Tuesday, August 07, 2018
Dazzling Smile Care PC and Dr. Shahrzad Haghayegh-Askarian Indicted on Medicaid Fraud Charges
August 7, 2018
Boston — A Quincy-based dentist who was banned from the state’s Medicaid program has been indicted in connection with an alleged scheme to fraudulently bill MassHealth under another dentist’s name, Attorney General Maura Healey announced today.
Dr. Shahrzad Haghayegh-Askarian, age 43, of Norwell, was indicted by a Statewide Grand Jury on charges of Medicaid False Claims (2 counts) and Larceny over $1,200 (2 counts). Haghayegh-Askarian’s company, Dazzling Smile Care PC, located in Quincy, was also indicted on the same charges.
An audit by the State Auditor’s Office uncovered Medicaid fraud committed by Dr. Haghayegh-Askarian. Following that audit, Dr. Haghayegh-Askarian agreed to a $300,000 settlement with the AG’s Office in 2015 and was terminated from participating in the MassHealth program. The settlement stipulated that she could only re-enroll with MassHealth if she met standards of compliance and instituted a monitoring program mutually agreed upon by Dr. Haghayegh-Askarian and the AG’s Medicaid Fraud Division.
The AG’s office alleges that, despite her termination from MassHealth, from April 2014 to December 2017, Dr. Haghayegh-Askarian continued to treat MassHealth patients and billed those services under the name and identification number of another dentist, without his knowledge or authorization. That dentist contacted the Office of the State Auditor to report this alleged fraudulent activity when he learned of it in September 2017.
“I commend my staff and the staff of Attorney General Healey for their work to bring charges against Dr. Haghayegh-Askarian,” said State Auditor Suzanne Bump. “Her license should be immediately revoked, and her continued, brazen abuse of MassHealth should be punished.”
“This matter illustrates the commitment of all agencies to combat medical billing fraud which affects all citizens,” said Anthony DiPaolo, Chief of Investigations at the Insurance Fraud Bureau of Massachusetts. “The IFB places a high priority on fighting this type of insurance fraud. The collaboration in this matter is unprecedented.”
All of these charges are allegations and defendants are presumed innocent until proven guilty.
The matter was investigated by Assistant Attorneys General Jay McCormack and Kevin Lownds, Investigations Supervisor Lisa Bailey and Investigators April Waterhouse and Deborah ElMajdoubi, all of Attorney General Maura Healey’s Medicaid Fraud Division, with assistance from MassHealth, the Insurance Fraud Bureau of Massachusetts, the State Auditor’s Office, and Massachusetts State Police assigned to the AG’s Office.
Friday, July 20, 2018
Monday, July 16, 2018
Kool Smiles featured on CBS Whistleblower Series
Benevis/Kool Smiles Response to CBS Report:
Dr. Greenwald and Dr. Rai blew the whistle on Kool Smiles after they say they witnessed unnecessary dental procedures performed on children. CBS reached out to the company for a comment and they provided the following statements:
Statement from Kool Smiles:
"Our patients and their safety are our top priority and we will continue to work toward our mission of ensuring every child in America has a dental home. The settlement reached in December 2017 addressed treatment provided between 2009 and 2011, and was unrelated to the quality of dental care provided to patients. The company's compliance and quality assurance programs lead the dental industry and we continue to implement ongoing measures to ensure every patient receives the best care."
This past December, 2-year-old Zion Gastelum died four days after visiting the Kool Smiles office in Yuma, Arizona. Zion's death occurred just days after the Whistleblower suit was settled. The case had been in litigation for almost a decade.
Statement from Kool Smiles regarding death of Zion Gastelum:
"Kool Smiles treatment protocols follow the guidelines and best practices established by the American Dental Association and the American Academy of Pediatric Dentistry. Treatment is provided only after conducting a consultation and obtaining the informed, written consent of the patient's parent or guardian. Our dedicated dentists, anesthesiologists and the rest of our Kool Smiles family mourn this tragic loss."
Saturday, June 23, 2018
Dr. Behzad Nazari, D.D.S., ET AL. v. The State of Texas; Xerox Corp; and Xerox State Healthcare, LLC, f/k/a ACS State Healthcare, LLC, n/k/a Conduent Business Services, LLC
Despite all the claims, counter-claims, third, forth and fith party claims, here is the the short version:
Texas withheld reimbursement from several dentists due to a high suspicion of Medicaid fraud. Dr. Nazari, his clinic Antoine Dental and others argued they needed and deserved their money for all the honest and much needed work they had done on so many children with terrible orthodontic deformities and rotten baby teeth. They were the saving grace to the underserved population as they saw it.
Being royally pissed, Nazari suesTexas and Xerox (NYSE:XRX) (ACS) demanding his money.
The Feds (that is us, the US taxpayers) says “Hey Texas, we pay 50% of all you spend on Medicaid, and we want our money back!
Texas says, “We really have that kind of cash to hand back, we spent it already. But we will try to get it from Xerox. They ran the show down here for years. In fact we knew nothing about this until Byron Harris did a series of reports for WFAA in Dallas. We learned about it on the local evening news!”
Texas sues Xerox, under whatever name Xerox was using at the time. The suit ends up at the Texas Supreme Court.
Texas tells the Texas Supreme Court justices, it was no seeking actual damages from Xerox in a civil Medicaid fraud suit in a civil Medicaid fraud suit accusing the company of signing off on $1.1 billion in claims for orthodontic services without properly vetting them, and therefore the remedies it has sought aren't subject to proportionate responsibility calculations.
Xerox says that it is wrongly facing sole liability in the matter, despite the fact it trained paid employees to basically rubber stamp “Approvals” as fast as they could. Additionally, in early testimony it was learned they trained the dentists how to game the systems.
Yesterday, June 22, 2018, the Texas Supreme Court handed down its decision. Xerox, it is all on you guys. Pony up the $2 Billion!
Now, doing business as Conduent Business Services (CNDT) reports are that Conduent’s “benefit wallet” is empy and they will probably settle for $500 Million.
Related:
Dentist the Menace blog posts on this matter
Case Details and Documents
Saturday, April 28, 2018
Emerging Advocacy Groups Support Small Business Dentistry
20 Apr 2018 Michael W. Davis, DDS
Small business dentistry is increasingly establishing advocacy groups designed to address specific issues. Areas of concern range from protecting the doctor/patient relationship against the intrusion of the insurance industry and corporate dentistry to honest evaluation and solutions for the public’s “access to care.”
These associations are springing up in a variety of different states. Because of their distinctive smaller sizes, they are highly attuned to specific predicaments unique to a given state. Larger national groups may have multiple and conflicting agendas, which too often grind effectiveness to a standstill. These smaller spearhead organizations often serve as the initial testing ground for addressing and solving challenges. Many times, state dental associations will later pick up the banner and carry forth with their added weight and power of membership.
Three organizations that exemplify this movement are the Concerned Dentists of Texas (CDoT), the Concerned Dentists of Washington State (CDWS), and the Massachusetts Dentists Alliance for Quality Care (MDAQC). Each of these relatively small associations is free to examine problems unique to its specific state and discover optimal mechanisms for local problem solving. They aren’t handicapped by the political or economic motivations of a faraway distanced leadership. They aren’t bogged down by neverending and do-nothing committee meetings. And, they lack multiple layers of leadership hierarchy, which often hinders effective action…
Read Dr. Davis’ entire article here.
Thursday, February 22, 2018
Southern Dental Alliance and Sale to Pouschine Cook Capital
Keep in on your radar.
Sept 2017:
Deloitte Advises Southern Dental Alliance on Sale to Pouschine Cook
Deloitte Corporate Finance acted as exclusive financial advisor to Atlanta-based VSM Management d/b/a Southern Dental Alliance on its sale to Pouschine Cook Capital Management and its co-investor group.
Southern Dental is a multi-specialty dental service organization in the Southeastern U.S. with 32 clinic locations across eight brands.
“DCF’s assistance was indispensable for us throughout the transaction process, offering both expertise in the space and extensive resources. We are excited about our future growth prospects and the new partnership with Pouschine Cook,” said Mark Lakis, CEO of Southern Dental.
Tom Harbin, managing partner at Source Capital, echoed the sentiment, “DCF’s deep knowledge of the dental space was invaluable and helped lead to a successful transaction. We could not be more pleased with the outcome.”
Monday, February 05, 2018
So far only 2 states have released their share of the $23,900,000 Benevis/Kool Smiles Dental Fraud Settlement
So far only 2 states have released their share of the $23,900,000 Benevis/Kool Smiles Dental Fraud Settlement that covers a 3 year period of Jan. 2009 to Dec. 2011.
Arkansas - $478,500
Massachusetts – $1+M (the state is to receive $1,700,000 with a portion of that going back to the Federal Government)
They started their business model of “Abuse Children; Collect Medicaid $” in June of 2002 with Drs. Frick (Tu Tran) and Frack (Thein Pham) and Kool Smiles still at it today; it will soon be 16 years!
One must never forget Dr. Tu M. Tran and Dr. Thien Chi Pham were dentists working at Smile High Dentistry in Colorado. Smiles High Dentistry is part of the Small Smiles Dental chain in 2001.
That leaves 13 years of the same fraud and abuse that has gone unchecked.
Below is a post from Massachutches Attorney General Maura Healey’s facebook page which nearly caused me to have a seziure.
I have to comment:
"This is a story of an enormous company defrauding Medicaid and pushing unnecessary procedures onto kids. We investigated and reached a settlement. Now millions will be returned and this company will change its practices forever."
ARE YOU KIDDING ME!
First, that statement left out the fact these unnecessary procedures were accomplished whereby small children, even babies, were tied up and tortured for speedy traumatic and painful procedures.
This has been going on in state for over 15 years. MassHealth state auditors noted in a published report Kool Smiles and it's cousin Small Smiles had a high incident of crowns back in 2005 or 2006. I have that report somewhere, I’ll find it and post it for you.
In a report you state “With this settlement, we’re recovering more than $1 million for the state and will ensure this company cannot use these practices in the future.” That is the most naive thing I've ever heard in my life. They were doing it before auditor walked in, while auditors were there, the minute auditors walked out the door and while they were signing this Settlement Agreement.
Question Attorney General Maura Healey: How much did Mass get in 2010 when Small Smiles was sanctioned $24M? Did they change their business practices? Uh...no! Actually, they doubled down! Small Smiles even signed a 5 year Quality of Care Corporate Integrity Agreement.
Imagine the millions of dollars pillaged and the number of children abused by this “enormous company”.
This is state-sanctioned child abuse, you just can't paint it any other way.
Virginia’s Attorney General Facebook page posted about the settlement as well. Of course I had to comment:
As I’ve pointed out before, as far back as 2009 Kool Smiles has had representative on the Virginia Department of Medical Assistance (DMAS) Dental Advisory Board (DAC). First David Strange, the Paul Walker. Small Smiles had representitives as well.
In January 2010 a similar “Settlement” was reached with Small Smiles Dental Centers—Kool Smiles’ step-cousin 2 times removed.
Small Smiles even went to far as to signed a 5 year Quality of Care Corporate Integrity Agreement and agreed to pay nearly $24M (nearly $27M when you add in the separate amount for the state of New York.) plus interest.
By February 2012, Small Smiles filed for Chapter 11 Bankruptcy protection. Three years later in February 2015 Small Smiles filed Chapter 7 Bankruptcy. It still owed $26,049.276.61 from the January 2010 settlement.
What happened to Small Smiles?
They simply sold a few clinics to Kool Smiles, Adventure Dental (also root with Small Smiles) and DentaQuest, also operated by former Small Smiles executives and kept a few for themselves, esepcially in Georgia and South Carolina.
Saturday, January 20, 2018
Evidence shows Benevis, LLC / Kool Smiles Dental Centers Knows the Laws.
Screen shot from Benevis website January 20, 2018:
They simply believe the laws don’t apply to them.
Ad from the Kentucky Dental Association Website.
Benevis, (formerly NCDR, LLC) is owned by FFL Partners and operates Medicaid dental clinics under the name Kool Smiles Dental, focused on children (perferably under the age of 5 from the looks of things). However they operate a disturbing non-Medicaid division under the corporate umbrella of PSBB, PC, Inc. with Dale Mayfield CFO, Secretary and CFO. Mayfield is the Chief Dental Officer at Kool Smiles. In 2016, Mayfield was appointed to the Georgia Board of Dentistry by Governor Nathan Deal. (try not to puke if you read this link)
Monday, January 15, 2018
$23,900,000.00 Benevis / Kool Smiles Dental Clinic Settlement Agreement with DOJ
This is for the period of January 1, 2009 through December 31, 2011.
That is 3 years.
They have been in business with this exact same business model since 2002, when FFL Partners found Dr. Tran and Dr. Pham at the Denver Small Smiles Dental Clinic and offered them an opportunity of a lifetime; to start their very own Medical Mill and become “owner dentists”.
It’s now January 2018.
So, 15 years, right? This settlement covers 3 of 15 years.
The way I see it, they should pony up an additional $286,800,000.00.
I don’t see any Corporate Integrity Agreement; let’s hope that is a seperate Agreement yet to be released.
$23,900,000.00 Benevis Kool Smiles Dental Settlement Agreement with DOJ - January 2018
Related:
Tuesday, January 09, 2018
Mother speaks out against Yuma, AZ Kool Smiles Dental Clinic
A mother is speaking out following the death of two children who visited a dental office in Yuma.
Nearly six years later, Elva Aranda is sharing her experience at Kool Smiles, who claims her daughter was being choked by a dental assistant in Summer 2012.
"It was a horrible experience, a horrible experience because when you see someone else hurting your child, you feel helpless," said Aranda.
Aranda says while her daughter was getting her regular checkup, the dental assistant was acting aggressively towards her daughter during the procedure. She claims the dental assistant was adding pressure to her daughter's neck as if she was choking her without realizing it.
"You know the suction tool, she started putting that into my daughter's mouth, and that was making her "gag". I'm here looking at my daughter, and I'm seeing her gag because that tool was shoved in her mouth and I started comforting here saying "it's okay, you're going to be okay" but I did not see that this lady had her whole hand shoved into my daughter's neck choking her."
Read the entire report here.