After WFAA investigation, company settles with State of Texas for record $235.9 million

Xerox Corporation and its former subsidiary, Conduent, agreed Tuesday to a record $235.9 million settlement with the State of Texas, according to the Texas Attorney General's Office. 
It was the largest single Medicaid fraud-related settlement in a case filed by the Texas Attorney General.

The settlement comes after a three-year WFAA investigation that uncovered millions of dollars in alleged overbilling by Texas dentists targeting low-income children for unnecessary and often harmful dental and orthodontic work.

Read entire story at WFAA website

Related:

 WFAA's Byron Harris reports 

Tailwind Capital's Dental Service Organization Investments: Benevis and Lone Peak

Just an FYI, since I'm sure this information will be needed one day:

Smiles 4 Kids, which had been purchasing many old Small Smiles clinics and Kool Smiles are both now operated by Tailwind Capital.

Benevis is Kool Smiles and Resolution Dental

Lone Peak is Smiles 4 Kids as well as a few other names.

Financing for Benevis's sale to Tailwind seems to be, in part,  by New Mountain Finance and happened during the 1st quarter of 2018. Probably before the ink on the Kool Smiles settlement was dry. 

In a May 2018 conference call transcript New Mountain states:

Our new investments were highlighted by a larger-size directed origination of a unitranched loan for Benevis, several club deals including a loan to ACA Compliance and one addition to both our net leased portfolio and our SBIC investing program. We believe that the consistency of our deal flow in this competitive market shows the strength of the broad sourcing network that we have built.

(unintranched debt: debt is a type of structured debt that obtains funding from multiple participants with varying term structures.)

 

In their 2018 holdings report, Washington State Investment Board is invested is Tailwind and New Mountain.


Although Benevis still shows up on FFL Partners website's portfolio page,  it is listed under the "Former" tab on their website.

Tailwind Captial Portfolio
FFL Partners Portfolio

Toddler who died after dental procedure at Kool Smiles was hooked up to empty oxygen tank as staff muted heart alarm: lawsuit

Toddler who died after dental procedure was hooked up to empty oxygen tank as staff muted heart alarm: lawsuit

Jan 9, 2019

The heartbroken family of a 2-year-old boy who died after a visit to the dentist last year is suing the Arizona clinic, claiming that a staff member repeatedly muted the alarm on a heart monitor that he was hooked up to, and that the oxygen tank he was supposed to be receiving supplemental air from was either faulty or empty.

Zion Gastelum’s mother, Veronica, brought her son to the Kool Smiles dental clinic in Yuma in December 2017 after it was determined that the boy needed crowns to address severe cavities. According to a police report obtained by ABC 15, Aaron Roberts was contracted by the clinic and was supervising the procedure, and a dentist later told responding officers that the procedure had gone “well.”

According to the family’s lawsuit, while under general anesthesia Zion had nine of his baby teeth worked on, including root canals and crowns on six of them. The complaint alleges that X-rays or further investigative exams were not conducted to confirm that the nine procedures were necessary.

Read more here.

Related:

Police report offers new details in case of 2-year-old who died after Yuma dental appointment

DOJ: Kool Smiles dental clinics to pay $23.9 million, allegedly submitted false claims

150 families have now filed lawsuits in Orange County Superior Court , Santa Ana, California against Children’s Dental Group — Number is expected to grow

By Deepa Bharath | dbharath@scng.com | Orange County Register
PUBLISHED: January 16, 2019 at 6:11 pm | UPDATED: January 18, 2019 at 2:19 pm

                              

IRVINE — Sixty-five families whose children were infected by rare bacteria when they underwent pulpotomies, or “baby root canals,” at an Anaheim clinic two years ago filed a lawsuit Wednesday, Jan. 16, naming the clinic, its operators, the company that installs and maintains water filtration systems, and several dentists.

The lawsuit, which was filed in Orange County Superior Court in Santa Ana, alleges that Children’s Dental Group and dentists who provided services there performed hundreds if not thousands of unnecessary pulpotomies on children. Potentially deadly Mycobacterium abscesses was found in several samples the county’s Health Care Agency took from the clinic’s water system. 

The children, ages 3 to 9, all underwent pulpotomies at the clinic between April and July 2016. In all, 500 children underwent the procedure during that time.

Children’s Dental Group has since become part of Western Dental. The clinic in question on East Lincoln Avenue is not owned or operated by Western Dental, but has changed hands.

So far, 150 families have filed lawsuits against the clinic and the number is expected to grow, said Dan Hodes, Irvine-based medical malpractice lawyer who is representing the children and their families.

READ THE ENTIRE UPDATE ON THIS STORY HERE

Related links:

Orange County Public Health - Dental Outbreak (Mycobacterium)

57 children who underwent baby tooth root canals, orpulpotomies, at Children’s Dental Group have been hospitalized – October 27, 2016

Anaheim dental clinic ordered to stop using water after 10 kids hospitalized – September 16, 2016

Law Offices of James R. Moriarty Facebook

Law Offices of James R. Moriarty Website

New Complaints About Lone Peak Management Group and Smiles 4 Kids Dental Clinics

Pediatric dental chain faces new complaints

By: Alison Grande
Updated: Nov 16, 2018

A new complaint was filed against a local pediatric dental chain, Smiles 4 Kids. The chain is managed by Dr. Justin VanBibber and owned by Lone Peak Management.

The latest complaint was filed by the Washington State Dental Association with the Department of Health and the Dental Quality Assurance Commission. The complaint alleges the dental offices in the chain, only refer patients to their other practices for oral surgery or orthodontia.

Dr. Chris Delecki is the president of the Washington State Dental Association.

"They're failing to disclose the fact the patient has other options besides their self-referrals to their own managed practices," said Dr. Chris Delecki, President of the Washington State Dental Association.

"Patients are often being asked to travel from Tumwater to Tacoma for their orthodontic care and these are Medicaid patients and for many of them transportation is one of the biggest things they face.
he complaint includes an email apparently sent by the Smiles for Kids Regional manager to office managers.

"Patients in your offices should NOT be given options as to where they would like to go for their wisdom teeth extractions -- referring patients anywhere else is sending OUR business and money away and is therefore, unacceptable."

Read the entire report here.

Washington State Dental Association: LOCAL DENTAL CLINICS OPERATED BY LONE PEAK MANAGEMENT ENGAGED IN DANGEROUS AND DECEPTIVE PRACTICES

Contact: Bracken Killpack
206.973.5227; bracken@wsda.org

LOCAL DENTAL CLINICS OPERATED BY LONE PEAK MANAGEMENT

ENGAGED IN DANGEROUS AND DECEPTIVE PRACTICES, COMPLAINTS ALLEGE

Practice at Smiles 4 Kids, Kids Dental, Family Orthodontics Put Patients at Risk

and Cost Low-Income Families

TACOMA – November 13, 2018 – The Washington State Dental Association (WSDA) has filed a new complaint with the Washington State Department of Health, alleging dental clinics operated by Lone Peak Management Group, LLC (Lone Peak) are engaging in dangerous and deceptive practices.
The WSDA complaint is just the latest complaint against Lone Peak, which operates more than a dozen clinics in Washington state, specializes in pediatric dentistry, and serves a high percentage of low-income, Medicaid-eligible patients.

The WSDA complaint was filed after research into Lone Peak practices. It alleges that the chain arranged a kickback scheme that generated nearly $170 for Lone Peak every time a patient was administered general anesthesia. Disguised as a “facility use fee” charged to the anesthesia provider, these payments far exceeded fair market value of the record-keeping Lone Peak provided the anesthesia provider, generating substantial additional profit for Lone Peak.

Dentists and staff in Lone Peak offices also were directed to engage in a system of self-referral to affiliated clinics for specialty dental services like oral surgery and orthodontia. This system ignored patient preferences and in many cases resulted in families traveling significant distances to affiliated clinics when other qualified providers were nearby.

Internal Lone Peak documents cited in the complaint clearly demonstrate the profit motive behind this policy: “Patients in your office should NOT be given options as to where they would like to go for their wisdom teeth extractions,” reads one email. “Regardless of how near/far the office … referring patients anywhere else is sending OUR business and money away and is therefore unacceptable.”

Previously, Seattle’s KIRO 7 TV reported on another whistleblower complaint against Lone Peak, filed by a former office manager who left the company after refusing to follow directives from company managers to re-use dental mouthpieces that are intended for single-use only.
Internal company emails cited in the whistleblower complaint show Lone Peak putting profits ahead of patient safety. In one email regarding the reuse of mouthpieces, a Lone Peak executive lamented the fact that “our expenses would go through the roof if we didn’t find a way around” the single-use requirement.

The emails also describe how Lone Peak ignored concerns raised by at least one clinic dentist about the reuse of single-use mouthpieces. Lone Peak agents directed dental office staff to deceive that dentist: “We should probably hide our open Isolites (mouthpieces) on the days we know she is coming in,” wrote a Lone Peak agent. “In the meantime, just make her happy when she is around, and then go back to business as usual when she leaves.”

“The concerns brought forward by the whistleblower and uncovered by our team are deeply troubling and represent a dangerous corporate intrusion in the doctor-patient relationship,” said Dr. Chris Delecki, president of the Washington State Dental Association. “This speaks to what can happen when corporations are allowed to directly or indirectly own dental practices. In this environment, corporations can direct, question and over-rule the decisions dentists make in how to best treat their patients. This is why our association has consistently advocated for state laws to prohibit this type of interference and why we have engaged in bringing these practices to light.”

Washington law prohibits corporations, including dental service organizations (DSOs), from practicing dentistry, which includes directing a dentist’s treatment plan; limiting or imposing requirements on how a dentists uses equipment or materials in the provision of treatment; or limiting or imposing requirements on the materials, supplies, instruments or equipment a dentist deems necessary to provide diagnoses or treatments consistent with the standard of care.

Lone Peak is a DSO headquartered in Colorado that manages approximately 50 dental clinics in 12 states, including Washington. Lone Peak is owned by Tailwind Capital, a private equity firm whose stated mission is to transition businesses to become “larger, more profitable enterprises.”

Documents received by WSDA indicate that certain executives of Lone Peak may also have been involved with the Small Smiles dental chain DSO, and a number of Lone Peak dental offices formerly may have been Small Smiles dental offices. Small Smiles was included in a scathing 2013 US Senate report that found the chain performed unnecessary services and that its business model deceptively gave managers rather than dentists control over the clinics. The report also recommended that Small Smiles be excluded from participating in the federal Medicaid program. 

Small Smiles and its parent company, Church Street Health Management (CHSM) have faced litigation before. In 2012, Small Smiles paid $24 million to settle allegations of Medicaid fraud brought by the U.S. Department of Justice. And in 2015, Small Smiles agreed to pay nearly $39 million in claims for alleged “unnecessary, inappropriate, unsafe, and excessive dental procedures.” Church Street Health Management has since declared bankruptcy.
 
The most recent complaints here in Washington also name Justin VanBibber, a Utah-based dentist who serves as the nominal head of the clinics engaged in the kickbacks and the mouthpiece reuse practice. He is listed as a practicing dentist on Lone Peak clinic websites in Washington, but the profile for his South Jordan, Utah practice lists him as a resident of Utah.
The Washington State Department of Health has opened active investigations into Lone Peak’s and VanBibber’s practices.


About the WSDA
The Washington State Dental Association’s 4,400 member dentists are committed to solutions that prevent disease and ensure quality oral health for all Washingtonians. WSDA empowers its members to advocate for and provide optimal oral health care.

Law Offices of James R. Moriarty: $5.1 Million Settlement in Whistleblower Case Involving Samson Dental Partners, LLC and ImmediaDent of Indiana, LLC

HOUSTON, Nov. 2, 2018 /PRNewswire/ -- Samson Dental Partners, LLC and ImmediaDent of Indiana, LLC agreed to pay $5.1 million to the federal government, the State of Indiana, and a whistleblower dentist to resolve a qui tam case with fraud allegations, according to the legal team for the dentist.

A settlement agreement was entered into among the U.S. Department of Justice (on behalf of the Office of Inspector General of the U.S. Department of Health and Human Services), the Medicaid Fraud Control Unit of the Office of the Indiana Attorney General, and Jihaad Abdul-Majid, DDS.

The qui tam complaint alleged that the defendants engaged in illegal corporate practice of dentistry and various types of fraud, including fraudulent billing, excessive and unnecessary treatments of excessive patients, and a sustained pressure by non-dentists in management positions to place corporate profits over patient care by exerting undue influence on dental care decisions.

Dr. Abdul-Majid, who will receive $925,000 plus expenses, attorneys' fees and costs, is represented by Charles S. Siegel, of Waters & Kraus, LLP, of Dallas; Daniel Hargrove, of The Hargrove Law Firm, P.C., of San Antonio; James R. Moriarty, of the Law Offices of James R. Moriarty, of Houston; and Joseph D. Satterly and Paul Kelley of Satterly & Kelley, PLLC, of Louisville, Ky.

According to the settlement, the federal government and the state of Indiana contend that they have certain civil claims against Samson Dental Partners, LLC and ImmediaDent arising from the submission of false claims for payment to Medicaid during the period from Jan. 1, 2009, through Sept. 30, 2013, for the following conduct:

• Samson Dental Partners, LLC engaged in the corporate practice of dentistry in violation of Indiana state law by exerting obtrusive influences over ImmediaDent's medical professionals and staff by rewarding production and disciplining for not meeting production objectives and directing personnel in a manner which compromised clinical judgment;
• Samson Dental Partners, LLC and ImmediaDent upcoded simple tooth extractions and improperly billed them as surgical extractions; and
• Samson Dental Partners, LLC and ImmediaDent improperly billed for scale and root planing (deep cleaning) when they were either not performed or not medically necessary.

ImmediaDent operates nine dental care practices in Indiana. Samson Dental Partners, LLC, headquartered in Kansas City, Mo., provides administrative and other support services to ImmediaDent.

The case is "United States ex rel. Jihaad Abdul-Majid, et al. v. ImmediaDent Specialty, P.C., et al.," Civil Action No. 3:13-cv-222-CRS in the U.S. District Court for the Western District of Kentucky. The case was originally filed on Feb. 20, 2013 by Dr. Abdul-Majid. The federal government and the state of Indiana intervened in the case in September 2018.

The lawsuit alleged violations Federal False Claims Act, 31 U.S.C. § 3730(b), and the Indiana False Claims and Whistleblower Protection Act, Indiana Code 5-11-5.5-4.

The settlement agreement is neither an admission of liability by SDP and ImmediaDent nor a concession by the federal government and the state of Indiana that their claims are not well founded.

CONTACTS:

Charles S. Siegel
Waters & Kraus, LLP
(214) 357-6244
siegel@waterskraus.com
www.waterskraus.com

Daniel Hargrove
The Hargrove Law Firm, P.C.
(210) 710-2867
dh@hargrove-law.com

James R. Moriarty
Law Offices of James R. Moriarty
(713) 528-0700
jim@moriarty.com
www.moriarty.com

Joseph D. Satterly
Satterly & Kelley, PLLC
(502) 785-8758
jsatterley@satterleylaw.com
www.satterleylaw.com

Paul Kelley
Satterly & Kelley, PLLC
(502) 785-8758
pkelley@satterleylaw.com
www.satterleylaw.com

SOURCE Law Offices of James R. Moriarty

Related Links

http://www.moriarty.com

Kool Smiles PSC dba Ruby Dental in Kentucky

Kool Smiles PSC dba Ruby Dental in Kentucky-181102 by Dentist The Menace on Scribd

Smiles 4 Kids Dental Clinics Under Investigation in Washington State

Smiles 4 Kids is “managed” by Lone Peak Management Group (LPMG), located in Colorado. Tailwind Capital.  In January 2017, Tailwind Capital purchased a controlling interest in LPMG for $55M.  Waller Law Group represented LPMG.  In press releases at the time, it was stated LPMG had nearly 50 clinics in 12 states.  As of March 2018 I counted 59 clinics and 73 known business entities. But as always, I could be wrong. (smile)

Let me just say this is only the tip of the iceberg about this company.

Below is the excellent report, by Alison Grande, that aired October 25, 2018 on KIRO7 News.

Whistleblower: Local pediatric dental chain reusing disposable tools

By: Alison Grande
Updated: Oct 26, 2018 - 6:19 AM

The Washington State Dental Quality Assurance Commission is investigating after a whistleblower complaint accused a local pediatric dental chain of re-using dental tools.

Lisa Walker quit her job as the office manager at the Smiles 4 Kids at Allenmore Hospital in Tacoma after she says the dentist overseeing the businesses, Dr. Justin VanBibber, told her to re-use disposable Isolite mouthpieces.

"That we re-use the Isolites, he asked that I put them in the cold sterile and re-use them on patients and I refused," said Lisa Walker.

The Isolite Mouthpiece package is clearly labeled "Disposable. Do not re-use. Re-use can result in the transmission of infections, pathogens."

Isolite mouthpieces are used to keep the airway clear during a dental procedure. "It suctions out the blood, the saliva, pus, tooth decay, you name it -it keeps the airway free of debris," described Walker.
"The worry for my kids and it was my worry for all kids is that,  I mean we have hepatitis B, hepatitis C, there's HIV, I mean there's numerous numerous diseases and long-term illnesses that can be contracted through blood."

Read entire story here.

Massachusetts Dentists Support Independent Practitioners

13 Sep 2018 Jill Tanzi, DDS

Todays Dental News

Most dentists in the United States have not heard of the Massachusetts Dentists Alliance for Quality Care. We are a group of dentists who are passionate about private practice and maintaining an excellent standard of care in our profession and for our patients.

In recent years, many of us have felt that organized dentistry’s advocacy for private practice has declined. In all fairness, not every dentist is in private practice. Many are working for dental service organizations (DSOs), academia, insurance companies, and other fields. The ADA and state organizations represent all dentists, not just one special interest group.

Last year, several dentists in Massachusetts decided to seek legal advice and petition our Attorney General in response to a contract received from Delta Dental of MA (currently called Total Choice PPO). Not only did we raise enough money to file a formal petition with the Attorney General, but we also formed a group that has grown to more than 60 members today.

In July, we voiced our concerns to the Division of Insurance at a hearing regarding a “new fee methodology” proposed by Delta Dental that would automatically decrease reimbursements to the entire network of Premier providers in the state. To date, we continue to educate our legislators and advocate for private practice dentists, as well as mentor students and recent graduates.

Although Delta Dental’s new for-profit Total Choice PPO was approved in our state, Delta continues to sell the non-profit Premier plan (96% of dentists in Massachusetts are Premier providers). In June of this year, it was announced that our state dental society decided to make a deal with Delta Dental of MA to cut all of the Premier dentists’ reimbursements by 10%.

This 10% “recalibration,” a euphemism for lower reimbursements, will affect that 96% of dentists in our state. Conversely, the Total Choice plan that offers a larger 30% discount has not been less popular with employers in Massachusetts and has far fewer contracted participating dentists.

Many dentists in our state understand these subtleties and were extremely upset by the decision of the leadership of the Massachusetts Dental Society, while other dentists may not be paying attention to these small details or fear retribution for getting involved.

Now is not the time to sit back and let others figure out the details that affect the future of our profession. Do you recall what has happened to primary care physicians? Not only have they been forced to work increasingly faster by insurance companies, but the quality of patient care also has suffered as a result. This is especially important for the younger generation of dentists to understand, as they will need to work faster and longer hours to try to make a living with ever decreasing reimbursements and huge amounts of student loan debt.

It is our hope that organized dentistry in our country will learn from the mistakes of the American Medical Association and try to slow the corporatization of dentistry and the reliance on dental benefit companies. We would like to see more support for the private practitioner members who, in fact, serve most patients in our country.

The Massachusetts Dentists Alliance for Quality Care is continuing its work on behalf of our profession. We believe that by educating our legislators, we will have a stronger voice in our state government. We also believe there is hope for our future and welcome as many dentists who are interested in becoming part of this movement to join our group.

Stand up, fellow dentists. It is time to make your voice heard. The time to make a difference is now!

Dr. Tanzi, a graduate of the University of Maryland School of Dentistry, has more than 18 years of private practice experience. She started The Dentist at Hopkinton in Hopkinton, Mass, 15 years ago near the starting line of the Boston Marathon. Passionate about issues facing dentists and private practice, she is also a founding member of the MA Dentists Alliance for Quality Care, which advocates for private practice dentistry and high quality dental care for patients. She can be reached at jilltanzidds@hopdent.com. 

Related Articles:

Massachusetts Dental Society Strikes Delicate Balance in Delta Dental Discussions

Massachusetts Dentists Continue Battle Against Delta Dental

Emerging Advocacy Groups Support Small Business Dentistry