153 total criminal cases (dentists, support staff,private equity investors)
45 are orthodontia related 30 % orthodontic are fraud cases
27 orthodontic provider investigation completed
$229,000,000 of probable fraud
93% is the average of cases where patients did not qualify for braces. Ranging from 39% to 100% of records checked so far.
$154,000,000 in general dentistry of probable fraud
55% is the average of overutilization - billing fraud; overtreatment. Ranging from 25% by some providers to 99% by other providers.
Office of Inspector General & TMHP
August 2008 audit of TMHP revealed problems
2011 was follow-up on 2008 audit
12 investigation in 2011
108 so far in 2012
Time needed to complete an investigation
4 years in 2011
8 weeks by end of 2012
How do the new DMO's (MCNA & DentaQuest) in Texas negotiate to enroll providers?
Individual dentists - if the own their own clinic
Management, i.e. NCDR, LLC and CSHM - in the case of group practices.
TSBDE cases turned over to district attorneys
200 in 10 years - of individuals practicing dentistry without a license
3rd degree felony
5 convicted and jail time
if acted upon, most have plea agreements and board is not notified
Curbing illegal corporate practice of dentistry and patient shopping
DentaQuest - Cease and Desist Letters
Texas State Board Dental Examiners (TSBDE) -
Forward to AG's office for investigation
Could but have not sent Cease and Desist Letters.
Look if someone is working for a non-dentist owner and take action against that dentist
Non-dentist may not influence or attempt to influnce a dentist in treatment, doing so is practicing dentistry without a license.
i.e. Doug Brown - Kool Smiles
i.e. David Wilson - Small Smiles
i.e. Stephen Thorne - Pacific Dental
i.e. Michael Dell – Affordable Dental
Have had cases where dentist being investigating said he or she was influenced by a Office Manager or other employee of a DSO.
5 dentists reported such in last 2 years
Took action against the dentist
# of Dental Practices or Dental Management Organizations
Unknown by TSBDE
Acronyms for illegal operating dental management companies
DSO – Dental Service Organization
DMSO – Dental Management Service Organizations
NDOE – Non Dentist own entities
Indicator of fraud
Billboards offering Free Braces
OIG re: Jail Time:
There will be, and there are, and it’s a parade of horrors. We don’t see the end of the parade but we are going to make sure that every body that participated in the parade gets to be evaluated to see if we can criminally prosecute them. We’re going to make sure that if there’s an ability to recover under the Texas Medicaid Fraud Prevention Act we will pursue that.
We are coordinating with the Office of Inspector General through our task force, if we find that the quickest way to get resolution and recover the money from them is to go through the Office of the Inspector General processes, through SOA, we will do that. So we are trying to attempt to anything and everything to facilitate the quickest resolution and get the state of Texas money that has been stolen from it, back.
It’s the “quickest resolution” that gives me pause.
There is a chain of clinics in South Carolina, called DentalSmart. It appears they are set up to attract foreign investors through, what is called an EB-5 Immigrant Investor program. (see bottom of post) I say this because it has entities set up described as EB5 Investment companies. Of course I could always be wrong.
DentalSmart 2020 Savannah Highway Charleston, SC 29407 P. 1-843-735-6727
http://dentalsmartus.com/index.php
Trademark Registered May 12, 2011 by National Dental Centers of America, Inc.
National Dental Centers of America, Inc is a Delaware Corporation
South Carolina filings - National Dental Centers of America, Inc Brian Schleifer 17 Lockwood Dr. TE 401 Charleston, SC 29401 Filed 10-26-2010
DentalSmart EB5 Investment V, LLC Registered Agent: EB5 Investment Managers, LLC 301 Augusta Street Greenville, SC 29601 Filed 9-6-2012
Below is a story that should scare the hell out of every American. A Texas judge doesn’t care about the laws, she says exactly that. Sally is trying to silence free speech and especially whistleblowers.
It is an undisputable fact that if people like Byron Harris, Candace Evans, Jim Moriarty, myself and others weren’t talking about this scandal in dentistry and dental clinics like Malouf’s All Smiles clinics, where do you think we would be right now?
Would anyone be paying attention in Austin?
Just last week, at a hearing on Public Health Texas Rep. Lois Kolkhorst, said, ‘thank goodness for the Bill of Rights, because that’s really what brought it to a head.’
But for Harris and WFAA’s reporting there would be no joint task force in Texas and taxpayers would still be bleeding millions of dollars by the day.
Would anyone be paying attention in Washington?
In March, at a hearing in DC, it was recognized that it took a reporter in Texas to uncover the massive orthodontic fraud.
Would anyone be paying attention to the child abuse happening behind closed doors in these dental offices. That answer is NO!
Evidently, Judge Sally Montgomery of Dallas County Court, is not too fond of our “Bill of Rights.” She doesn’t care too much about Texas’s Citizens Participation Act either, a law passed unanimously in 2011.
It’s clear time has come to put Sally Montgomery out to pasture, and elect someone else to Dallas County Court No. 3.
Malouf, a dentist who's been accused of Medicare fraud, and his wife, Leanne, filed a lawsuit October 16 alleging that Evans et al trespassed on their property; invaded their privacy; and defamed, libeled and slandered them after publishing photos of the Maloufs' backyard with its ongoing construction of a massive waterpark.
"The parties have agreed to mediate the case, and we'll begin that process [Friday]," says Larry Friedman, who is representing Evans.
The Maloufs filed a lawsuit October 16 alleging that Evans, Laura Wilson and WFAA trespassed on their property; invaded their privacy; and defamed, libeled and slandered them.
On October 19, Judge Sally Montgomery of Dallas County Court at Law No. 3 issued a temporary restraining order for two weeks, forbidding anyone from stepping onto the Maloufs' property. That put the case on hold and gave the parties an opportunity to mediate a solution rather than going back to court.
3 and 4 surface fillings are up, some more than double. For instance 4 surface amalgam's up from $60.02 to $125, 4 surface composites $75.06 to $135 – effective September 1, 2012.
Being the cynic I am, is this to make up the difference if it is finally decided stainless steel crowns have to be pre-approved?
Is to help keep the fraudsters stay out of hot water and still in the dough? Stainless steel crowns are $153, now 4 four surface amalgams just slightly less, where before they were dang near $100 less.
The sedation fees disturb me a slight bit. Of course none of it would disturb me if not for the lack of regard of children’s health and wellbeing these days.
Effective October 1, 2012 -
D9220 – General Anesthesia was $85.75 now, $125 first 30 min. D9920 – GA each additional 15 min, was $30.63, now, $35.00
D9230 – Nitrous Oxide – NO CHANGE
D9241 – IV-Sedation was $119.44, now up slightly to $125 for the first 30 minutes. D9242 – IV – Sedation was $28.44, now up slightly to $35 for each addition 15 min.
D9248 – Non- IV Sedation was $183.75, huge drop to $125.00.
The law firm of Waller Lansden was selected to serve as legal counsel to the Texas Health Services Authority (THSA), whose objective is coordination the implementation of strategic and operational plans for the health information exchanges (HIEs) that will provide access to electronic medical records throughout the State of Texas. (which is a whole other can of worms I’m leaving for someone else!) On October 15, 2012, Elizabeth Rogers of Waller Lansden testified before Texas House Public Heath Committee meeting in which she basically threw the Texas Dental Board under the bus for not doing it’s job. I agree whole heartedly with her assessment. (yes, I know, whether I agree with her or not is inconsequential) According to the roster, she was there representing the Texas Coalition of Dental Support Organizations
Anyway, here is Rogers’ testimony. Pull up a seat and listen. Then let’s talk. (This was immediately after Diane Earle of Kool Smiles gave her testimony.)
Here’s what:
Waller Lansden serves as legal counsel to Dr Richard Malouf, of All Smiles Dental, in his initial plea deal w/ state Attorney General Abbott.
Waller Lansden also serves as legal counsel to Church Street Health Management (CSHM) (d/b/a Small Smiles Dental, Wild Smiles, etc.), and has been involved with the company from its acquisition by private equity investors. 2007 Waller Street News
I’m wondering how Waller’s, clients like Richard Malouf – All Smiles and CSHM-Small Smiles feels about what she had to say.
Currently Small Smiles is owned by Garrison Investment. Not sure if Waller spends a lot of time on CSHM? Well,here’s a time sheet. If you look closely you will see where they are actually the ones handling some serious compliance issues at one of the Ohio clinics.
Why is this a problem? Small Smiles gave birth to Kool Smiles. Two dentists from Small Smiles, along with a paramedic (sounds like the beginning of a bad joke) joined with FFL Partners to start Kool Smiles and NCDR, LLC.
I don’t know this to be 100% fact - but I’m pretty darn sure, Kool Smiles is one of the clinics on CAF – Hold in Texas. (Credible Allegations of Fraud) Meaning, they are not getting their money, hence Diane Earle sent to “fall on the sword”. Earle goes to Texas, swears her testimony is the truth, and 4 days later is having a production meeting in Atlanta at NCDR headquarters!! These execs at Kool Smiles and spineless cowards and have yet to lay themselves on the alter for sacrifice. But they will sure send out the stupid folks – Earle and Buckey for example. (sorry, got off on a KS rant there for a minute)
Another troubling aspect - Waller Lansden professes it is the counsel to the DSO’s here in this ad: Waller Lansden Ad to Be Dental Management companies Top Firm
Besides all of the above, Waller Lansden are also members of theDGPA, the group propagating the illegal operation of the dental management companies. Most of it’s members, founders, and officers belong to the dental management companies backed by private equity. I being a member of the “club” most likely to land in legal trouble, it’s a great idea. But… be part of the governing body involved in these matter is a whole other situation.
If Texas is working hard to close the doors on the hen house, don’t lock it down with the wolves’ operatives inside, unless they are double agents, of course. Other written testimony from the hearing
Kool Smiles senior district manger tries to explain dental service organization to Texas lawmakers. Hope this wasn’t under oath. Ooops, it was. See Witness Affirmation Form
EFFINGHAM — While international news services are reporting that Heartland Dental Care is for sale in a potential 10-figure deal, a Heartland executive said Wednesday that no deal would affect the local presence of the dental practice management giant.
“We want the people of Effingham to know that we are committed to Effingham,” said Chad Thompson, the company’s vice president of administration.
Thompson declined to comment on the potential deal, but international news service Reuters reported earlier this week that private equity firms KKR & Co., Apax Partners and Madison Dearborn Partners have bid for Heartland Dental. Reuters said the sale price could reach $1.3 billion.
Dedicated to all those who are not deterred from speaking out
During a Texas Public Health committee meeting on October 15, 2012, committee Chair Rep. Lois Kolkhorst, tipped her hat to the public, for speaking out about the massive amount of dental Medicaid fraud taking place in Texas.
“…This wasn’t a huge issue on this committee or others would have maybe been a little more privy to it—it took a lot of news reporting for us to really, and thank goodness for the Bill of Rights, because that’s really what brought it to a head, “ s
“…I want to tip my hat to Channel 8 and WFAA in Dallas, certainly the Texas Tribune has given this a lot of coverage…”
Without the public and company insiders speaking out, without Mr. Harris at WFAA, listening, Representative Kolkhorst and the Public Health committee would still be in the dark.. And I suspect the Texas Inspector General and Attorney General’s office would still be turning a blind eye to the red flags they found in 2008.
However, since Richard Malouf - under fraud investigation himself - filed a SLAPP lawsuit last week against WFAA TV; investigative reporter, Byron Harris; Mary C. Jones and his neighbor, Laura Wilson, I’m guessing he’s not as appreciative of the “reporting” and our “Bill of Rights.”
Note, Rep. Kolkhorst said it took a “lot of news reporting” to get their attention. So don’t quit; keep blowing those whistles and beating your drums. Don’t be intimidated by even the sleaziest of those who may try to twist the truth.
On a side note: I don’t live in Texas and I don’t have a clue who Lois Kolkhorst is. But I would vote for her over the two loons we have running for President based on the October 15, 2012 hearing alone.
