Monday, November 18, 2013

Florida Dental Board allows Dr. Michael Tarver access to children after Florida Department of Health says he’s too dangerous

Apparently the Florida Board of Dentistry is more concerned about “saving face” of one of their licensees—Dr. Michael Addair Tarver— than they are about the  safety of the public, most notably, children.

At a board hearing on November 15, 2013, the board voted to reinstate the dental license of Dr. Michael Addair Tarver and agreed to a proposed settlement  with a few changes. Reports say the Dental Board members agreed to “reduce the fine imposed by 1/2;  from $15,000 to $7,000 and to removed a stipulation whereby Dr.Tarver must publish a 2,500 word article. (don’t worry, Dr. T, I think the the 2,500 word article is covered)

In September 2013, the Surgeon General and Secretary of Health, John H. Armstrong, MD, FACS, issued an Emergency Suspension Order for the dental license of Dr. Tarver after an investigation of serious allegations of patient endangerment and malpractice.  (see Background below)

According to the Ocala Post article, Tarver admitted he would sedate children if they misbehaved!  This is far past outrageous!  It’s criminal!!!  What next will happen that sends the message it is acceptable to sedate a child for misbehaving?!  Teachers?  Daycare providers?  Parents?  Grandparents?  Does this not scare anyone but me?!

Tarver must also complete continuing education on Ethics and keeping Dental Records.  By reading the Emergency Suspension Order, Tarver knows all about record keeping, since he was able to go into the computer an altered many of them.  Maybe this required CE class is about how to restrain the urge to alter patient records when investigators come knocking.  Reports also say he must be “monitored” by another dentists, someone other than his wife. 

WSJ - Getting a Grip on Dental Expenses

LOL, ya gotta love it.  There’s a “grip” on it alright.  A damn tight one!

 

wsj

 

 

Getting a Grip on Dental Expenses

Health Law Should Help Children and Some Low-Income Adults

By Kristen Gerencher

Nov. 16, 2013 8:05 p.m. ET

Oral health typically isn't covered by traditional health insurance, but kids and low-income adults soon may have more opportunity to take care of their teeth. As many as 8.7 million children are expected to gain dental insurance through the Affordable Care Act by 2018, according to the American Dental Association, though some experts expect a more modest addition of about 5 million children.

The news for adults is mixed. Medicaid, the federal and state health-insurance program for low-income people, will expand in some states under the health-reform law, providing more adults with dental coverage. While 29 states offer adult Medicaid recipients limited or comprehensive dental coverage, 21 states offer bare-bones, emergency-only coverage—or none at all, according to Oral Health America, a national nonprofit based in Chicago.

Medicare, the federal insurer for the disabled and for adults 65 or older, doesn't cover routine dental care, so many seniors still face hefty out-of-pocket costs. Two-thirds of 407 seniors earning less than $35,000 a year said they couldn't afford a procedure such as a crown, implant or bridge, according to a recent survey by Oral Health America and Harris Interactive.

Here are a few tips for managing dental costs, whether you're shopping for insurance or discounts:

Starting Jan. 1, more kids may find coverage through Medicaid, as 25 states and the District of Columbia make plans to expand the program, and through state or federal health-insurance exchanges. But the options can be confusing. Only two states, Washington and Nevada, require families who shop for health coverage on the exchanges to buy pediatric dental insurance as well, says Evelyn Ireland, executive director of the National Association of Dental Plans in Dallas.

On the exchanges, you need to weigh whether to buy a separate "stand-alone" dental plan or one that is part of a health plan. In some markets, because of the way deductibles are structured and because premiums could exceed the cost of expected care, it may make more financial sense to forgo dental coverage altogether.

If you choose to get pediatric dental coverage through a medical plan, check to see how the deductible is applied, Ms. Ireland says. "We've seen them all over the map," she says. The health plan may require you to pay its deductible before the dental plan will cover routine care such as well-child cleanings, sealants and X-rays. Because dental insurance has traditionally paid the full cost of preventative care, "it will be a big shock if [consumers] go under a medical plan and end up having to pay all of it out of pocket instead of none of it out of pocket."

Sunday, November 17, 2013

Texas Dentists for Medicaid Reform Press Release Re: Antoine Dental Center

Hey folks, it’s not the Office of Inspector General who “lost”, it’s not just the taxpayers of Texas, it’s all taxpayers.  The Medicaid system is funded with state and federal funds.  Taxpayers should be outraged over this ruling! 

Texas Dentists for Medicaid Fraud Reform Press Release Re: Antoine Dental Center:

Judges Finds Another Texas Orthodontic Practice Innocent of Medicaid Fraud and Misrepresentation

Two administrative law judges with the Texas State Office of Administrative Hearings (SOAH) have issued their proposal for decision in the case of Antoine Dental Center of Houston (ADC) SOAH Docket No. 529-13-0997. ADC had been placed under a 100% payment hold in April of 2012 by the Texas Health and Human Services Commission Office of Inspector General (OIG) for "credible allegations of fraud" and willful misrepresentation in their orthodontic billings from 2008 to 2011. ADC had been one of the top 25 billers of Medicaid for orthodontic services in the state. The judges, in their decision, found that ADC had not committed fraud or any willful misrepresentation and ordered the payment hold discontinued.

"I am extremely relieved and happy with this decision," stated Dr. Behzad Nazari, the owner of ADC. "We had been crippled to the point of near bankruptcy by this payment hold and the allegations that had been swirling around the practice. I have been saying for a long time that we weren't guilty and I am thankful that the judges recognized that fact. There is something wrong with the way these cases have been prosecuted by the state."

Oh, I bet Dr. Nazari is happy happy happy.  Just because some judge (or jury)says you aren’t guitly doesn’t make it true.i.e.Casey Anthony, O.J. Simpson.

Judges Howard S. Seitzman and Catherine C. Egan wrote in their decision that "the prima facie evidence failed to support a credible allegation of fraud or willful misrepresentation and failed to show that ADC filed claims for non-reimbursable services. The few non-fraudulent record retention violations that ADC committed were technical violations that do not warrant a payment hold."

Sorry, judges, I 100000% disagree!  Anyone at that hearing could clearly see the fraud, and their expert Dr. Orr, was a joke.

It’s hard to pin fraud on top executives in big complex companies! Poppycock, says Judge Jed Rakoff

This may seem to have nothing to do with corporate dentistry and fraud, but you would be wrong.
Judge Rakoff Blasts Breuer, Prosecution of Companies Rather than Individuals in Bar Speech

Thursday, November 14, 2013

naked capitalismAbsent sitting on the Supreme Court, it is difficult for a single judge to effect much change. Yet Jed Rakoff, in sending the SEC back to the woodshed in two separate cases over its failure to get factual admissions, meaning admissions of misconduct, on civil settlements of SEC cases, singlehandedly embarrassed the SEC and the Department of Justice into seeking these statements (for instance, numerous media reports indicate that the Administration wants that sort of confession as part of its pending settlement with JP Morgan).

Rakoff threw down another gauntlet in a New York Bar Association speech on Tuesday. I’m taking the liberty of quoting it at length because his rebuke is a breath of fresh air and roused the Department of Justice to issue a “we really are doing our job” response.

But if, by contrast, the Great Recession was in material part the product of intentional fraud, the failure to prosecute those responsible must be judged one of the more egregious failures of the criminal justice system in many years.

Rakoff then pointed to the fact that the FCIC and numerous government officials had discussed fraud in connection with the crisis and went further:

While officials of the Department of Justice have been more circumspect in describing the roots of the financial crisis than have the various commissions of inquiry and other government agencies, I have seen nothing to indicate their disagreement with the widespread conclusion that fraud at every level permeated the bubble in mortgage-backed securities.

He then goes through their litany of excuses (his word). Ooh, it’s hard to pin fraud on top executives in big complex companies! Poppycock, says Rakoff:

Who, for example, were generating the so-called “suspicious activity” reports of mortgage fraud that, as mentioned, increased so hugely in the years leading up to the crisis? Why, the banks themselves. A top level banker, one might argue, confronted with increasing evidence from his own and other banks that mortgage fraud was increasing, might have inquired as to why his bank’s mortgage-based securities continued to receive triple-A ratings? And if, despite these and other reports of suspicious activity, the executive failed to make such inquiries, might it be because he did not want to know what such inquiries would reveal?

This, of course, is what is known in the law as “willful blindness” or “conscious disregard.” It is a well-established basis on which federal prosecutors have asked juries to infer intent, in cases involving complexities, such as accounting treatments, at least as esoteric as those involved in the events leading up to the financial crisis. And while some federal courts have occasionally expressed qualifications about the use of the willful blindness approach to prove intent, the Supreme Court has consistently approved it.

The second, “weaker” excuse came out of Lanny Breuer’s mouth in his notorious Frontline interview: that the investors in mortgage-backed securities were sophisticated; it would be hard to prove they relied on ratings and fraudulent misrepresentation. Rakoff basically says that Breuer is a crappy lawyer:

Actually, given the fact that these securities were bought and sold at lightning speed, it is by no means obvious that even a sophisticated counterparty would have detected the problems with the arcane, convoluted mortgage-backed derivatives they were being asked to purchase. But there is a more fundamental problem with the above-quoted statement from the former head of the Criminal Division, which is that it totally misstates the law. In actuality, in a criminal fraud case the Government is never required to prove reliance, ever. The reason, of course, is that would give a crooked seller a license to lie whenever he was dealing with a sophisticated counterparty. The law, however, says that society is harmed when a seller purposely lies about a material fact, even if the immediate purchaser does not rely on that particular fact, because such misrepresentations create problems for the market as a whole.

The third excuse is that prosecution might hurt the economy. Rakoff indicated his discomfort with the “too big to jail” idea, but used that to lambaste the notion of prosecuting institutions as opposed to individuals. No institution would perish if an executive were prosecuted.

Rakoff carefully and pointedly says he’s not accusing prosecutors of revolving-door corruptions and that prosecutors maximize their value in the post-government service market by collecting scalps. Whether of not he actually believes that to be true, he has to say that or risk never hearing a big securities case ever again, in that both defendants and regulators could ask to have cases assigned to other judges based on the notion that Rakoff had said that prosecutors were soft of big corporate crime because they were currying favor with prospective future employers. Notice, by contrast, the cautionary example of Judge Shira Scheindlin, who had a ruling opposing New York City’s stop and frisk rules overturned because she violated the code of conduct for Federal judges by showing partiality.

But he point out other reasons why no one could be bothered to go after the conduct that wrecked the economy. The best US Attorney’s office, the Southern District of New York, was busy on the Rajaratnam case. Any smart prosecutor would ride that horse, which was ready to go, rather than take on the slog of a case that was years away from being files. So basically, with Congress starving the SEC of budget and making it capable only of handing out parking tickets in the form of insider trading cases, SDNY staffers were incentivized to go after the comparatively easy cases the SEC threw over the transom rather than pursue far more important crisis-related cases. Rakoff argues the other reason for the government’s reticence to prosecute is that it would embarrass government officials and expose policy failings.

And Rakoff described why prosecuting companies, rather than targeting individuals, produces lame outcomes:

But if your priority is prosecuting the company, a different scenario takes place. Early in the investigation, you invite in counsel to the company and explain to him or her why you suspect fraud. He or she responds by assuring you that the company wants to cooperate and do the right thing, and to that end the company has hired a former Assistant U.S. Attorney, now a partner at a respected law firm, to do an internal investigation. The company’s counsel asks you to defer your investigation until the company’s own internal investigation is completed, on the condition that the company will share its results with you. In order to save time and resources, you agree. Six months later the company’s counsel returns, with a detailed report showing that mistakes were made but that the company is now intent on correcting them. You and the company then agree that the company will enter into a deferred prosecution agreement that couples some immediate fines with the imposition of expensive but internal prophylactic measures. For all practical purposes the case is now over. You are happy because you believe that you have helped prevent future crimes; the company is happy because it has avoided a devastating indictment; and perhaps the happiest of all are the executives, or former executives, who actually committed the underlying misconduct, for they are left untouched.

Saturday, November 16, 2013

Terrence Ewing Syler, DDS was sentenced to 22 months in jail

A joint investigation between the Feds and the State have landed another Texas dentist in the poky.  70 year old Terrence Ewing Syler, DDS was sentenced to 22 months in jail by U.S. District Judge Thad Heartfield.

Texas dentist sentenced to prison for Medicaid fraud

Dr BicuspidBy DrBicuspid Staff

 

November 14, 2013 -- A Beaumont, TX, orthodontist has been sentenced to federal prison for Medicaid fraud after submitting claims for palatal expanders that were never provided to his patients.

Terrence Ewing Syler, DDS, 70, pleaded guilty in June to healthcare fraud and was sentenced to 22 months in federal prison on November 7 by U.S. District Judge Thad Heartfield, according to a U.S. Department of Justice statement.

Dr. Syler, who owned and operated Syler Orthodontics in Beaumont, submitted the fraudulent claims from January 2007 to October 2012, according to the statement. As a result of the scheme, Dr. Syler received $829,000 to which he was not entitled. As part of his plea agreement, Dr. Syler agreed to forfeit several bank accounts totaling just over $829,000 and pay a $6,000 fine.

Friday, November 15, 2013

Small Smiles Dental Center Attorneys Want “Jury Stalking” Proceedings Sealed

I know a little about creepy attorneys and Small Smiles. See, it was about this time of year in 2008, Small Smiles Dental Centers sent a creepy attorney, named Thor, knocking on doors, of anyone in a 100 mile radius of me that had my same name. (By the way, there are several)  It was well into the night when he knocked on mine.  He was searching for the person (me) who was exposing the secrets of their criminal dental scam, which was defrauding Medicaid from hundreds of millions of dollars. They wanted me to shut the hell up! 

Now, Small Smiles Dental Centers and their malpractice insurance carrier want to silence the post-trial proceedings dealing with their jury tampering in the first malpractice trial in Syracuse, New York.  I’m shocked! (sarcasm)

National Union Fire Insurance Company (NUFIC) a subsidiary of American International Group (AIG) hired New York attorney, Scott Greenspan to “monitor” (a.k.a. “stalk”) the jurors of the first Small Smiles Dental/FORBA malpractice trials in Syracuse, New York.  Mr. Greenspan is a partner at Sedgwick Law, with offices around the world.  According to Mr. Greenspan he was hired by Denise D’Assaro,  AIG Complex Claims Director and it was pure coincidence he was in every restaurant they jurors visited.

Read:

NUFIC/AIG wants State Supreme Court Justice Deborah Karalunas to seal all records and court documents related to the jury stalking event.  Frankly, they would like to wave a magic wand and have the whole incident removed from, not just the record, but the memory of all parties.  I would think they especially want the transcripts where their employee Mr. Scott Greenspan is said to be“creepy” and “seedy” buried under the courthouse. 

They also want the public barred from any hearings about said jury stalking event. Well, of course they do!  They would like it if the jurors didn’t notice they had a creepy and seedy stalker but that ship has done sailed.

Apparently, on October 16, 2013 - shortly after the verdict, Judge Karalunas  called at least one juror back to court for a hearing.  I’m sure this judge wanted to hear more details of the jury stalking incident.   Heck yeah, I want to know just how far Mr. Greenspan went in his intimidating and harassing of the jurors during the 10 day trial.  What line did he not cross?  What lines did he cross without hesitation?  No doubt NUFIC/AIG wants the transcript between Judge Karalunas and the juror marked “Super Duper Top Secret”,

If there is anything that should NOT be sealed it would be this!  The public doesn’t need to know the jurors names or other person information — that should be redacted.  But, boy oh boy, the public sure needs to know the extent NUFIC/AIG will go to in order to deprive young children from being compensated for injury, pain and suffering at the hands of one of their insured.

AAPD Behavior Guidance Symposium Nov 2013

According to the American Academy of Pediatric Dentistry, their Behavior Guidance Symposium “kicks” off today at their headquarters in Chicago.  I can simply not believe I was not invited to this event!  I should pay much closer attention to their event schedule in the future.

AAPD BHM Symposium 11-15-2013

Frankly, I’m not sure why the AAPD even has the event, since apparently the AAPD and their “policy and guidelines” are of little value.  According to testimony from ethically challenged dentists involved in various malpractice lawsuits across the nation, he policy and guidelines are mere “suggestions”.

Attending the event will  garner you Continuing Education credits.  With the massive number of dentists working in the Medicaid dental mills, you would think they would need a venue such as McCormick Place or the United Center instead of the Westin Hotel.

Thursday, November 14, 2013

Inside Edition puts spotlight on Happy Valley Pediatric Dentistry and The Smile Center

I’m sure Dr. Simpton of The Smile Center is popping a cork over this Inside Edition piece.  I’ve been a “victim” of Simpton’s cover-up, his attorney sent me a cease and desist letter, a year or two ago.  Why you ask?  Because I reposted a story or two out of Texas. I’ll be watching my mail for yet another one!

 

Airdate: 11/13/2013  Are Some Dentists Drilling For Dollars?

insideeditionGoing to the dentist is a scary proposition for many people. But imagine what it must be like for a child who goes to the dentist and comes out with a mouthful of metal crowns that may have been unnecessary.

When she was just four-years-old, Savannah’s mother Alicea White says she took her daughter to the Happy Valley Pediatric Dentistry in Phoenix, AZ for a routine appointment.

But Alicea says instead of just filing four cavities on Savannah, dentist Dr. Karan Nett turned Savannah’s mouth into a smile of steel.  

“I was completely shocked,” said Alicea. “All that silver in her mouth. I was like, ‘Oh my God, what happened?’”

Alicea says every single tooth in Savannah's mouth was crowned with metal!

People compared her new smile to the James Bond villain, Jaws.

Alicea said, “It broke my heart. I was in tears right along with her.”

Alicea believes Dr. Nett was just drilling for dollars; doing unnecessary and excessive work to jack up the bill.

INSIDE EDITION’s Lisa Guerrero tried to speak with her outside her clinic.

“I'd like to talk to you about a little girl whose mouth you filled with metal? Would you like to look at these pictures and explain these pictures?” Guerrero asked Dr. Nett as she walked to her car.

Dr. Nett did not respond to Guerrero but has denied any wrongdoing, saying the work was necessary due to Savannah's significant tooth decay.

It turns out that metal mouth cases like Savannah's are not rare.

One look at Maya Anderson's mouth and you can see why she falls to pieces reliving her traumatic trip to this dental chain in San Antonio, Texas called the Smile Center.

“I had 24 teeth worked on. All I have is like five teeth left. I’m sorry. He ground down my teeth so small they were like little stubs.”

The dentist who worked on Maya's teeth for eight hours is Dr. Mark Hong, and Maya's isn't the only patient who claims he drilled for dollars. 

On just five children, parents allege that Dr. Hong performed over 30 baby root canals and crowned over 50 teeth.

Tuesday, November 12, 2013

Maine DHHS may reduce fines for dentists–No danger there!

Paperwork mistakes is the number one excuse for fraud for heaven sake! 

 

portand press

November 12

Maine DHHS could reduce fines for dentists

Dentists complain about large fines by an auditor for minor clerical errors in MaineCare patient cases.

By Joe Lawlor jlawlor@pressherald.com
Staff Writer

The Maine Department of Health and Human Services could reduce or eliminate the controversial fines recently levied against dentists serving MaineCare patients, according to a contract between the agency and the independent auditor who issued the penalties.

Dr. Michael Dowling works on Aiden Serber, 8, of Westbrook, as dental hygenist Trisha Drewry assists at Falmouth Pediatric Dentistry in Falmouth.

Gabe Souza/Staff Photographer

Related Documents
Read Maine's contract with Health Management Services

The fines have been appealed and are in limbo awaiting DHHS rulings.

Dentists have complained to the Portland Press Herald that they were shocked to receive fines as large as $200,000 from new audits required under the federal Affordable Care Act. Statewide, the fines totaled about $800,000, and dentists have said they may have to close or sharply curtail services to low-income patients served under the MaineCare program if the fines are allowed to stand. The fines were based mostly on minor paperwork and coding errors, dentists have said, and the contract gives auditors financial incentives to penalize Medicaid providers for clerical errors.

“This has just been incredibly spiteful and petty,” said dentist Mark Zajkowski, of Oral and Maxillofacial Surgery Associates in South Portland. Zajkowski said his practice is facing a “substantial” fine. “The only thing this is going to do is disincentivize dentists serving MaineCare patients.”

While the ACA requires more comprehensive audits of Medicaid services, the specifics on how the audits are carried out and what types of penalties can be imposed are controlled by the states. In Maine, dental services are the first to be scrutinized by the new Medicaid audits, while hospitals are next on the list.

Monday, November 11, 2013

Dan DeRose–Soda in Schools King

Here is a “Blast From The Past” article on Small Smiles Dental Centers founder, Dan DeRose and his visions of sugar plums – Soda in Public Schools. This article was written during the period his dad, Eddie DeRose, formed DeRose Management, LLC.  DeRose Management, LLC was the precursor to FORBA, LLC — the “test” dental management company of sorts.

New York Times Articles

 

Today's Lesson: Soda Rights; Consultant Helps Schools Sell Themselves to Vendors

By CONSTANCE L. HAYS
Published: May 21, 1999

Dan DeRose, marketing consultant, was busy doing the math for his new client, the Newark Public Schools.

The question on everyone's mind: how much money could the district make if it sold a soft-drink company the exclusive right to vend its products on school grounds? The answer, according to Mr. DeRose: a lot more than it gets right now.

''Let's just say everyone drinks one product a day, and let's just count the students,'' he said. ''At 45,000 times 180 days of school, that's 8.1 million cans. At 75 cents apiece, that's $6 million walking out the front door of your school every year in quarters and dollars.

''Let's get a lot of it,'' he told his audience, a collection of school principals, athletic directors, P.T.A. officials and one student. ''Let's get some of it back to the schools.'' Even $5 million would make a difference in the district's $550 million budget.

With his square shoulders, steady smile and conscientious use of the first-person plural, Mr. DeRose and his company, DD Marketing, are storming a once-quiet backwater in the soft-drink business. Schools regard him as a font of information. Soft-drink companies, which used to make low-key deals on their terms with local school districts, hate him with a passion.