Erie PA dentist pleads guilty to fraud–Dr. Kristi Ayn Liebau-Grassi

Former Erie-area dentist pleads guilty to billing fraud

By ED PALATTELLA, Erie Times-News
ed.palattella@timesnews.com

Friday September 26, 2012 11:32 PM

Former Erie-area dentist Kristi Ayn Liebau-Grassi would have gone up against many of her former patients if she had gone to trial on fraud charges.

The patients or their parents were prepared to testify that Liebau-Grassi billed Medicaid for dental work -- including crowns and the equivalent of root canals for children -- that was unnecessary or never provided.

The courtroom confrontations will not occur.

Liebau-Grassi, 39, pleaded guilty in U.S. District Court in Erie on Wednesday to 14 felony counts that she defrauded Medicaid by making false statements in health-care matters. The government said the fraud occurred from January 2008 through March 2011, when she was practicing at 4010 East Lake Road in Lawrence Park Township and at the UPMC Hamot Surgery Center.

Liebau-Grassi agreed to pay restitution of $289,000 and faces a year to 18 months in federal prison at her sentencing before U.S. District Judge Sean J. McLaughlin on Feb. 13.

Assistant U.S. Attorney Marshall Piccinini and Liebau-Grassi's lawyer, David Ridge, agreed that the federal sentencing guidelines call for that amount of time for Liebau-Grassi, who has no prior record and who will get credit for pleading guilty.

Liebau-Grassi formerly lived in the 6000 block of Bridlewood Drive, in Fairview Township, and now lives in Sugar Land, Texas, near Houston. She remains a licensed dentist, according to the Pennsylvania Department of State. She is free on her own recognizance.

The U.S. Attorney's Office charged Liebau-Grassi, also identified in court records as Kristi Ayn Liebau, by filing what is called a criminal information against her in August. The federal government typically secures grand jury indictments, but Liebau-Grassi, signaling her desire to end the case quickly, agreed to waive an indictment and plead guilty to the information.

Liebau-Grassi spoke softly and dabbed her eyes with a tissue as she told McLaughlin she wanted to plead guilty.

The FBI and a Medicaid investigator with the state Attorney General's Office built the case against Liebau-Grassi. They opened the probe to review concerns about the dental work she said she provided to patients, most of whom were children, Piccinini said.

The investigators found Liebau-Grassi performed unnecessary work, performed work and then billed it as more expensive work, billed for work on teeth that did not exist and billed for procedures so numerous she could have not performed them in the allotted time, Piccinini said. He said patients and other dentists were prepared to testify against her.

In one case, Piccinini said, Liebau-Grassi billed for performing 16 pulpotomies -- or root canals for children -- and installing 16 steel crowns and four composite fillings, all in 17 minutes of surgery time.

Ridge, Liebau-Grassi's lawyer, has said she pleaded guilty to take responsibility for "any and all billing problems."

Liebau-Grassi on Wednesday admitted she was the sole person who signed the billing forms for her office.

ED PALATTELLA can be reached at 870-1813 or by e-mail. Follow him on Twitter at twitter.com/ETNpalattella.

Senator calls for dental inspections Peeler says he'll introduce legislation if need be

Written by
Tim Smith, Staff writer

COLUMBIA — Routine state inspections now protect people more from bad food at restaurants than from possible unsafe conditions in dental offices, says the chairman of the Senate Medical Affairs Committee, who said he wants the state to begin routine dental inspections.

And the chairman of the Senate Judiciary Committee told GreenvilleOnline.com that he thinks the Legislature should look at the idea of routine inspections and broaden them to medical offices.

Sen. Harvey Peeler of Gaffney, who heads the Medical Affairs Committee and is the Senate’s majority leader, said he previously wasn’t aware that dental inspections weren’t conducted by the state.

The Greenville News and GreenvilleOnline.com revealed this month there were no inspections — unlike at least 15 other states — though the state does regularly inspect barber shops and hair salons and looks into complaints about dentists or dental offices.

“If need be, I’ll sponsor the legislation,” he said. “If you inspect a restaurant that you are putting food in your mouth, it seems like you would inspect a dentist office where you put a hand and instruments in your mouth.”

Sen. Larry Martin of Pickens, chairman of the Senate Judiciary Committee, said lawmakers should at least study the idea of routine inspections.

“I think that’s something we ought to look at since that issue has been raised,” he said.

Martin said one reason the state may not have developed a system for inspecting dental offices is that three agencies have some part in regulating them — the Department of Health and Environmental Control, the Department of Labor, Licensing and Regulation, which houses the state dental board, and the state Occupational Safety and Health Administration.

“That may be why there’s no systematic inspection, no more so than there would be of a doctor’s office,” he said.

Martin said other than responding to certain complaints, state agencies might not regularly look at dental and doctors’ offices, even though the labor agency does systematic inspections of manufacturers or other businesses under OSHA responsibility.

“Maybe there should be,” he said. “I don’t know why they wouldn’t ensure that those various requirements are being met on a spot-check basis.”

Asked how Gov. Nikki Haley felt about requiring routine inspections, Rob Godfrey, her spokesman, said the idea has been discussed by the state Dental Board.

“LLR licenses the professional, not the facility, as is authorized by statute, and LLR does undertake inspections when it receives complaints about licensees — the Dental Board by comparison to other boards receives a relatively low volume of complaints,” he said. “The Dental Board has discussed legislation to mandate inspections but thus far none has been introduced.”

“It doesn’t matter a whole lot to me one way or the other,” said Sen. Ray Cleary, the only dentist on Peeler’s committee. “If they think they need more of them (inspections), my feeling is we need to give government the tools they need to govern. So I don’t have a problem increasing the budget for that.”

Cleary, who said he has been in practice since 1975, says he has a “fairly upscale practice.”

“So my patients expect that,” he said. “I haven’t been in some offices that are not upscale, so it’s hard for me to relate to it.”

At least 15 states, according to the American Association of Dental Boards, conduct routine inspections. Nine more — including South Carolina — conduct inspections only if a consumer complaint is lodged.

Other states’ inspections have found violations.

Already this month, six dentists in Ohio, plus a radiographer and a registered dental hygienist have been cited by the Ohio State Dental Board for infractions and violations of that state’s laws and safety precautions, according to public records. Those citations were due to routine inspections conducted by that state’s Dental Board.

The routine inspections in Ohio, said Lili Reitz, executive director of that state’s dental board, are to prevent slips or lapses — or even outdated methods — from occurring. She prefers not to think dentists would deliberately break safety guidelines, even though she knows that happens.

“We’ve had everything from dentists bringing pets into the office to them sterilizing instruments in toaster ovens,” she said. “We have a checklist for them to follow. A dentist can’t say they’re caught off-guard.

“But in 90 percent of the cases, we’ll find a violation or two. When we do, we’ll be back.”

Recently, her inspectors visited a Veterans Administration hospital after a consumer complaint. VA facilities don’t usually fall under the board’s jurisdiction, but they conducted an emergency inspection regardless.

“We discovered a dentist had potentially infected 600 patients with Hepatitis C because he wasn’t sterilizing properly,” she said. “He wasn’t using gloves, he wasn’t meeting standards. He was 81 years old and that’s how he’d always done it.

“How would you ever know this if you’re not going out there to inspect?”

The South Carolina Board of Dentistry conducts licensing exams and annual registration of dentists, dental hygienists, dental laboratory technicians and ortho-technicians.

It also investigates complaints and conducts disciplinary hearings. But it doesn’t conduct routine inspections. Nor does the state Department of Health and Environmental Control, which treats dental offices differently than some other medical providers, such as hospitals or nursing homes.

Under the South Carolina Occupational Safety and Health Administration, dentist offices are subject to federal safety standards like the “Bloodborne Pathogens Standard” and guidelines for X-ray machines. Employees must safeguard themselves with gloves, face and eye protection and gowns, but no routine inspections are conducted for compliance.

This leaves the state’s dentists solely responsible for infection control in their own facilities, responsible for patient safety, for their own safety and for the safety of their staff.

An examination of the latest LLR annual report, from 2010-11, shows the state has 2,700 dentists, 3,300 hygienists and 3,600 dental assistants. Those individuals were subject to 86 complaints during the fiscal year. Those complaints prompted 71 investigations. From those, two licensees — not necessarily dentists — were ordered to cease and desist; one entered into a consent agreement; and nine received letters of caution.

Employee complaint about dental office sanitation

http://news.com.au/national/dentist-clinic-operates-without-steriliser/story-fndo4ckr-1226483364907

Judge stops case where dentist sues patient for Yelp review

http://www.kval.com/news/local/Dentist-who-sued-patient-over-Yelp--171840671.html?m=y&smobile=y

Whistleblowers, we should all be one!

Whistleblowers Help Texas In Medicaid Fraud Cases

• by Becca Aaronson
• September 27, 2012

With the help of private whistleblowers, Texas has reaped more in Medicaid fraud settlements with pharmaceutical companies than any other state, according to a report released Thursday by Public Citizen, a nonpartisan consumer advocacy organization. 

“When I’ve spoken with a couple of other states, they definitely recognize Texas as a leader in enforcing pharmaceutical fraud,” said Dr. Sammy Almashat, one of the report's authors.

Texas has recovered at least $354 million in Medicaid fraud settlements from pharmaceutical companies since 1991 with the help of private whistleblowers, according to the report. Almashat said that’s because under Texas law, whistleblowers can receive between 15 to 25 percent of the financial penalties of a Medicaid fraud settlement for bringing the case forward.

Although 13 states have similar laws, “Texas is a unique case, because other states haven’t been nearly as active as Texas in taking advantage of whistleblower revelations in prosecuting,” civil Medicaid fraud, said Almashat.

“A whistleblower brings unique underlying knowledge about the fraud that was perpetrated by the defendant in the case,” said Daniel Hodge, first assistant attorney general. In all civil Medicaid fraud cases — including those against pharmaceutical companies and many others — in the last 10 years, Texas has recovered $880 million, said Hodge, and $373 million of that went to the state treasury. 

The whistleblower cases are entirely responsible for that $880 million, Hodge said, explaining that although the Inspector General at the Texas Health and Human Services Commission referred 12,000 criminal Medicaid fraud cases to the AG's office since 2002, during that same time, that agency only referred three civil Medicaid fraud cases.

Currently, a top priority at the AG’s Office is to pursue orthodontic and dental fraud in the Medicaid Program, said Hodge. The office has assembled the Orthodontic and Dental Fraud Task Force to combine resources at various agencies, including the Office of Inspector General at the HHSC. At least one case being pursued by the task force was referred by a whistleblower. 

Given the significant portion of the state budget that goes to Medicaid, “it’s more critical than ever for the taxpayers that we aggressively pursue any actors that defraud the taxpayers and recover those dollars,” Hodge said. “We’re thrilled that Texas has been recognized for [Attorney] General Abbott’s efforts to prioritize uncovering and recovering waste, fraud and abuse in the Medicaid program.”

Sun Orthodontix raided by FBI–Life in dental fraud is not as rosy as it used to be, is it?

We’re getting there… 

by BYRON HARRIS

Bio | Email

WFAA-TV

Posted on September 26, 2012 at 5:58 PM

Updated today at 6:18 PM

Story TimelineClick to open timeline

Related:

• More from News 8 Investigates

NEWS 8 INVESTIGATES

In the largest action to date, the FBI, state investigators and the attorney general have raided the offices of Sun Orthodontix.

Sun doesn't have locations in North Texas, but it was the second largest biller for braces under Medicaid in 2010.

Part of its huge growth in Texas is linked to Medicaid dental bills. News 8 found Texas dentists were charging taxpayers for putting braces on kids who didn't qualify for them under Medicaid.

Sun collected more than $9.6 million in 2010, according to state records.

FBI agents were part of Monday's raids at Sun offices, which stretch from El Paso to Corpus Christi.

"The FBI doesn't show up when they think you've committed a crime... they know you've committed a crime long before they show up," said Houston attorney Jim Moriarty, who is part of a whistle-blower case against Dallas-based All Smiles Dental Centers.

The joint raid is the largest action so far against a dental firm in Texas.

"I think you may see tens or hundreds of dentists who end up with civil or criminal charges against them," Moriarty said. "I think there is a tsunami of criminal action against crooked orthodontists in Texas."

No criminal charges have been filed against Sun or its dentists. But the company has been in a dispute with Medicaid. The state quit paying Sun Orthodontix earlier this year, questioning its practices.

Sun has taken the state to court for money it says it is owed.

E-mail bharris@wfaa.com

Ohio State Dental Board Compliance Manual

Remember the stories last week about state not inspecting dental offices for sanitation.

Ohio State Dental Board Compliance Manual

Mohamed El Deeb continues to have Minnesota dental license suspended.

Mohamed El Deeb, license number D9508, is no stranger to the Minnesota Dental Board:

November 6, 2008  - Stipulation and Order for Conditional License after a complaint that was serious enough to be referred to the Attorney General. (I guess the Minnesota dental board knows the right person to contact at the AG’s office there, unlike Texas, where they haven’t a clue)

The incident occurred in January 2004. They found “record keeping violations” – a great catchall, like “improper equipment for us motorists” – substandard care and “incorrect billing” – aka “fraud” as it related to three patients. Evidently it related to conscious sedation, as the board called in an expert for a report.

In 2005 there was another complaint. It too was referred to the AG. Somewhere along they reviewed 5 years of his records and found several items worthy of sanctions.

September 24, 2010 Dr. Deeb petition the dental board to have his license reinstated.  They did so, with no conditions attached.

September 7, 2012 – The board issued an order of a Temporary Suspension during a closed session.

September 17, 2012 – The board continued its Temporary Suspension

Don’t’ miss WFAA–TV–Byron Harris Report

I hear there was a raid by the FBI at a Texas Orthodontic clinic. Watch for Byron’s report. 

Think “Sun”shine!

Here’s a challenge -

Here is the Laffer Associates Study that says DSO’s (Kool Smiles, Small Smiles, etc)  perform less procedures per patient than private dentists. It also says they steal less than money per patient than private dentists. Ok, it doesn’t use the word steal…  but still…. 

You can find a link to the raw data at the bottom of page 5 of Laffer’s study. Or at their dropbox here.  Or this dropbox here.

WARNING – if you have a copy saved as an .xls file instead of a .xlxs your speadsheet does NOT contain all the data! 

Here is the challenge – Debunk it!

According to the study they found 35 Texas Providers Identifiers for Kool Smiles in Texas. Considering Small Smiles used at a minimum 25 provider numbers for 4 of their dental centers in 2010, I betting there were a whole lot more than 35  numbers used for Kool Smiles and their many clinics in 2011.  Hell, there are at least 55 “providers” in the Indiana Kool Smiles centers.  It might have been 35 that could be identified, for Texas in 2011, but that’s the point, isn’t it?

Laffer says this about the data:

Data and Methodology
We were provided Medicaid claims paid data for the fiscal year 2011 by Kool Smiles, who had received these data from the Texas Medicaid Program via a Freedom of Information Act request. We did nothing to verify the authenticity or accuracy of these data.
Before going into the results of our analysis, let me provide a few definitions. In Texas, Medicaid covers children in families from no income up to 185% of the federal poverty level for children up to 1 year old, up to 133% of the federal poverty level for children from 1 year old to 5 years old, and up to 100% of the federal poverty level from children 6 years old to 19 years old.

Thus, the data contain all Medicaid claims arising from children aged zero through 19 years, 11 months in families with income up to the applicable multiple of the federal poverty level (the federal poverty level is an annual income of
$18,530 or less for a family of three as of 1/1/12), regardless of what type of dental provider treated the child.

We counted as a procedure every separate dental activity that was charged to Medicaid with a Medicaid billing code.
Unfortunately, the data did not contain a separate total count of patients accessing dental services. Instead, unique patient counts were provided for each Medicaid billing code. To derive an estimate of the total number of patients, we added the number of patients treated via each code for a prophylaxis cleaning and used that count as our number of unique patients.

We used this procedure for all DSOs and all non-DSOs as well.
Prophylaxis cleanings, or “prophies”, are the standard dental cleanings that every patient receives as part of a routine dental visit.24 These dental cleanings, which are typically billed under the same code each visit, provide a more reliable method for this patient count than other routine services, such as exams, which might be billed under different codes and lead to double counting. There are three codes for prophylaxis cleaning, each based on age: D1110 for patients 13 to 20 years old, D1120 for patients 6 months to 12 years old, and D0145, 25 a code specific to the Texas Health Steps program, for children under 3 years old.

The Medicaid data we received contained a count of clients who received the procedure associated with each Medicaid billing code, broken out by location of dental service (see below). Summing the number of clients receiving each prophylaxis procedure thus provides a proxy for the total number of unique patients treated under Medicaid in Texas in 2011.

Accordingly, we use “prophies,” a routine procedure administered with regularity, as the count for unique patients, or “patients,” as we’ll refer to them in this analysis.

Additionally, the data quite naturally did not explicitly identify which dentists were associated with DSOs. The amount of reimbursement doesn’t differ for DSO dentists and non-DSO dentists. In order to receive reimbursements for treatment
performed on Medicaid patients, however, a dentist must apply for and be assigned a Medicaid Texas Provider Identifier (TPI) number. We made a list of all of the DSOs we could identify that do business in Texas, and any TPI that filed a claim using an identified DSO address was counted as being a DSO dentist (see Appendix A for a full listing of all DSOs included in our calculations). All other TPIs were counted as non-DSO dentists. In the process, we dropped the claims data for any TPI that filed with Texas Medicaid but was associated with an address that was not within or immediately bordering Texas.

An important caveat is that the total population of DSOs within the data represents office locations, and not individual dentists. In going through the data, we were unable to find multiple dentists working at the same DSO office billing
separately. With few exceptions for non-DSOs, it seems a rule that most group practitioners bill under a single base (7-digit) TPI instead of their unique and individual 9-digit TPI.

Basically, I read this to say “GIGO” – Garbage In – Garbage Out. So someone spent a hell of a lot of money for a report that means nothing and I mean nothing. Goes to show you though, tell a company what you need it to say, and they can get the data to make it so.

As well, these DSO’s work very hard to hide the fact they are operating as a DSO, since it’s illegal, so the number of non-DSO dentists numbers have to be distorted, right?  Like I said, GIGO!