Antoine Dental calling for a federal investigation into the judge because their win was overturned. Calling his decision “cut and paste”. What a bunch of cry babies.

Since the Antoine Dental Center's favorable ruling was overturned last week, TDMR, is calling for a Federal investigation into the judge. (God, I hate linking to these people! I think this is a ploy to get me to send them web traffic!  LOL Don’t enter a password, it’s a phishing expedition.)

Yes, they want a Federal Investigation into the judge! Talk about cry babies! These guys simply can’t stand defeat. I bet they all got trophies for participation when they were kids. 

However, to read about their game plan, you need a password. That’s right, a password. They have this big headline, then tell you to read it, you need their permission. Maybe it’s only a headline? Think?

I'd say an investigation should look at the previous decision of the administrative judges, but I try to give them a break that they just didn’t know what they didn’t know.

Frankly, the more Federal investigations into this the better. What's really odd, is this particular case is over some $400,000. Who spends $2-5 million in attorney fees to recoup that amount? Yeah, this is much bigger than Antoine Dental Centers. 

 

 

 

 

 

 

 

One thing that crosses my mind, is how Dr. James Orr and Bob Anderton trained these dentists how to cheat the system—in Anderton’s own private law office—and now Orr is the “expert” witness for the dentists and Anderton is their attorney. Talk about conflict of interest! Geez! This seems to be more about Orr and Anderton covering their own butts, than it is about Antoine Dental Center’s pay hold.

Currently Orr and Anderton are touring, teaching dentists about—of all things—record keeping!

There is just no way that this is sliced where the attorneys representing Antoine Dental Center and Dr. Nazari have their clients best interest ahead of their own. I almost feel sorry for Nazari. He could have, reached some settlement, taken his slap on the wrist, paid a little fine, and gone on about his business. At worse, a few months jail time; he would have gotten more sleep there than I bet he’s getting these days. I believe he is being coerced. Pure craziness.

Where’s the popcorn?

Analysis of ADC vs. Texas Health and Human Services Commission

Analysis of ADC vs. Texas Health and Human Services Commission

By Michael W. Davis, DDS, DrBicuspid.com contributing writer

March 6, 2014 -- Why should anyone care about a dental Medicaid ruling from an administrative law court in Travis County in Texas? One reason is that this case involves several millions of taxpayer dollars. Other similar cases brought before this court of alleged dental Medicaid fraud and abuses have and will involve taxpayer money, in excess of $100 million. 

The vast majority of dental Medicaid fraud cases are generally resolved in settlement agreements. Alleged violators usually pay some amount of restitution to the government in exchange for no admission of wrongdoing. Often, the alleged violators return to "business as usual." We, the public and dental profession, receive little or no data on case specifics. Records of investigations are sealed upon settlement.

Public record disclosure of this particular case exposed some of the dark underbelly of the dental Medicaid industry, along with some of its nefarious inner workings.

Read the entire article on Dr. Bicuspid

Dr. R. Quinn Dufurrena named Executive Director of that nasty Dental Group Practice Association (DGPA)

In the Welcome Letter from Dr. R. Quinn Dufurrena as posted on the Dental Group Practice Association (DGPA) and the DGPA’s press release, I think it’s clear what the plan is for the group; more “creative” dentistry —i.e. teledentistry (whatever the hell that is)—and changing state dental practice acts to be more revenue generating friendly, despite any loss in patient quality of care. After reading excerpts of several articles and interviews with Dufurrena published over the years, it appears he’s wishy washy on many issues, other than teledentistry. Other than that, he will be whatever they need him to me. Of course, I could be wrong.

From Dufurrena’s Welcome Letter at the DGPA:

• Nearly 20 years ago, I first learned of the dental support organization (DSO) model.
• DSOs financial benefits, administrative capabilities and group structure truly resonated with me.
• I’ve practiced dentistry in many different arenas, from the military and government to private practices and the non-profit sector.
• …dental professionals are still unable to circumvent the financial and time limits that have restricted them for years.
• …problem that requires collaboration and unity throughout the dental community.
• It has become a mission of mine to help answer the many challenges dentists are facing in this economic and regulatory environment, and my first step is creating awareness on the advantages of the DSO model.
• …my course of action for DGPA revolves around three key contentions: ethics, metrics and innovation.
• …build on the DGPA’s current code of ethics.
• …offer innovative ideas to dentists around the country
• I believe with the help of our member organizations, we can achieve a level of awareness for DSOs that will diminish the misinformation that has plagued our model and shed new light on the success DSOs

From the March 3, 2014 DGPA Press Release:

• “Much as the Affordable Care Act strives to increase patient access to quality care through innovative approaches to the health care system, the DSO model strives to do much the same.” – Doug Brown, co-president of the DGPA
• “…confident that Dr. Dufurrena will lead our association during an exciting period of evolution in the field of dentistry, one where more dentists are shifting from solo practitioners to group practices and the DSO model” – Doug Brown, co-president of the DGPA
• Use of the DSO model has shown success.
• "Dr. Dufurrena's background – ranging from work as a solo practitioner working on policy for the ADA to serving as executive director of a state dental association – provides him unparalleled insight into the role DSOs and their supported dentists can and must play in helping to bridge our nation's growing dental divide" – Steve Thorne co-president of the DGPA.
• Beyond his chair-side duties, Dr. Dufurrena served an associate professor at the University of Colorado School of Dental Medicine and worked at the ADA as a Hillenbrand Fellow.
• Dufurrena will officially begin his role as executive director on March 3 and will be based in Denver, Colorado.
• "I've been committed to promoting and providing affordable, high quality oral health care throughout my entire career. These are the same values shared by all members of DGPA and their supported dentists.- Dr. R. Quinn Dufurrena
• "I am honored to have been selected and look forward to working with all stakeholders at the state and federal levels to help them better understand the role and value a DSO plays in supporting quality dental care to millions of Americans every year." Dr. R. Quinn Dufurrena
• He is replacing Dr. Ed Meckler who served as executive director since DGPA's inception.

Doug Brown is president of Affordable Care, Inc. Steve Thorne is president of Pacific Dental Services. Neither are dentists.

Dr. Richard Quinn Dufurrena hasn’t been interested in the actual practice of dentistry in years; if ever. But he has been interested in the business of dentistry. So he is going to fit right in the DGPA and the DSO business modeling they promote.

From the June 2008 article about Dr. Dufurrena’s Hillibrand Fellowship and him taking the position as Executive Director of the Idaho State Dental Association:

• The 12-month program comes with a stipend and focuses on non-clinical organizational experience and education and allows fellows to select a special project and area of study. It provides fellows with an intensive orientation to all ADA agencies and departments, orientation to other organizations serving oral health, a basic orientation to federal and state government agencies playing key roles in oral health, academic courses and project experience

Antoine Dental Centers to remain on payment hold

Judge finds credible evidence of Medicaid fraud by Texas clinic

By Donna Domino, Features Editor

March 5, 2014 -- A Texas judge has upheld payment holds on Medicaid payments for Houston dental clinic Antoine Dental Care (ADC), citing credible evidence of Medicaid fraud. The clinics billed about $8.1 million for orthodontic services in less than three years.

The 36-page ruling was issued February 28 by Judge Rick Gilpin, an administrative law judge for the Texas Health and Human Services Commission (HHSC).

Reimbursements for Medicaid claims by ADC, which has two clinics in Houston, have been on hold since 2012, pending an investigation by the HHSC and the Texas Office of Inspector General (OIG) for Medicaid fraud involving orthodontic care. ADC ranked in the top 25 providers for Medicaid payments; about 70% of ADC's patients were Medicaid recipients, the ruling stated.

Read Complete Article at Dr. Bicuspid

What happened to Richardmalouf.com?

In February 2013, Dr. Richard Malouf of All Smiles and home waterpark fame started his own website, richardmalouf.com. Below is his press release about all the issues he was addressing.

• New Website Released for Dr. Richard Malouf of Dallas

Successful Dallas dentist and entrepreneur sets up own news portal at http://www.richardmalouf.com.

Amazingly, it’s gone poof!

His facebook page is barebones, so is his youtube channel.

• Richard Malouf Facebook - https://www.facebook.com/DrRichardMalouf
• Richard Malouf Youtube Channel - http://www.youtube.com/user/DrRichardMalouf

But no Richardmalouf.com.

Houston dentist, Behzad Nazari, and Antoine Dental to remain on 100% “pay hold” due to fraud investigation

UDATED 03-03-2014

The scammers running the Texas Dentists for Medicaid Fraud Reform (TDMR) website have boasted time and time again, over rulings made against Texas taxpayers and for Antoine Dental. Heck, they have a whole section of their website devoted to their “wins”. They have also had their cronies on this website, commenting about how they are winning their cause; which appears to be “Let us continue to defraud taxpayers.” Frankly, I think their name should be “Friends of Dental Medicaid Fraud”. I’m not sure what they consider a “win”. Apparently, it’s not what you and I call a “win”. Their headlines over there are outright false! So imagine the bullshit contained within! I especially love their comment section, entitled “Speak Your Mind”, amazingly what is on my mind doesn’t seem to make it, maybe yours will. Click here.

Examples:
On November 5, 2013 their headline read, “OIG Loses Another Medicaid Fraud Court Battle” an article they were happy to assist with in the Texas Tribune.

(Battle, yes, WAR, NO!)

Then on November 6, 2013 their headline read – Antoine Dental Center Innocent of All OIG Allegations of Fraud and Misrepresentation.

(This is especially galling, since it is an outright lie! Lie!!! Lie!!)

Again, on January 17, 2014—SOAH Judges Again Reject OIG Arguments in Antoine Dental Case

(Laughable!)

Today, what’s missing from their website is the headline of this blog post;or something close to it.

It appears the Applet Court and Judge Rick Gilpin disagreed 100% with all other rulings in the Antoine defraud Texas taxpayers case. He issued a “Final Order” on Friday (February 28,2014) that walked through this case and all the hearings and ruling step by step and ruled completely opposite of all other rulings—Antoine Dental to remain on 100% pay hold.

You don’t want to miss reading the Final Order. He all but called them all, Antoine owner, Dr. Nazari—including the Administrative Law Judges—criminals and at the best—imbeciles. You read it and decide.

Dr. Daniel Chaparro III, owner of Smile By Design, under investigation by FBI

I found Dr. Chaparro’s concerns over his investigation by the FBI a bit odd.

Apparently, he has enough wrong doings on the radar of authorities to result in a raid by the FBI. Yet, his concerns seems to me a bit misplaced, but I could be wrong.

The icing on my cupcake was his apparent frustration of having to deal with the government’s “spider webs of government red tape”  He seems to think he was forced to see Medicaid patients.I doubt he was grumbling when he was receiving taxpayer monies for those services.

Looking at the 2011 data made available by the 2012 Kool Smiles funded Art Laffer DSO Study, Smiles By Design was way down on the list of outrageous billers in Texas.

However, Chaparro has been in trouble before.

See: http://cqrcengage.com/capg/app/document/1697422;jsessionid=klTJmUc7gY-oFKgGZsWXQeAF.undefined

"Chaparro has faced criminal charges in the past including aggravated and domestic assaults between 1995 and 2000, practicing dentistry without a license in 2003 and injury to a child in 2004. He was convicted of domestic assault in 2002, according to court records."

He was also disciplined by TSBDE in 2000 & 2006.

---

Lubbock dentist warns of 'Big Brother' as FBI investigates Medicaid billing

Posted: Feb 20, 2014 12:03 PM CST Updated: Feb 20, 2014 10:45 PM CST

By Shaley Sanders - bio | email

LUBBOCK, TX (KCBD) -

A Lubbock dentist is voicing concerns about patient privacy and complaining about "Big Brother" after the FBI seized his patient records on Thursday morning.

The FBI executed multiple search warrant around 8 a.m. Thursday at the home of local dentist, Dr. Daniel Chaparro III and at his business, Smile by Design.

"They didn't need a warrant, they could come ask for anything they wanted and the record room is always open to them. I don't know why they escalated this to a drama, basically," Chaparro said.

Dr. Donald P. Prohovich pays $400,000 to settle fraud allegations in Massachusetts

 

 

 

By Maria Papadopoulos
The Enterprise
Posted Feb. 25, 2014 @ 12:39 pm
Updated Feb 25, 2014 at 6:17 PM

An Easton dentist has agreed to pay $400,000 to the state’s Medicaid program to resolve allegations of improperly billing for visits to MassHealth members living in nursing homes, Attorney General Martha Coakley announced Tuesday.

An investigation found that Dr. Donald P. Prohovich, a dental provider in the MassHealth program, violated a regulation established in 2010 that limits payments for providers to one “house call” to a facility per day, Coakley said in a statement.

Investigators found that from July 2010 to September 2013, Prohovich allegedly improperly billed for house calls to elderly MassHealth patients in nursing homes in eastern Massachusetts on a per-patient, per-day basis.

UPS Employees targeted by California dentist

Calif. dentist indicted for $1M in fraudulent billings

By DrBicuspid Staff

February 25, 2014 -- A California dentist has been indicted on federal healthcare and mail fraud charges of billing more than $1 million for work never performed, sometimes for teeth patients didn't even have.

According to the U.S. attorney's office, Sacramento dentist David M. Lewis, DDS, 60, began targeting United Parcel Service (UPS) employees in 2008 for dental treatment. The UPS healthcare plan provided 100% coverage with no annual limits. Dr. Lewis offered cash and other incentives to UPS patients for getting dental care from him or for recruiting other UPS employees to receive treatment.

The grand jury's 18-count indictment alleges that Dr. Lewis submitted claims to Delta Health Systems, which administered the UPS healthcare plan, and falsely billed the plan for work that was never performed. In many instances,

READ THE COMPLETE STORY HERE

Dr. David Timothy “Ty” Turbyfill, accused of sexually molesting 3 teens is back in business in Florida.

Dr. David Timore Turbyfill, accused of sexually molesting 3 teens is back in business in Florida. Among claims in the complaints, witnesses alleged that Turbyfill was “seen moving his hips and pelvic region suggestively near patients and seemed to be sexually aroused in the presence of some patients — covering his groin and leaving the room on more than one occasion.”

I guess it’s possible he was just “twerking”. (sarcasm)

Blessed by the Florida Board of Dentistry, he now has access to patients at Orange City Surgical Solutions
2574 S. Volusia Ave.
Orange City, FL 32763
386-744-2999
info@orangecitysurgicalsolutions.com

It’s also noted he has dropped the “Ty” nickname and using his real name, David Tim (Timore) Turbyfill.

His bio at the website lists numerous titles and awards, but fails to include any mention of the accusations and settlement.

According to his settlement agreement,Turbyfill is required to be “monitored” by a “licensed health professional” when using anesthesia or conscious sedation. I wonder exactly who is doing that “monitoring” and how the “monitoring” is being “monitored”.