure the state had a comprehensive and coordinated response to a dramatic uptick in fraud by Medicaid providers,” said Daniel Hodge, the first assistant for Attorney General Greg Abbott. “The highest levels of all affected agencies and divisions are actively involved in advancing the investigation as efficiently and effectively as possible."
John Scott, the deputy attorney general for enforcement litigation, chairs the task force, which also includes officials from the Medicaid Fraud Control Unit and Civil Medicaid Fraud Unit at the AG's office, and officials from the inspector general and other departments of the HHSC.
In 2010, Texas spent as much on orthodontic services as every other state combined, according to a report released in April by the U.S. House Committee on Oversight and Government Reform. "The state has admitted that widespread fraud was occurring and that the organization the state hired to assess prior authorization forms was essentially rubber stamping forms for approval," the report states. An orthodontist consulted by the inspector general's office at HHSC estimated that 95 percent of approved claims should have been denied, according to the report.
State officials said the task force, which was created this year, allows the agencies to take advantage of what each group brings to the table. For example, the inspector general’s office has software to monitor whether a provider’s claims data looks suspicious and can put payment holds on providers it suspects are committing fraud. And the AG has teams of lawyers from the two Medicaid fraud units who follow through on investigations, subpoena records and press charges.
The state is also getting an assist from whistleblowers like Dr. Morna Staffel, a pediatric dentist in Fort Worth, who said she has stacks of evidence — in the form of patient records — of children being overtreated and, in effect, abused by dental clinics seeking to profit off the state’s dental program for low-income children.
On Monday, for example, she had to remove six teeth in a child’s mouth that had abscessed less than six months after Medicaid paid for the child to be treated at a nearby dental clinic. “When I see this type of situation, I’m pulling patient records, I’m keeping patient records, I’m calling the [Office of the Inspector General],” said Staffel.
Evidence turned over to the state by whistleblowers is filed under seal. And state officials cannot disclose how many investigations they are currently pursuing. But one provider, All Smiles, which was the focus of a WFAA-TV report in October that brought the allegations of fraud into the national spotlight, appears to be in their crosshairs.
State authorities familiar with the task force’s investigations said the group is committed to recovering all taxpayer funds lost to dental fraud, from both dental providers and the Texas Medicaid and Healthcare Partnership, which was responsible for evaluating the medical necessity of dental claims and approving payment.
The state audited TMHP’s process for evaluating dental claims in 2008 and recommended that the contractor increase the number of licensed dental professionals reviewing orthodontia claims, according to a State Office of Administrative Hearings report related to a recent allegation of Medicaid dental fraud. “TMHP responded to the audit’s recommendation by saying that an increase in the use of dental professionals would require a change in TMHP’s contract, which did not occur,” the report states.
TMHP recently renewed its state contract, and state officials familiar with the investigations said they plan to work with the company on negotiations to recover state funds lost to medically unnecessary claims.
In an email to The Texas Tribune, Ken Ericson, a spokesman for TMHP, said, “Several providers are under state attorney general investigation — and we are cooperating with that investigation.”
Most of the rise in Medicaid dental claims was probably legitimate, said Stephanie Goodman, spokeswoman for HHSC, because the state had increased reimbursement rates by 50 percent to expand access to care. “Those other factors kind of masked the fact that there was also probably an increase of bad actors in the program,” she said.
Texas became a target for dental fraud after 2007, when the Legislature allotted an additional $1.8 million for Medicaid children’s dental services, as part of a legal settlement to increase access to care.
State authorities familiar with the task force's investigations confirmed it has found that some dental clinics have illegally solicited Medicaid patients by standing outside large retailers and grocery stores and handing out gift cards in exchange for signing up for a free dental exam. And the inspector general recently issued a statement that said, “Offering inducements to Medicaid clients is a violation of state and federal law and is subject to a penalty of up to $10,000 per violation.”
As the Tribune reported in July, the crackdown on orthodontic fraud has left many patients with untended braces, and a difficult transition to Medicaid managed care has exacerbated problems with access to care. The state is currently severing ties with Delta Dental, one of three Medicaid managed care plans, in part because state officials said the company failed to establish a computer system for providers to submit claims in a timely manner. In December, 1.1 million individuals enrolled with Delta Dental will be transferred to the other two managed care dental plans.
Staffel said the transition to managed care has limited the number of orthodontists willing to take referrals for Medicaid patients, and many patients have been left "hanging in limbo," after the state shut down their orthodontic clinic by withholding Medicaid payments while the state investigates allegations of fraud.
HHSC has informed orthodontic providers that the dental board can suspend or revoke their license for abandoning Medicaid patients.
"We’ve worked really closely with the dental board on that issue," said Goodman, adding many orthodontists have also stepped up to help address the problem with access to care. "Even providers that didn’t normally take Medicaid patients have agreed to take a few."
- Dr. Staffel worked for Dr. Eugene Kouri at Eugene Kouri, DDS MSD, Inc. 2921 Lackland Road #201, Fort Worth, TX 76116
- Gene M. Kouri, DDS, MSD - Dr. Kouri received his MSD in Pediatric Dentistry and his doctorate in Dental Surgery from Baylor University. He began his private practice in 1961 with a brief interruption for service as a captain with the United States Army Dental Corps. Dr. Kouri’s professional associations include the Texas Society of Dentistry for Children, American Academy of Pediatric Dentistry and the Southwestern Society of Pediatric Dentists. – http://genekouriddsmdfortworthtx.com/texas-pediatric-dentists
Dr. Eugene Kouri came in at number 8 in 2010 Texas’s Top Stainless Steel Crown state records, topping off at 6,108. In 2011 his office billed the state over $2M, nearly $700M for stainless steel crowns alone!
2010 Top Ten Dentists to bill Texas for stainless steel crowns:
- Linda T. Burke - Harlingen, TX
- Trueblood Dental Associates - Austin, TX
- Buckner Market Place Dental - Dallas, TX
- Smile Center – San Antonio, TX
- Robert Morgan DDS MSD – Irving, TX
- Kool Smiles Laredo, TX
- Valley View Smiles/ All Smiles Dental – Dallas, TX
- Eugene Kouri, Fort Worth, TX
- Bill Pope, McAllen, TX
- Robert Morgan DDS, Richardson, TX
Wednesday, October 10, 2012
Beekman Group, unloads Gentle Dental on Linden Capital Partners. Just in time?
October 10, 2012
PRESS RELEASE
Harris Williams & Co., a middle market investment bank focused on the advisory needs of clients worldwide, announces the sale of Northwestern Management Services, LLC (NMS) doing business as Gentle Dental (Gentle Dental), a leader in the dental service organization (DSO) industry, to Linden Capital Partners (Linden). Gentle Dental was a portfolio company of The Beekman Group, LLC (TBG). Harris Williams & Co. acted as the exclusive financial advisor to Gentle Dental. The transaction closed on October 5, 2012 and was led by James Clark, Geoff Smith and David Allebach.
“Gentle Dental has established itself as a clear leader in the attractive South Florida dentistry market through its commitment to quality, operational excellence and results-driven approach to physician and practice support. In addition, this transaction demonstrates investors’ continued strong interest in the DSO sector driven by investors’ desire to find scalable business models in markets positioned to benefit from positive demographic trends,” said James Clark, a managing director in Harris Williams & Co.’s Healthcare & Life Sciences (HCLS) Group.
Tuesday, October 09, 2012
A peek under the sheets at Heartland Dental
I ran across a propaganda piece today on – dentalhealthcarecenter.net. about the super duper fantastic Heartland Dental Care.
It tells about Heartland Dental, in Effingham, IL and what they can do for dentists who are finding it hard to develop their own dental offices. It tells dentists, that by becoming an “affiliate” of Heartland, it can “make your career better.” Their career will be better because Heartland “will increase your creditability and reputation”. It goes on to say:
- “Working with this company will never lead you to regret”
- ”your office will be way better”
- “The company will help in marketing your office, providing you qualified staff,, managing your office, advertising your services and many more.”
- ”people consider that dentists who are working under the name of the company are all professional”
- “it is not the company that decides how your office should work. You can decide how you run your business yourself. The company just helps you reach your dream.”
- “if you face serious problem when running your office, the company will give you effective suggestion in how to break the problem.”
- “you will likely to become a partner of the company”
But what really happens?
Here is what I’m told