Actually there were at least 3 Objections filed today, this is just one.
Objection to $39M Settlement for victims of Small Smiles Dental Centers
Western Dental has been in a financial bind for some time, I would guess mainly due to the poor care, many complaints and most of all the OIG audit taking place. Then last week the OIG issued it's report on California's Denti-Cal program which indicated many Western Dentists has "Questionable Billing". Two days later, Western Dental issued a statement that they would no longer accept new Medicaid patients beginning June 1. citing low reimbursement from the state program. Hmmm... Sounds like an attempt to extort more money from California taxpayers and the Denti-Cal program to me. Apparently they need more money if they are to survive without "questionable billing". And who is right there campaigning for them... the California Dental Association. Didn't hear a thing from the CDA about the Questionable Billing Issue! Knock knock!! Anyone there...!!
Here is an article at Dr. Bicuspid
Here is where I agree with the CDA, reimbursement rates need to be increase. But only and I mean ONLY when they get the massive amount of fraud stopped dead in it's tracks. Until then... no way!
Maybe Western Dental is still a little pissy about the 1997 raid.
California's largest dental HMO, already under state investigation for allegedly "shoddy" patient care, is now the focus of a federal criminal probe into insurance-fraud allegations made by former employees of Western Dental Services.
About a dozen investigators from the Federal Bureau of Investigation and the U.S. Postal Inspector's Office raided two Western Dental clinics Friday morning in the Sacramento area and hauled out boxes of medical records sought under court order.
Investigators were seeking evidence of what they believe to be "widespread overbilling" by Western Dental offices throughout California, according to an affidavit filed in U.S. District Court in Sacramento, a copy of which was provided to The Times. The court papers also say that federal investigators suspect the alleged insurance fraud scheme was carried out with the knowledge of Western Dental management and owners.
Below are select excerpts from the transcript and powerpoint slides of a January 2015 CMS Learning Lab Weninar entitled “Advancing Program Integrity for Medicaid Dental Programs: Federal, State and Stakeholder Efforts”. The Webinar was held by Medicaid-Chip State Dental Association’s (a must check out website) Lynn Douglas Mouden, DDS, MPH, Chief Dental Officer with the Centers for Medicare and Medicaid Services (CMS), (also associated with a host of other organizations). Speakers included:
First, John Hagg, Director of Medicaid Audits, Office of Inspector General, US Department of Health and Human Services, John.Hagg@oig.hhs.gov. His presentation begins on page 3.
Second, Meridith Seife, MPA, Deputy Regional Inspector General, Office of Evaluations and Inspections, Meridith.Seife@oig.hhs.gov, 212-264-2000. Her presentation beings on page 5, about 2/3 the way down the page, and;
Third, Linda Altenhoff, DDS Chief Dental Officer with the Office of Inspector General, Texas Health and Human Services Commission (THHS). Linda.Altenhoff@hhsc.state.tx.us. Her part of the presentation at the bottom of page 7.
(Bios of each speaker can be found on page 2 of the transcript)
I found a few things troubling, that I’ll discuss later.
Below are the excerpts from Ms. Seife portion where she speaks about the latest (at the time) OIG Questionable Billing Dental Medicaid Reports:
Who we are:So why are we looking at Medicaid dental services? Well, as I'm sure many of you know, in recent years, there have been a number of high-profile cases where certain dentists and dental chains were found to have engaged in some extremely abusive dental practices. Although such cases represent an extremely small number of bad actors, they can have truly devastating effects on children. Dentists have been found guilty of routinely extracting healthy teeth, performing unnecessary pulpotomies, or putting stainless steel crowns on teeth that didn't need them. Obviously our primary concern is that no kid should ever have to endure unnecessary treatment, or that treatment that doesn't meet basic standards of care. But this can also have a significant impact on taxpayers as well.
The primary goal of our evaluations was to use Medicaid claims data in a way that could accurately identify dental providers who exhibited patterns of questionable billing. We're doing this currently in four states. In 2014 we issued reports on providers in New York, Louisiana, and Indiana. And our California report will be issued early this year. Although we were somewhat limited in doing these studies in only a few selected states, we hope that these reports will serve as a model for how other states can use their Medicaid data to identify potentially problematic providers in their Medicaid programs, and, hopefully, to target their resources more effectively in looking at those providers.
So I've already referenced, a few times, this idea of questionable billing, but I haven't really defined what it means. It's based on a type of analysis that the OID has done in other parts of Medicare and Medicaid, but this is the first time we've applied such an analysis to dental services. What is it? It's really just a method of determining certain billing patterns that are significantly different from one's peers.
We base these analyses on certain key measures that we developed in consultation with numerous experts. We spoke with law enforcement officials who specialized in working dental fraud cases. We also spoke with dental experts in state Medicaid agencies and CMS. We also received a tremendous amount of help from experts within the AAPD and that ADA.
Once we developed these measures, we then analyzed Medicaid's claim data in each state to identify extreme outliers or questionable billers, as we referred to them in our report. Specifically, we use these measures to identify providers who received extremely high payments per child, provided an extremely large number of services per day, provided an extremely large number of services per child per visit, and/or provided certain selected services, such as pulpotomies and extractions, to an extremely high proportion of children.
Process for Conducting AuditsOnce we developed these measures, we then analyzed Medicaid's claim data in each state to identify extreme outliers or questionable billers, as we referred to them in our report. Specifically, we use these measures to identify providers who received extremely high payments per child, provided an extremely large number of services per day, provided an extremely large number of services per child per visit, and/or provided certain selected services, such as pulpotomies and extractions, to an extremely high proportion of children.
Just to give you a sense of what those outliers look like, here is an example of a questionable billing analysis on average Medicaid payments per child by individual dentists. As you see, the vast majority of dentists are clustered around the median and mean amount, with an average payment of about $200 per visit. But, of course, way out towards the left, you start seeing outliers that are very different from that amount. For example, you can see that one outlier was paid over $1,100 per visit on average.
So, before I get into what we found, I do want to make just a few brief points about our methodology. One of the biggest challenges in conducting this type of an analysis is to be sure that you're comparing similar peer groups. Obviously you don't want to compare a general dentist in private practice with an oral surgeon working in a hospital setting. So, first, we separated out general dentists from other selected specialties. And once we grouped each peer group appropriately, we then established key thresholds for each of the measures.
These thresholds were established using a statistical method that's known as the "Tukey method." For the more statistically inclined among you, it basically calculates values that are greater than the 75th percentile plus three time its interquartile range. For those of you that are not statistically inclined, it's simply a way of identifying really, really extreme outliers. It also does this in a way that takes in the overall distribution into account. It means that you will not just be taking the top ten billers on a particular measure, it has to be significantly different from the norm. As a result, in a number of case, we found no outliers at all for a specific measure.
I should emphasize that this analysis does not confirm that a particular provider is engaging in fraudulent or abusive practices. Some providers may be billing extremely large amounts for perfectly legitimate reasons. Our position is simply that these providers are significantly different enough from the norm that it warrants further scrutiny.
So, using those measures, we identified a number of dental providers with questionable billing in each of the states we looked at. In total, we identified 151 providers with questionable billing, and Medicaid paid these providers over $56 million for pediatric dental services in 2012.
Questionable Billing Examples:
New York :
•Dentist averaged 16 procedures per child, compared with a statewide average of five.
•Dentist extracted the teeth of 76 percent of children he treated, compared with a statewide average of 10 percent.
Louisiana:
•Three dentists each provided an average of 146 or more services per day, compared to an average of 27 services for other dentists in the state.
16.
We also found that a significant proportion of these questionable billers were concentrated in certain dental chains. As many of you know, systemic problems within specific chains is a concern to many policymakers. In the three states we've reviewed so far, between one-third to more than half of the questionable billers worked for certain dental chains. Many of these chains had been previous investigated for providing services that were medically unnecessary or that failed to meet professionally recognized standards of care.
10 year (1999-2011) Florida Medicaid Expenditures for using child restraint (D9920) in Florida. In 2007 and 2008 the reimbursement was listed as "By Report" indicating there was specific requirement were necessary. In 2009, "By Report" was removed from the fee schedule.
Looks like children was lucky if they saw the dentist in 2008.
Clearly there were no requirements between 1999-2003.
Nearly $2 million dollars paid to dentist to restrain children in 2003! The reimbursement rate was $24 in 2003, you do the math!
There is a huge decrease between 2003-2004. Numbers certainly tell the story don't they?!
(I have these reports if needed including 2007-2012 fee schedules)
Medicaid dental mills are clinics primarily focused on delivery of government funded dental services in the private sector. Their chief focus is maximal generation of dollar production. The interests of patients and parents are of minimal concern.ThreatsParents often receive threats for not consenting to their child’s dental care at these types of Medicaid clinics. Threats come from office managers, doctors, and other staff, most of whom are operating under production bonus and quota programs, unknown to parents. The threats range from intimidation of reporting parents to state Child Protective Services, to reporting parents and children to “La Migra” (immigration authorities).
Note: adults can safely receive far more local anesthetic. Therefore, dentists will often limit the amount of dental care they provide a child at a single dental visit, so only a safe and limited level of local anesthetic is given. The child may require several visits to complete planned dental care, in a safe and responsible manner. The child’s welfare should assume first priority.The Medicaid dental clinic places dollar production ahead of all other concerns. Once the child is firmly secured in a restraining devise, and their mouth held in an open and locked position; dental drilling, pulpotomies (baby root canals) and extractions can proceed, regardless of adequate local anesthetic for patient comfort. Children will commonly generate screams from acute dental pain as the dentist drills on teeth with lack of anesthesia, while their tiny feet ceaselessly kick on the papoose board. The Medicaid clinic’s objective is to maximize PPP, regardless of the patient’s interest, pain and psychological damage.
Oklahoma City Baby Waterboarding-
Initially, the child is firmly restrained in a papoose board and reclined in a dental chair. The feet are positioned higher than the head, to allow water to more easily flow up the nasal cavity from the mouth. A rubber mouth prop is firmly positioned between the child’s teeth, which will not allow them to close. The swallowing reflex is greatly inhibited, because the teeth aren’t allowed to close together. Next, the doctor fills the child’s mouth with water. The small patient can’t swallow and water flows up into their nasal passages. They experience a terrifying sensation of drowning, alone and without their parent. The concept is to break down the child, in order to maximize Medicaid dollar production.
ConclusionOne will not find any of what I’ve described in the peer reviewed dental literature. It it far too threatening for dentistry’s leadership to face. Adults, who were dentally abused as children, under this toxic dental Medicaid program will have terrible memories surface. Many are suffering from dental post-traumatic stress disorder (dental PTSD). Please bring this article to your counselor or therapist to futher support your traumatic experience. What you faced as a child was horrendous and needless. I will absolutely validate the physical and psychological trauma you suffered.
Albuquerque Baby Waterboarding-This is similar to the Oklahoma City baby waterboarding method, but with a nasty twist. Instead of using a rubber bite block to hold open the child’s mouth, a paper patient bib is forcibly stuffed into the child’s mouth. These bibs are highly water absorbent. The doctor next will saturate the bib with water. The doctor may also elect to pinch off the child’s nose, so they have no ability to breath for a limited time. Other times, the doctor’s hand or a paper bib will also cover the child’s eyes. Again, the child is placed into a highly threatening position, with the sensation of imminent drowning. The spirit and will of the child is fairly easily broken. Maximal dental Medicaid production then ensues.
16.5.1.27 PROTECTIVE PATIENT STABILIZATION: Unless otherwise stated in rules or statute, the board, licensees and certificate holders shall refer to the American academy of pediatric dentistry’s guidelines on protective patients stabilization. [16.5.1.27 NMAC - N, 01-15-15Now the challenge is to prevent members at the AAPD from easing their guidelines. In these trying times the AAPD appears to be over run by members who are attempting to rewrite the guidelines that reflect less interest in treatment and more interest in speed and production per patient.
Ethan Barton
May 18, 2015
Nearly 500 dentists in four states billed Medicaid almost $175 million for potentially fake, unneeded or shoddy work on kids in 2012, a government watchdog reported Monday.
Investigators most recently caught 335 California dentists who sent $117.5 million of questionable bills to Medicaid, the Department of Health and Human Services inspector general reported. The watchdog caught another 151 dentists in New York, Louisiana and Indiana over the last year, who billed Medicaid $56.1 million in 2012.
“In recent years, a number of dental providers and chains have been prosecuted for providing unnecessary dental procedures to children with Medicaid and causing harm in the process,” the report said. “A concentration of providers with questionable billing in chains raises concerns that these chains may be encouraging their providers to perform unnecessary procedures to increase profits.
The 335 providers, which make up 8 percent of all California dentists, served more than one-third of all the Medicaid children investigators reviewed.
Here is hoping insiders and victims of dentists and chain dental clinics across the county contact her show and let her know this is an epidemic and needs her attention in the worst way.
Link to the show that aired:
Disturbing video: Dentist torturing young patient?
Contact Information:
The Nancy Grace Show
CNN
1 Time Warner Center
New York, NY 10019
1-212-973-2800
nancy.grace@turner.com
Below is a story from WISHTV.com about yet another overtreating, Medicaid defrauding crooked dentist published May 12, 2015. In the story they mention the 2014 OIG Report about 95 dentists with “Questionable” billing. That’s where the real story lies. Why do I say that, you ask? Well, out of those 95 dentists 28 work for Kool Smiles clinics, owned by FFL Partners, 13 work at clinics that were formerly named Small Smiles, also owned by private equity investors, and 10 work for Reachout Healthcare America’s “Smile Care” mobile clinics that tend to visit schools. The list of dentists is at the end of this post.
Indiana dentists accused of overtreating patients, overbilling Medicaid
May 12, 2015
INDIANAPOLIS (WISH) – Kyong Farnsley feared she had cavities in her teeth.
She hadn’t been to the dentist in a while.
So in August 2012 when she walked into Amazing Family Dental in Indianapolis, she says she expected to have an initial exam and a treatment plan set up.
Farnsley says she walked out with half her teeth.
“(The dentist) proceeded to do the exam and told me I had an infection in my mouth and that some of my teeth were infected. He would need to pull them,” Farnsley told I-Team 8. “He said the infection was so bad that if I didn’t have (my teeth) pulled out, I could walk out and have a heart attack and die. I had never heard that before.”
Fearing for her health, Farnsley said she gave consent for Dr. Shadrach Gonqueh to perform the procedure. A copy of her dental records, obtained by I-Team 8, show 15 of her teeth were extracted.
“If he says it’s that severe and I’m going to die, I am going to trust him. I have two small boys at home. I can’t leave them. I am a single mom at that time; I can’t leave them,” she said.
Afterward, Farnlsey said she was given pain medication but no antibiotics. She left, she says, thinking she would eventually receive dentures. As weeks went by, she sought a second opinion from a new dentist who she says told her the procedure she endured was unnecessary.
Farnsley’s story is not unique. She is currently one of five former patients suing Dr. Gonqueh. Another lawsuit representing three former patients claims Dr. Gonqueh made them “believe that they were in imminent danger and needed to immediately have all their teeth pulled … or risk death by suffering a heart attack,” according to the lawsuit.
An I-Team 8 investigation found allegations of “dental overtreatment” or unnecessary work is not uncommon. In fact, it makes up nearly a third of the 44 active licensing complaints against Indiana dentists, according to Indiana Attorney General Greg Zoeller’s office.
In March, Zoeller’s office filed a licensing complaint against Dr. Gonqueh, accusing him of engaging in fraud by overbilling and receiving more than $27,000 in reimbursements for procedures performed on 158 patients.
“The Board of Dentistry is expected to consider this complaint at its hearing on June 5. At that time, the board will act as jury and judge to determine what, if any, disciplinary action will be taken against the license holder,” Molly Johnson, a spokeswoman for Zoeller’s office, wrote in an email to I-Team 8.
DENTIST REACTS
I-Team 8 spoke to Dr. Gonqueh by phone at his Raymond Street office, where he is still practicing. After a reporter identified himself and informed Gonqueh that he was recording the conversation for his news report, Gonqueh declined to answer questions, but did say:
“This story is nothing new,” Gonqueh said. “And I will refer you to my attorney for any further comments. I think you are looking for something where there is nothing.”
Gonqueh’s attorney, Peter Pogue, provided a statement that read:
“Amazing Family Dental, and its dentist, is aware of the recent filings by a few patients and the Attorney General’s Office. These claims arise out of treatment from several years ago. Amazing Family Dental and its dentist is vigorously defending each of these claims as they proceed through the appropriate legal venue, and Amazing Family Dental and its dentist intend to avail itself of all appropriate legal defenses. Amazing Family Dental and its dentist maintain that the treatment of each patient is medically appropriate and within the appropriate standard of care, and Amazing Family Dental and its dentist look forward to the opportunity to present the defense to these claims at the appropriate time and in the appropriate forum. Beyond that, Amazing Family Dental and its dentist do not feel that it is appropriate to comment on pending legal matters.”
(Editor’s note: In the days leading up to this story, I-Team 8 received repeated phone calls from another lawyer, Steve Eslinger of South Bend, who claims to also represent Gonqueh.)
Eslinger’s statement said in part that “expert witnesses” contend that Dr. Gonqueh did nothing wrong.
INSPECTOR GENERAL FINDS ‘QUESTIONABLE BILLING’
Last November, the Office of Inspector General from the U.S. Department of Health and Human Services issued a report on pediatric dentistry in Indiana that found “questionable billing practices” among 95 dentists in the state.