2004 Cease and Desist Letter from Colorado Dental Board: Michael A. DeRose, Eddie DeRose, William (Bill) Mueller

I've heard the Michael DeRose out there in Pueblo under oath say he did not "train" dentists. They were simply there to "observe" for a few days.  Yet, here is the 2007 C & D letter from the Colorado dental board where he admits the dentists performed general dentistry and it was the program offered by his father, Eddie DeRose and William Mueller as well as himself.

Michael A Derose Cease and Desist Order Colorado Dental Board 2004 

Howard S. Schneider of Jacksonville, Florida files Motion to Dismiss and asks for Sanctions against Gust Sarris attorney-Adsum Law Firm

Jacksonville, Florida

On May 22, 2015 Howard S. Schneider's attorney Richard E. Ramsey of Wicker, Smith, O'Hara, McCoy and Ford, has filed a Motion in Jacksonville Circuit Court asking the court to Dismiss the lawsuit filed, Expunge it from court records and Sanction attorney Gust Sarris of Adsum Law Firm.  I read it as they firmly believe Gust Sarris / Adsum Law Firm failed to follow proper procedures before the filing of the suit.

Howard S. Schneider of Jacksonville, Florida - Motion to Dismiss

Previously Indicted Dentist Gilberto Nunez Arrest for Perjury. WHAT?

Seems things continue to worsen for dentist Gilberto Nunez. After his April 2015 Indictment of Grand Larceny, Insurance Fraud, and 5 counts of Falsifying Business Records he was released on $15,000 cash bail ($30,000 bond). (court documents below) According to Mid Hudson News, he's been arrested on charges of perjury brought by the Ulster County Sheriff's Office. I seldom hear of perjury charges these days! The original Indictment stems from a February 2014 fire in which he claimed an $8,400 loss.  I'm serious.

Poughkeepsie dentist arrested for perjury
May 29, 2015

Nunez

KINGSTON, NY – A Poughkeepsie dentist was arraigned on Thursday (May 28, 2015) in Kingston City Court on a felony complaint charging him with two counts of perjury, two counts of offering a false instrument for filing, and making an apparently sworn false statement.

Gilberto Nunez, a dentist with offices in Kingston, is also under indictment in Ulster County Court on charges of grand larceny, insurance fraud, and falsifying business records.

Both cases are being prosecuted by the Orange County District Attorney’s Office acting as special prosecutor.

The latest charges, brought by the Ulster County Sheriff’s Office, stem from several allegedly false statements contained in a pistol permit application Nunez filed in February 2014. They pertained to his previous military service.

The complaint alleges Nunez was AWOL from the US Marine Corps from August 1987 until he was apprehended in July 1990, and that his subsequent “Separation in Lieu of Trial by court Martial” was a “discharge for cause” that had to be reported on the application.

In his 2014 pistol permit application, Nunez checked off the “no” box in answer to questions as to whether he had ever been “terminated/discharged from any employment or the armed forces for cause” and whether he had ever “been arrested… anywhere for any offense.”

Kingston Judge Lawrence Ball released Nunez on his own recognizance pending a future court appearance in county court on the indictment charging him with grand larceny, insurance fraud and falsifying business records.

State of NY vs Gilberto A. Nunez 

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

I just don't have the energy, take it away guys...expand on this... 

HOUSTON, TX--(Marketwired - May 27, 2015) - Dr. Behzad Nazari, a talented Houston general dentist, has launched a new website that includes video, easy-to-use features and convenient scheduling options for new and existing patients.

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.

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.

Doc 834 -DeRose-Padula-FORBA Objection to $39M Settlement
 

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

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
• Schneider type dentistry
• Schneideresque
• Schneiderized

Just thinking…

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.

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.

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