Wednesday, May 27, 2015

Dr. Behzad Nazari, "talented Houston general dentist". Really?

Dr. Nazari’s dental practice, Antoine Dental Center, recently partnered with SmartBox Web Marketing to build the state-of-the-art website and provide online dental marketing.

"This new partnership allows us to have a beautiful new website that provides our patients with detailed information about our practice," Dr. Nazari said. "When it comes to having a good presence on the Internet, convenience and accessibility are both key. We want our patients to have the ability to access information anywhere and schedule their appointments at any time or place."
The new website, www.antoinedental.com, includes video testimonials from staff and patients; comprehensive information about practice services; a smile gallery filled with Antoine Dental Center patients, and convenient scheduling options. Patients can access free eBooks about the power of dental implants and orthodontics, and the website will be updated monthly with blogs relating to services at Antoine Dental Center and recommendations about at-home oral hygiene.

"I'm excited for patients to visit our new site so they can see our superior dental work and hear from patients who have absolutely had their lives changed after becoming a patient at Antoine Dental Center," Dr. Nazari said.

Tuesday, May 26, 2015

DeRose / Padula Family - FORBA files Objection to $39M Settlement

So today was the deadline to file Objections in the $39M Small Smiles Dental Center's settlement. I'm perplexed. How the hell did this thing even get filed?!?! At least 3 Objections were filed today! Old FORBA (The DeRose/Padula family) don't like it, the victims don't like it (neither do I) and one Insurance Company doesn't like it! So who the hell liked it enough to call it "Settled" Honestly! Who was it?!?!?! Could it be the a select group of attorney's wanting their money and run, or the Trust Administrator who will snatch up a quick million or two within days of it's approval? Could it be AIG, who has filed so many pleadings courts have had to reprogram their systems or maybe AIG ran out of "stalking" attorneys to follow jurors around.

Apparently they know children will be seeking compensation for their abuses for years to come and low and behold, old man Dr. Adolph Padula and others have figured out they are included in the count of 333 dentists who will lose their malpractice coverage for all their misdeeds. Yeah, I laughed pretty hard at this one.

Creepy ole Aldoph Padula says his retroactive coverage is to last until the end of time. No wonder he's scared! 

 "The Objectors believe that some or all of the Claimants will continue pursuing claims against the Objectors which claims are covered by the insurance policies that are the
subject of the Motion and Settlement and Release Agreement.Upon information and belief, the Supplemental Extended Reporting Period Endorsement provides for a period of “unlimited duration” during which “claims” arising from “dental incidents” that occurred after the retroactive date (i.e., February 1, 2001) and before the end of the policy period (i.e.,September 26, 2010) may be reported under the Entities Policy." 

 Be sure to hit page 6 and 7 for the long list of clinics!! And note that it says "among others"...that a boat load of clinics!! One thing is for certain, these old boys haven't been enjoying their retirement as much as I bet they thought they would.


Continental Casualty filed an Objection as well.

It must have been a real party at the court today, down there in Nashville. 

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Objection filed opposing the $39M settlement for small victims of FORBA/CSHM’s Small Smiles Dental Centers


Actually there were at least 3 Objections filed today, this is just one.

Objection to $39M Settlement for victims of Small Smiles Dental Centers






Monday, May 25, 2015

Western Dental extorting $ from California Taxpayers?

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.

Read the story here

Will Schneider be forever used to describe unethical and abusive dentistry?

Don't be a Schneider

 

 

 

 

  • Don’t be a Schneider
  • Schneider type dentistry
  • Schneideresque
  • Schneiderized

Just thinking…

Sunday, May 24, 2015

What are the “Powers That Be” saying when it comes to Medicaid dental fraud and overtreatment?

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:
•The Office of Evaluation and Inspections (OEI) conducts national evaluations of HHS programs from a broad, issue-based perspective.
•We are working on a series of studies evaluating Medicaid pediatric dental services in selected States.

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.

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.

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.

Process for Conducting Audits
•Audit Notification Letter / Entrance Conference
•Define: Audit Objectives, Scope, and Methodology
•Data Collection and Analysis
•Exit Conference
•Draft Report
•Auditee Comments
•Final Report

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.

Friday, May 22, 2015

Florida 10 year (1999-2011) Florida Medicaid Expenditures for using child restraint (D9920) in Florida.

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.1999-2011 spenditures for D9920

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)

Florida reimbursement schedules can be found here

WARNING: Common Submission Tricks and Common Red Flags at Medicaid Dental Clinics

By: Michael W. Davis, DDS
Dr. Michael Davis
This is a guide for parents, government regulators and law enforcement. The American Academy of Pediatric Dentistry (AAPD) has issued a number of valuable guidelines, which illustrate methods and materials to gain the pediatric dental patient’s cooperation, in the child’s best interest for dental healthcare. This paper is not about that. The manner in which clinical care should be delivered in the child’s welfare is of minimal concern in the Medicaid mill environment.
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). 
A “red flag” for parents is that when they ask questions about the need for their child’s dental treatment, there is never an offer for the parent to seek a second professional opinion or other optional treatment. The clinic representative usually ups the intimidation pressure, when the parent even hints at a desire for a second opinion.

Once the child is successfully isolated away from their parent, they are be frequently threatened to gain cooperation and compliance for clinical treatment. “If you don’t hold still, I promise you’ll NEVER see your mommy again.”  “If you keep moving you head around, a needle will be going into your eyeball.” (Interestingly, I first heard that sick line from a dental educator.)
Keeping Children Isolated from ParentsMost children feel comforted and safe in the company of their parents. They generally enjoy a more positive overall dental experience in the presence of their trusted guardians. This is fully supported by AAPD Guidelines. However, the best interests of the child do not comport with maximizing clinic “Production per Patient” (PPP- a specific term used in the corporate training literature of Medicaid mill, Small Smiles Dental).
Isolation of the child is a method to break the child’s will, and employ further techniques to generate maximal production, at the patient’s psychological expense. In Medicaid mills, parents are often expressly forbidden to accompany their children in dental treatment areas. If there’s no parent to observe child abuses, abusive compliance techniques often ensue.
RestraintsThese devises may euphemistically be called “papoose boards”, “protective stabilization devises”, taco board, or “blanket wraps”. In reality, they represent child straightjackets. If the child is restrained, the doctor is more able to maximize clinical production (dollars generated). There is no longer a need to work within a child’s stamina or their individual understandings and ability to comprehend. It represents a seriously disturbing psychological trauma to a child. Again, usually no parents are allowed to provide their presence, with comfort and reassurance.
There are obvious clinical risks associated with child restraints. If the child is not properly monitored, which is often the case in busy Medicaid mills as dentists hop from patient to patient; the chest restraints inhibit a child’s breathing. This elevates risk of morbidity and mortality. The child may struggle to free oneself, with a potential for a restraining strap to compromise the carotid artery (blood flow to brain) or trachea (airway). At least one confirmed death (possibly more) has been attributed to the use of restraints.
Trying desperately to escape children struggle to the point of falling from a dental chair, while still secured in a restraining devise. They were subjected to needless contusions (bruises), lacerations (cuts), inclusive of head and neck trauma (potential for brain injury or nervous system damage). It should go without saying (and AAPD Guidelines do say so), the potential for a child’s psychological injury is also very real.
Due to wrist injuries being commonly reported by parents from the velcro bindings inside the restraint device, clinics are using socks to cover the hands and arms. If your child reports socks placed on their hands, it is a good indication of the child being restrained.
Hand Over Mouth and Nose Technique“Hand over mouth” (HOM) technique was formerly a mainstay in pediatric dental training. The dentist would place their hand over the mouth of a child, who might be screaming out inconsolably. The child maintained an airway through their nasal passages. Often the child would subsequently calm down. This was never designed to be a method of first resort. In fact, this specific technique is falling out of favor with increasing numbers of pediatric dental specialists.

Medicaid clinics take this technique to a new and highly disturbing level. The doctor will not only cover the child’s mouth with their hand, but use the thumb and first finger to pinch off the nasal airway. In very short order, the child must gasp for a breath. At that instant, the doctor inserts a Molt mouth ratchet, or a rubber bite block (instruments to forcibly hold a child’s mouth open). The child is no longer capable of free will of verbal communication at that point, for the remainder of the dental appointment.

Limiting Amount of Local AnestheticLocal anesthetic is commonly termed “Novocain”. In fact, Novocain is a generic term which might refer to a number of different forms of local anesthetic. This agent is essential for patient comfort, regardless of a dental patient’s age. Many elder patients have tooth nerves which regress, and little to no local anesthetic may be required for patient comfort. Children have relatively very large sized tooth nerves, and generally feel dental pain quite easily.
A child’s lower body weight often dictates a significantly reduced amount in delivery of local anesthetic by the doctor. If local anesthetic is overdosed to a child in particular, death can and does result.
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.

Screaming in Child’s FaceScreaming in the face of a child by the doctor is a method to break the will and spirit of the child. This abhorrent technique is very similar to a Marine drill instructor screaming in the face of a raw enlisted recruit. Only this isn’t a young Marine, but a very young child. This is but one tool to bring the child into a psychological state of cognitive disassociation. Figuratively, the child leaves their body. The doctor is then free to invoke their more powerful will upon the child. Again, the goal is to maximize PPP, under the broken dental Medicaid program.
Physical AssaultA doctor punching, choking or slapping a child is another unacceptable method to gain a child’s compliance. Strikes may be to the abdomen (stomach), thorax (chest) or appendages (arms and legs), so bruising won’t immediately and as easily show. The doctor is frequently 3-5X the physical size and body weight of the patient. The concept is that with adequate physical intimidation, pain, and additional fear of pain, the child’s cooperation will be achieved. Again, often the patient is rendered into a state of cognitive disassociation, in order to generate maximal dental production. 
Waterboarding
Medicaid mills where this has been done don’t refer to this abuse as “waterboarding”, but that’s exactly what it is. This isn’t inflicted upon suspected Islamic terrorists, but on our nation’s disadvantaged children. Once again, the objective is to fully break a child’s will and spirit, to generate maximal dental Medicaid PPP. I’ll describe the two most common methods (One was common in Oklahoma City and the other in Albuquerque).
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.

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.
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.
Parents please do not blame yourself. You trusted a dental professional. You may have trusted what you assumed to be a reputable national chain of dental clinics. You were betrayed on many levels. Yes, doctors took advantage of your child, and cheated taxpayers. State and federal regulators have been hiding under their desks for decades. Leaders in my dental profession abandoned the public welfare. Wall Street bankers have even gotten in on the dishonest action. Politicians have also taken their cut. Those who cheated you and your child have high levels of formal education and are entrenched in our political and economic system. The game is rigged, and the fix is in.
People in law enforcement and government regulations, this should be a wake-up call. Many of our disadvantaged Medicaid kids are being abused by dental professionals. These children aren’t to be blamed for their financial circumstances or disabilities. It’s not their fault. Blaming victims is toxic thinking. Let’s get these kids the helping hand they need. Let’s give very serious attention towards filing criminal actions (not only civil actions) against doctor violators, and the corporate managers, who often pull the strings.
Finally, our dental Medicaid program is in complete disrepair. We need to place this sick program on the scrap pile, and rebuild a dental Medicaid system, which truly assists and honors patients it is intended to serve. Our current system is an out-of-control boondoggle of “welfare for the rich”. American taxpayers deserve better. Our nation’s disadvantaged children deserve better.*

In 2014 Dr. Davis sponsored a proposal to incorporate the AAPD Guidelines for the use of restraints into the New Mexico Dental Practice Act.  Despite much opposition his efforts were successful and in 2015 the AAPD guidelines are no longer “suggestions” by rules in New Mexico. see NMAC 16.5.2.27
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, 01-15-15
Now 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.

Thursday, May 21, 2015

Nearly 500 Dentists in 4 States bill Medicaid for almost $175 Million

The Daily Caller

 

 

Dentists Charged Taxpayers $175M For Unneeded Work On Kids

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.

Wednesday, May 20, 2015

Crooked unethical dentists and crooked corporations who own them… you are on notice

Stop Dental Abuse - Anderson Cooper Discusses the Jacksonville Case of Dr. Howard Schneider