CSHM comes out of hiding to issue statement regarding Medicaid Exclusion

CSHM and Small Smiles have been dodging media phone calls for days. They have finally issued a statement; begrudgingly I'm sure.

They say they will appeal. I hear they won't. Hell, they have been appealing since 2010; dang near quarterly.

They have received at least 2 earlier threats to be excluded; maybe three. The report issued last year by Senator Grassley's office basically asked, "how bad do these folks have to be before excluding them. They may appeal just to keep the revenue flowing. But I would think they should be on a Credible Allegation of Fraud pay hold.

CSHM Small Smiles Dental Media Statement 03-11-2014 by Dentist The Menace

Vice Chairman and Ranking Member of House Committee on Energy and Commerce-Oversight and Investigation subcommittee express continued concerns of dental management service companies (DMSOs).

In a letter (see below) to Inspector General Daniel R. Levinson, Rep. Michael Burgess (R-TX) and Rep. Diana DeGette (D-CO) express their continued concerns about “deceptive practices of dental management service companies (DMSOs)”.

They further call on HHS OIG to exclude any corporate dental companies from participating in the Medicaid program, saying, “Based on the report by the Senate Committees and the prior findings of HHS OIG, we concur with our Senate colleagues and recommend that HHS OIG should consider excluding any corporate entity that employs deceptive business practices that result in substandard care, from the Medicaid program.”

Burgess and DeGette are also concerned about the length of time it has taken to bring one of these companies—Small Smiles Dental Centers—to justice.

The letter recounts the history of the Small Smiles investigation, starting with the “2008 investigative news report” by WJLA in Washington. That report actually aired in November 2007; so it’s even worse, right?

The 3 page letter also states:

• “based on evidence undertaken by our offices, we are very concerned that the corporate structure and management of dental clinics often results in a failure to meet basic quality and compliance standards.”

Small Smiles exclusion- Senator Grassley is happy with the “Victory for Accountability”

Grassley: Notice from Inspector General is a Victory for Accountability

March 10, 2014
WASHINGTON – Senator Chuck Grassley, senior member and former Chairman of the Senate Committee on Finance, said the decision of the Inspector General for the Department of Health and Human Services to disqualify CSHM, LLC from the Medicaid program “will protect both taxpayers and vulnerable children receiving dental care in the Medicaid program.”
The Inspector General delivered a Notice of Exclusion (click here to read the Notice) following a year-long investigation by Grassley and then-Chairman Max Baucus of Montana into allegations of abusive treatment of children in clinics controlled by corporate investors rather than dentists.  The senators issued a report and recommendations last July and urged the administration to ban dental clinics from participating in the Medicaid program if the dental clinics circumvent state laws designed to ensure only licensed dentists own dental practices to prevent substandard care.
“Our oversight found that when states can’t hold owners accountable, then clinics are more likely to fail to meet standards that protect the children who should be helped,” Grassley said.  “The actions of some dental practices strained the Medicaid program and put low-income children in traumatic, highly questionable situations.”

 

FINALLY! Small Smiles Dental Centers are EXCLUDED from Medicaid and other Federal health programs!

OMG! OMG! OMG!

After 7 long years of persistence, it’s finally happened! Small Smiles Dental Centers are excluded from participation in Medicare, Medicaid and all Federal Health Care Programs!

Small Smiles Dental Centers - CSHM Exclusion Letter by Dentist The Menace

Let us not forget, the dental centers Quality and Compliance was overseen by:

Dr. Paul Casamassimo
Dr. Arthur Nowak
Dr. Joe Bernat
Dr. Anupama Tate
Dr. Steve Adair

Quality & Compliance - Dental Centers - CSHM by Dentist The Menace

 

I can’t woo hoo and OMG enough—I’m shaking from head to toe with glee!!!!!

Now, where can I locate a bottle of the “good stuff” Champaign!

Do you own your dental practice?

Let’s say you own your patient’s charts, do you own your dental practice?

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.