The Real Cheaters

Boston Herald Monday September 26, 2011

The cheating done by food stamp recipients is peanuts compared to vendor fraud (“Life’s a beach on EBT street,” Sept. 22).

Most fraud is done by pharmacies, doctors, dentists, nursing homes, hospitals and sellers of medical equipment. The government recovered $2.5 billion in overpayments for Medicare in 2009 as the Obama administration focused attention on fraud enforcement efforts in the health industry.
Click here to read the full story
The Real Cheaters

Inside the mind of a corporate dentist who is paid based on production.

Here is what happens to a dentist working at a dental mill when they don’t produce. Names and dates have been changed.
I believe this is a letter from a “lead” dentist at a dental mill clinic sent to their “regional manager". It’s apparent production is the only goal and is precisely why getting a bonus and/or a piece of the pie for compensation is more than wrong! It’s criminal! This is exactly why under Quality of Care Corporate Integrity Agreements, employee compensation or bonuses are NOT to be based on “production” goals.

Dear Regional Manager,

This letter is in regards to the production levels of Dr. F. As you know the clinic was approximately $500 away in production from the $300/3000 Bonus for the month. This is one of MANY examples of Dr. F not completing the majority of the treatment on the patients she sees on a daily basis. The patient, RH, was seen on 12-1-2010 by Dr. F and the only treatment done was a facial composite on the #C and the rest of the treatment to be performed was dismissed because the patient was nervous and he wanted the dental visit to be easy.
The clinic missed out on the possible $425.96 of production because he wanted to make the visit EASY? I find this very upsetting because I strive to work at my full potential and lead by example to my fellow doctors and employees to work hard regardless if I want to make a dental appointment easy.
If I wanted to make the appointment easy for every nervous patient, I believe a strong majority of our parents would be upset that they would have to continuously keep coming back because the patient was nervous. RH was my patient today and I completed the majority of the treatment except the extractions (per mom) and yes the patient was initially nervous, but did great for the injections and treatment. In conclusion, my question is how many more patients are to be dismissed or partial work completed because they were nervous and how many production goals must be compromised because of Dr. F’s lack of effort?
Sincerely,
Dr. X Ray Fraud

As you can see, Dr. X Ray Fraud would have done all the extractions had mom not spoken up and refused.

Jim Moriarty “Only a human can practice dentistry” “No corporation is allowed to practice dentistry.”

by BYRON HARRIS
Bio | Email
WFAA
Posted on September 23, 2011 at 11:15 PM

WFAA's Byron Harris has investigated dental organizations that have charged the government millions for children's braces. Here is the latest from the on-going News 8 investigation which includes a statement from Texas attorney, Jim Moriarty. 

E-mail bharris@wfaa.com

 

Related:

• Feds investigate Texas dental Medicaid program  
• Questions surround lucrative Medicaid dental business
• Tax money for unneeded braces goes to hedge funds
• Texas taxpayers pay big for straight teeth

See all photos »

Don’t become part of the crime and cover-up–Report it!

This goes out to any Small Smiles or Church Street Health Management employees.

The Office of Inspector General and Health and Human Services take Corporate Integrity Agreements seriously, especially Quality of Care CIA’s and even more important the agreements that have to do with the treatment of children.

I know many of you are afraid to speak up about the violations and breaches of the Corporate Integrity Agreement.  I know many of you are concerned about other misdeeds happening at the dental centers as well as at corporate headquarters. 

I encourage each of you to report any and all violations.  If you don’t feel comfortable using the Hotline that is set up, and I understand that completely, then at least report directly to the OIG/HHS. 

You may direct complaints of suspected Medicaid fraud to
OIG's Hotline1-800-HHS-TIPS (1-800-447-8477) or directly to a

State Medicaid
Fraud Control Units

If the monitor is visiting your center, please talk to the monitor.  I’m sure all reports and allegations are taken seriously.  If you can’t talk freely right then, surely you can find a way to get the monitor’s attention to slip them a phone number or a note or something.  Get the name of the monitor and contact them later….do something.

Heck do all of the above if you don’t feel comfortable talking to the monitor and your concerns swept under the rug.  Even though I doubt that is the case.  But I understand just about every one of you are terrified. 

You guys are the first line of defense against children being mistreated and Medicaid fraud prevention.  Please do the right thing.  For example, if you see procedure being coded and billed improperly, please report it, please.  Don’t become part of the crime and cover-up.

Dr. James Crow sentenced to prison for Medicaid Fraud - using wrong billing codes

Medicaid Fraud and Perjury by Brownwood, Texas Dentist. Perjury(emphasis added).

Who at these Medicaid mills are willing to leave your family, newborns, sick parents and head off to prison? Better be thinking about it.
_____________

September 21, 2011
SAN ANGELO, Texas — A Brownwood dentist convicted in federal court in San Angelo of defrauding Medicaid has been sentenced to 70 months in prison and ordered to pay more than $1.6 million in restitution.

James Crow, 67, was ordered by U.S. District Judge Sam Cummings to surrender to the Bureau of Prisons on or before Oct. 26. He also was ordered to pay $1,653,474 to Texas Medicaid and forfeit that amount in cash, a truck, several Harley Davidson motorcycles, a residence in Brownwood and additional real estate elsewhere in Brown County, a camper, a boat and a trailer.

Cummings also issued a finding that Crow had committed perjury during the two-week, May 2011 trial in San Angelo.

Crow was convicted on evidence that he filed claims to Medicaid for services he didn't perform and for services billed under improper billing codes. Crow billed Medicaid for resin-based fillings when the service weren't performed or services were performed that were not reimbursable under Medicaid.

The case was prosecuted by the U.S. Attorney's office in Lubbock using investigations conducted by the Texas Medicaid Fraud Control Unit and the FBI.

Obit sheds light on DeRose family tree

Grove, Jean P.
Jean P. Grove - Pueblo Chieftain - March 12, 2001 - Longtime Pueblo resident, passed away March 9, 2001. Preceded in death by husbands, Frank G. Palladino and Arthur E. Grove; sister-in-law, Veronica DeRose; and brother-in-law, Bruno DeRose. Survived by nieces and nephews, Dr. Edward J. and Neta DeRose, Sel and Vivian Elizondo, Dr. Rudy and Berni Padula, Alfred J. and Rose Schiavoni, Mary Lou Keating; and sister in-law, Jada Willard. Mrs. Grove resided in Pueblo for 50 years and was a loyal member of Sacred Heart Cathedral and St. Pius X churches. Service will be held at Sacred Heart Cathedral on March 13 at 10 a.m. The family respectfully requests the omission of food and flowers. Contributions may be made to the Fellowship of Christian Athletes, 7 Glen Eagle Court, Pueblo, CO 81001, in memory of Mrs. A.E. Grove. Interment, Roselawn Cemetery.

How to slow the child abuse, tortuous dental overtreatment and fraud

If states want to stop the influx of these substandard dental mills; if states want to end the continued overtreatment and child torture perpetrated on the poorest and most vulnerable of our citizens; if states want to cut the Medicaid fraud by same dental mills by billions; the solution may be as simple as slowing down the reimbursements.

Many think they gravitate to states with the highest reimbursement rates or those states that pay for more procedures, but that’s not always true.  If you were to ask an exec at one of the mills, you may well be told it’s actually how fast the money flows into their coffers.

Look at the states who are slow to pay; you won’t find many dental mills there.  Take Illinois for example, they are considered to be slow to pay; no Small Smiles or Kool Smiles there. 

Of course that’s just one of the factors considered, but it’s a huge one!  Other factors could be:

How quickly dentists can be credentialed
How quickly dentists can be licensed with the state dental board
Who they know and can control at the state dental associations

Just Saying….

Being lectured about wasting taxpayer dollars by a Medicaid Fraudster is off the chart ridiculous.  Just saying….

Attorney Tom Crosley Taking The Smile Center Cases–Was your child injured?

SAN ANTONIO - More than 70 parents are preparing to sue a local company of dental clinics called The Smile Center.  A News 4 WOAI Trouble Shooters investigation unleashed a flood of complaints by parents who say their children got poor dental treatment at the San Antonio clinics.  The San Antonio clinics have made millions on work paid for by Medicaid
.
Tom Crosley runs the firm that is preparing to file suit. “In the last few weeks we've been approached by the families of 60 or 70 children to investigate whether their kids were victims of unnecessary dental work, shoddy dental work, excess dental treatment," said Crosley.

The Smile Center handed out letters to potential new patients that state the allegations are gross misrepresentation of the facts. The Smile Center also claims they are saddened and shocked that we would report this story without telling their side of the story.
 
See video and further story information here

Tom Crosley, Attorney At Law
2632 Broadway St
Suite 101 South
San Antonio, TX 78215
210-354-4500, 877-535-4529
Fax: 210-244-2744
info@crosleylaw.com

The Smile Center in San Antonio, Texas Under Investigation

WOAI TV

Published: 9/07 4:05 pm

Updated: 9/08 10:04 am


The Smile Center Investigation
Posted on 09/08/2011 by bcollister
A criminal investigation is underway into a chain of dental clinics here in San Antonio that targets children on Medicaid.  This comes after I uncovered complaints of poor treatment at The Smile Center.
The Texas Attorney General now confirms it has launched criminal and civil investigations into The Smile Center.
The Attorney General’s office wants to know if the clinics defrauded Medicaid by billing for dental work that did not need to be done.  I’ve been reporting since February about complaints from parents who say the clinics did unnecessary and shoddy work on their children.
These parents were unhappy with dental work done on their children and paid with millions of your tax dollars through Medicaid.
A representative from the Attorney General’s office confirms it’s Medicaid fraud control unit has 180 bankers boxes of records taken from The Smile Center locations here in San Antonio.  The agency’s civil Medicaid department has also filed a complaint in civil court against the business. But we don’t know what’s in that complaint because it’s sealed.

Medicare fraud strike force charges 91 individuals for approximately $295 million in false billing

 

FOR IMMEDIATE RELEASE
September 7, 2011

Contact: HHS Press Office
(202) 690-6343

Medicare fraud strike force charges 91 individuals for approximately $295 million in false billing

WASHINGTON – Attorney General Eric Holder and Health and Human Services (HHS) Secretary Kathleen Sebelius announced today that a nationwide takedown by Medicare Fraud Strike Force operations in eight cities has resulted in charges against 91 defendants, including doctors, nurses, and other medical professionals, for their alleged participation in Medicare fraud schemes involving approximately $295 million in false billing. 

Attorney General Holder and Secretary Sebelius were joined in the announcement by FBI Executive Assistant Director Shawn Henry, Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division and HHS Inspector General Daniel R. Levinson.

Busy week for wasteful and abusive dentistry in the news–Corporations should be feeling the heat about now

In Rick Perry's Texas: Medicaid Is Wasting Millions -- On Braces

Sat, 09/03/2011 - 12:22am — Joe Conason

Republican presidential frontrunner Rick Perry complains constantly about Washington’s “culture of runaway spending,” wasteful government programs, and federal intrusions into the affairs of the states. In Fed Up, the book he published last year, the Texas governor bitterly criticizes Medicare (which he terms “unconstitutional”) as well as the health care reforms passed by President Obama and by Mitt Romney in Massachusetts, which he regards as infringements on freedom.

Before Perry goes after Romney and Obama on medical spending, however, perhaps he ought to try putting his own state’s government in order first. According to a new investigation by a Dallas television station, the Medicaid program in Texas – overseen by Perry – is wasting millions of dollars annually on orthodontic braces for children who may not even need them.

But the story gets worse: Texas Medicaid wasting big money on unnecessary braces due to lax regulation by the state –and those millions are going straight to for-profit clinics owned by hedge funds.

Reviewing Dallas ABC affiliate WFAA’s investigation, health care expert Trudy Lieberman explains in the Columbia Journalism Review how the teeth of poor children in Texas became a golden opportunity for wealthy investors on Wall Street. Last year, the state spent more than $184 million to provide braces for 120,000 children – many of whom apparently did not qualify for orthodontic care under the state’s own criteria, according to WFAA investigative reporter Byron Harris. That is more than twice as much as Texas spent on the same program three years ago –and the same amount as all of the other 49 states combined.

“Judging by the increased payouts,” Harris noted, “the teeth of Texas children are growing more crooked each year.”

Read complete story here

Corporate dentistry receiving a lot of press lately isn’t it?

Columbia Journalism Review:

Golden Teeth
Dallas’s WFAA shows crooked Medicaid spending on orthodontia
by Trudy Lieberman

These days it’s rare for local TV stations to produce anything resembling an expose. With their steady diet of crime, weather, and canned medical news, there just isn’t room for the hard reporting. WFAA, the ABC affiliate in Dallas, has earned a reputation as a notable exception. Throughout the summer, the station and its investigative reporter Byron Harris have taken on the Texas Medicaid agency and its spending spree for braces for poor kids.

Now there’s nothing wrong with these children getting braces. Many, no doubt, will benefit in the long run. The problem, Harris reported, is that last year the state paid more than $184 million—nearly double the amount it spent in 2008—to supply braces for 120,000 kids, some of whom may not have met the state’s criteria for orthodontic work.

Read the full article at CJR

Kids Dental Place in Phoenix Arizona–Moses’ story

On Thursday morning of August 12, 2011 I received this email.  It was sent from a frantic mom.  No one can tell the story better than she can, so his is Moses’ story. Moses was seen by Dr. Joseph Nielson.

Moses O

You are God sent!  I found your blog last night while I was googling dentist torture. I need your help and advise. 
Yesterday while I was at work my mother took my son to the dentist (Kids Dental Place on Indian School Road, Phoenix, AZ 85016) He had NINE root canals, not to mention crowns and other unnecessary work that was preformed.

 His face and lips are swollen and he is all bruised up inside and outside his mouth. He also has scratches on his arms and imprints on his arm from where they strapped him down. 
I had NO IDEA that no parents are allowed in the back or else I wouldn't have brought him there!  My mother thought she was coming in for a couple of fillings turned into NINE root canals.  I am so horrified.

Can you give me some wisdom or guidance on what to do?
I spoke to the office manager and she was basically like "who cares" and he does Nine root canals all the time, like it is no big deal!!!  This is so unacceptable, who sits and get nine root canals in one sitting?? My poor baby. 

My son also told me that they did not give him any pain medication that he as crying the whole time! And that the densest was very mean!  My son does not lie either and is a vey smart boy for his age (4).
Thanks a million!

I asked Moses’ mom if she could send me any pictures of his injuries and asked if she had gotten his charts from Kids Dental Place. 

Parents Protest in front of Dr. Edward Dove’s office

 

This exact same thing is happening to 1,000’s of children every day in the Medicaid dental mills such as Small Smiles, Kool Smiles and the like!  The less fortunate children deserve a voice too, that’s why this site is here.

I’d love to see the masses at these clinics!

Parents telling their horror stories of Dr. Edward Dove after dad creates Facebook page and Dr. Bicuspid promoted it. Thanks to everyone who helped get this out to the masses.

Reposting the stories from the facebook page, just incase they magically disappear! 

Holly Cordova
On Wednesday August 24th I took my 6 year old son to Dr. Dove's office. He drank their "kiddie martini" and 9:40 in the morning and I was told they would take him back in 30 minutes. An hour went by and I asked if they had forgotten us.

The lady informed me no they hadn't forgotten us that things had come up. Almost another hour went by and they finally took him back. He didn't seem very sedated at all anymore. They called my name 30 minutes later to get him. He was crying a lot and I could tell something was wrong.

When we started driving away we were trying to comfort him and let him know everything was ok now. He managed to choke out that Dr. Dove was mean to him.

He said every time he would cry Dr. Dove would yell at him to quit crying. Later that evening he asked my daughter at the dinner table if she wanted to know what else they do at that dental office and he said they hurt you.

Akasmse Rose Tecumseh died in August 2010, Brayden was the lucky one that day. Here is Brayden's story.

Brayden’s mom sent me this yesterday, August 30, 2011 and asked that I tell this story and help how ever I can.  With that said, here is her son’s brush with death.

Brayden

Hello my name is Ashley and I am writing in hopes that you might be able to inform your readers and possibly direct me as to where to go . You see my son Brayden was also having work done on his teeth Aug. 12,  2010 at Dr. Charles Keithline's office, Tulsa Oklahoma,  although it was not Dr. Keithline that did Brayden’s or the little girls procedure.  He was supposed to but decided last minute to go on some sort of retreat with his wife also his office manage .

Dr. Ryan Roberts, Dr. Keithline’s associate in the office performed the procedures,  There was only 2 patients they were seeing that day her and my son. I can not get that day out of my head no matter how hard I try. The little girl was already in the room having her teeth worked on but I seen her being carried out by her mother and she was soooo- limp ...... I blame myself as well because I had a nagging feeling to just cancel his appointment and go home but I thought it is his first year in school and I wouldn't want him to have to miss school better to get it over with ( I will NEVER not listen to my instincts again ).

In reference to Facebook group “Bakersfield Dentist DOES NOT ROCK!!!- Does it begin and end with the dental boards?

 

I'm finding all kinds of problems with the dental community, most of which starts with state dental boards.  They are not there to keep the public safe, they exist to protect incompetent dentists and wall street corporations.

In most states the Executive Director is NOT a dentist, nor ever has been.  Most are appointed by bureaucratic state administrations; a friend of a friend recommended them to the governor and so forth.  However those "friends" are lobbyist!  After appointment, they are seldom removed from office.

New "board members" are elected, but those member only meet once a month, sometimes less and do the business recommended by the Executive Director, who is there to draw a paycheck and little more.  People are mislead into believing dental boards administer testing for new graduates to measure their competence, that is NOT the case any longer.

I hate Dr. Dove of Bakersfield Facebook Group going viral

UPDATE:
September 1, 2011
8:00 CSTMr. Cook has started another group under a new name – Bakersfield Dentist DOES NOT ROCK!!
Was Dr. Edward Dove trained at one of the Corporate dental mills infecting the nation?
UPDATE:
September 1, 2011
6:00 AM CST
I dunno, but I’m thinkin’ this has now become a HUGE story.
It appears as of this morning Facebook decided Free Speech is NOT for them.  After 40 or more complaints about Dr. Dove of Bakersfield reciting the same issues, Facebook took down Mr. Cook’s facebook group!!
If 40 parents posted similar stories about Dr. Dove in a period of a couple of days, imagine the real number of abused patients!  Facebook should be supporting Mr. Cook, not dissuading other victims from speaking out! 
Facebook, you can take down Mr. Cook’s page but it does not change the facts.
Mr. Cook, you have my full support and so do all the other’s who are being silenced! 
Another group has started “Let’s Investigate Dr. Dover”.  You can join it here!
August 31, 2011
A very upset parent has created a facebook group.  Here is the link to the group.
This is the parent’s post:

This past Monday which was August 22nd I took my 5 year old son to have a tooth that I was told needed to be extracted. After arriving at the office my son was given a sedative by mouth in a small cup to drink. He immediately threw up at least 50% of the mixture. I was told to keep an eye on him as he might have vomited it up and it not work.
After approximately 15 minutes a nurse came to me and my son and she wanted to take him in the back for the procedure. He was not ready and he was still very alert. I told the nurse this and she informed me she was only going to be taking x-rays and would be back shortly with him.
Ten to 15 minutes later a nurse comes from the back frantically calling for me and I can now hear my son screaming my name. I rushed to the back and he was being held down by the shoulders by 3-4 nurses and I snatched him up very quickly. He had blood coming from his mouth and was wet from head to toe.

Many dental restraints for young patients are being phased out

Many dental restraints for young patients are being phased out

BY KELLIE SCHMITT, Californian staff writer
kschmitt@bakersfield.com | Monday, Aug 29 2011 08:03 PM

Last Updated Monday, Aug 29 2011 08:53 PM

As critics of a local dentist who frequently restrains his young patients grew in size and strength Monday, experts said the practice of routinely using a so-called papoose board is being phased out.

The allegations against Dr. Edward Dove center on injuries such as slaps and scratches that reportedly occurred while the children were restrained with Velcro straps, under partial sedation, and while their parents were not allowed in the room.

A representative from Dove's office said staff had been instructed not to talk to the media, and Dove did not return a call Monday. In a prior interview, Dove, whose record is free of disciplinary action, denied allegations of slapping any patients, and said he offered good care to thousands of children.

Using a papoose board and keeping parents out of the operating room aren't necessarily problematic, but pediatric dentistry experts say children should not be injured in the restraining process.

"If the kid thrusts through the whole procedure and cries vociferously, they can come out of a procedure with their face red," said Dr. Ray Stewart, executive director of the California Society of Pediatric Dentistry. "But in terms of scrapes and scratches, no. It's a violation of ethics, and the law and it clearly crosses the line."

GROWING ALLEGATIONS

Last week, Bakersfield resident Chris Cook was angry about Dove's treatment during his child's tooth extraction. He launched a Facebook site titled "I Hate Dr. Dove of Bakersfield," which has grown to more than 400 members.

Before his 5-year-old's extraction, the child threw up some of his oral sedative, Cook said. During the procedure, which Cook was not permitted to watch, his son urinated on himself. Cook alleges that his child, who was restrained with the papoose board, was not numb, and should not have been operated on.

On that Facebook page, other parents have reported similar incidents involving Dove's care. Cook has created a document on that site listing 21 people who allege mistreatment, many of whom say they're planning to report the claims to the Dental Board of California. Some members posted pictures of facial scratches they say resulted from their child's visit to Dove.

Cook, who said he's also "speechless and dumfounded" that Dove described his children's dental history to the media, organized a protest Monday in front of the dentist's Union Avenue office.

Protester Carol Webb said her daughter, then 3, needed dental work two years ago. Webb wasn't permitted in the back room but heard a "blood curdling scream." Her daughter left Dove's office hysterical, and said the dentist had "told her to hush and hit her," Webb recalled.

At the time, Webb said she called the local dental association, but wasn't aware she could report a complaint to the Dental Board of California -- something she's now planning to do.

"When I heard about this on the news, I turned to my mom and said, 'That's the dentist who hit her,'" she said. "The stories are all the same."

USING PAPOOSE BOARDS

Restraints such as papoose boards are used to reduce or eliminate movement and protect the patient, dentist and staff from injury during dental treatment, according to the American Academy of Pediatric Dentistry. The academy's guidelines caution against using such stabilization on "patients who have experienced previous physical or psychological trauma" from the device, unless there are no alternatives.

The guidelines call for informed consent before using protective stabilization such as the papoose board. That's because of "the possible aversive nature of the technique."

Dove's office manager said last week that all patients sign a consent form before a papoose board is used.

Dentists say the board can be used in emergencies, or to keep young or uncooperative children stable and immobile during the procedures, which involve sharp instruments -- as an alternative to putting them to sleep.

Before placing a child in a restraint, dentists like Dove typically give an oral sedative to children that leaves them disassociated from their environment, but still conscious with normal protective reflexes. The relaxation can cause the body to lose functions, such as control of urinating, numerous dentists say.

If a patient spits up some of that oral sedation, dentists can either reschedule the procedure or continue if they think the patient is numb enough.

When papoose boards are used, it's essential that parents understand the device and its purpose, Stewart said. In his practice, he showed a video and made sure parents knew they could explore alternatives such as taking their child to a hospital and having general anesthesia instead. Dove said last week that general anesthesia can escalate costs for his patients, some of whom require financial assistance.

Many dentists say they're increasingly putting the child to sleep and using a tube to aid in breathing. Some dentists stay away from the restraint entirely unless it's an emergency, and others, like Dr. Paul Reggiardo, no longer use it at all.

"When I was younger, and it was more commonly used, I found parents were uncomfortable with it," said Reggiardo, public policy advocate at the California Society of Pediatric Dentistry. "When the parents see their child resisting, it's hard on the parent."

Anesthesia is less invasive for children, especially if they're uncooperative, said David Rothman, a San Francisco-based pediatric dentist: "Protecting the child's psyche is the most important part of this."

PARENTS IN THE ROOM

Dove said last week that anxious parents keep him from getting his work done, which is why he doesn't allow them in the room during procedures. Nationwide, there are no official guidelines on whether parents should be present in the room during dental procedures, and it's left up to the discretion of the dentist.

Rothman says he invites parents to observe his procedures even if they have to stand in the doorway. In the rare situation where he uses a papoose board, parents are always in the room, and they help place the child in the device.

"Parents can be distracting, but you explain what's going on and most of the time they're understanding," he said.

At the University of Maryland School of Dentistry, Dr. Warren Brill tells his students that's a decision they have to make on their own. Parents aren't always a positive influence since their presence might confuse the children as to whose instructions to follow.

Still, in his personal practice, Brill says having parents in the room helps them better understand procedures and instill more trust. And, it helps to clarify any potential miscommunications.

Brill, the vice president of the American Academy of Pediatric Dentistry, said he could envision a situation where a dentist was working on a child with a sharp instrument and the child reaches up to grab his hand.

"You might push the hand away, and the child might view that as a slap," Brill said. "Children will perceive things that don't necessarily reflect reality. You have to put it in perspective. If the dentist is trying to hold the child, the child might view that as aggressive action."

But, dentists agree, there's no excuse to ever inflict violence on a child. If a procedure involving a papoose board ever escalated, Stewart said he'd stop the procedure, tell the parent it didn't work out, and suggest general anesthesia in a hospital.

In several decades of practice, he fielded a couple of complaints from parents who said their kids weren't treated well.

"You're going to run into this," he said. "But, if you have dozens stepping up and the allegations are consistent, then I'd say there is a pattern that needs to be investigated."

Why the restraints were ever there in the first place is beyond me!!

I’m guessing Dr. Warren Brill must disagree with this illustrious colleague, Dr. Steven Adair, former editor-in-chief and trustee at the AAPD and Chief Dental Officer at Small Smiles, one of the largest papoose board purchaser in the US.

Feds to investigate Medicaid orthodontics fraud in Texas

 by BYRON HARRIS
Bio | Email
WFAA
Posted on August 25, 2011 at 10:37 PM
Updated Thursday, Aug 25 at 10:37 PM

NEWS 8 INVESTIGATES

For the past six months, News 8 investigations have revealed hundreds of millions of dollars of questionable Medicaid spending on braces for children in Texas.

Now federal investigators are auditing the Texas Health and Human Services Commission, which controls those funds. Taking the lead in the audit is the Office of Inspector General of the U.S. Department of Health and Human Services.

In a letter to the state, the inspector general says it will examine the "authorization process for orthodontic treatment" under Texas Medicaid. "The objective of our audit," the letter continues, "is to review the State's controls to ensure that only medically necessary orthodontic cases are paid." The time period covered by the audit is September 1, 2008 through May 28, 2011.

ReachOut Mobile Dental Michigan Locations

Cha Ching

Texas State Dental Board says it can’t stop the dental abuse and Medicaid fraud until someone complains, well someone complain already! Here’s help.

Texas State Board of Dental Examiners
Texas Dental Board Complaint Process
Texas Dental Laws, Rules and Regulations

Complaints:   complaints@tsbde.texas.gov
E-mailing the Board:
Indicate the intent of your communication in the subject and body of your email. This will help prevent our Security System from flagging your email as possible spam and deleting it.

Ms. Abigail Gutierrez, Administrative Assistant
Phone: (512) 475-2019
Fax: (512) 463-7452
Ms. Erica Bommarito, Administrative Assistant Phone: (512) 475-1996
Fax: (512) 463-7452
Ms. Jennifer Carriker, Compliance Officer, Administrative Assistant Phone: (512) 305-8991
Fax: (512) 463-7452
Ms. Gutierrez, Ms. Bommarito and Ms. Carriker can assist with:
          Contacting the Director of Enforcement
         How to file a compliant or check on the status of an on-going complaint           Information about a Closed or Dismissed Case
          Board Order Compliance
              (For Conditional Dismissal Compliance - Ms. Debbie Powell, Legal Assistant - (512) 475-0982)
Other Agency divisions and contact information

Texas State Dental Board Information:
Phone:  (512) 463-6400      (8am - 5pm, Monday - Friday, Except Holidays)Main Fax:  (512) 463-7452
Open Records Fax:  (512) 532-0637Open Records Requests: openrecords@tsbde.texas.gov

Mailing Address:

Texas State Board of Dental Examiners
333 Guadalupe, Tower 3, Suite 800
Austin, Texas 78701-3942

File a Consumer Complaint with Texas Attorney General here

File a Medicaid fraud complaint with Texas here
Report the fraud, reap the benefits-share in a portion of the recovery here.
Write your state lawmaker here
File a complaint with your local District Attorney or County Attorney, you can find them in the phone book.
Don’t forget to follow up all complaints with further letters and phone calls. 

American Dental Partners, Inc and Tooth Doctor for Kids Spreading from Arizona to Texas

Another dental mill is opening more Texas dental clinics since it appears the Texas State Dental Board of Examiners has opened the doors to the illegal practice of dentistry by corporations and dental Medicaid fraud.  Yes, Texas is open for business indeed, Mr. Perry. 

A Tooth Doctor for Kids/Braces For Less with 5 locations in Arizona and 7 locations in and around Houston and 2 locations in San Antonio Texas is coming to the Dallas/Ft. Worth area. 
With 9 locations already at work in Texas, Tooth Doctor for Kids has six more locations scheduled to open between August 2011 and late fall 2011, as seen here on their website.
Their website says they offer; Dental checkups, Cleanings, and x-rays; Dental Fillings and Crowns; Sedation; Sealants; Fluoride Treatment; Space Maintainers.
What is hard to find on their website is the name of the dentists treating the children and if those dentists are general dentists or pediatric dentists.  Website design and clinic décor is the main misleading marketing to parents, implying the dentists spent an extra 2 years of dental school to become pedodontists when they did not.

CSHM–Small Smiles Dental Centers are among exclusive group of 19 under a “Quality of Care” Corporate Integrity Agreement with US government

There are 346 Corporate Integrity Agreements individuals and corporations have signed with the Office of Inspector General (OIG).  Out of those 346 only 19 have the distinguished designation as being “Quality of Care Corporate Integrity Agreements”.  Church Street Health Management (f/k/a FORBA)  is among the exclusive bunch.

According to the OIG Quality of Care CIA’s:

Small Smiles and Corporate Practice of Medicine

Cashing In by Cashing Out

Texas Board Dental of Examiners allows non US residents to scam taxpayers out of $22 million dollars. Cheap labor from across the boarder helps make the Navarro brothers two of the wealthiest Orthodontists in the US. Texas Dental Board refused to answer these questionable practices.

by BYRON HARRIS
Bio | Email

WFAA
Posted on August 18, 2011 at 10:00 PM
Updated today at 3:16 PM

DALLAS - Many parents know it can cost as much as $5,000 to put braces on a child's teeth. Despite the high cost, it's a financial sacrifice some families make for a child's appearance.

Rarely are braces a health issue. But, while some families struggle to pay for braces, under Medicaid in Texas, tens of thousands of children get braces for free.

Last year, Texas spent $184 million on braces under Medicaid. And while Texas spent as much as the rest of the nation combined, some states, like Michigan and Kansas, spent zero.

Penny v. OrthAlliance, Jordan v. OrthAlliance & Glower v OrthAlliance- Corporate Dentistry Ruled Illegal

 

From Hospital and Health Systems Group – June 2008

One example of provider relations going horribly wrong is the OrthAlliance experience. OrthAlliance is an orthodontic practice management company that follows a model common in the industry: the company first purchases the assets and leaseholds held by individual orthodontists or professional orthodontic corporations; then it enters into an agreement with the orthodontist or practice to
provide comprehensive practice management services; and finally, the practice
management company employs the orthodontist’s existing nonprofessional staff. It appears, however, that the arrangements were not as financially successful as several of OrthAlliance’s orthodontists had hoped, and the relationships between OrthAlliance and many of those providers eventually broke down. By 2001, approximatelyfifty-six OrthAlliance-affiliated practitioners and/or  their professional corporations had filed lawsuits in eleven states.

 

2003 Penny v OrthAlliance
Corporate Dentistry Ruled Illegal

From Orthalliance 10-k Annual Report

On March 26, 2003, the U.S. District Court for the Northern District of Texas, in ruling on the plaintiffs’ motion for summary judgment in a case captioned Penny v. OrthAlliance, Inc. , held that, when construed together, the purchase agreements and service agreements between the plaintiffs and OrthAlliance and the employment agreements between the individual plaintiffs and their practices violated Texas statutes prohibiting the unauthorized practice of dentistry and were therefore invalid. In the court’s view, the interrelationship among these agreements allowed OrthAlliance to own, maintain or operate an office or place of business in which it employs or engages the plaintiffs to practice dentistry, in violation of Texas law. In reaching its conclusion, the court noted that OrthAlliance leases or owns and maintains the office space and tangible assets used in the plaintiffs’ practices and provides comprehensive practice

Terms of Avoidance

 

Essentially

Basically

Associated

Check the Senators Cardin’s campaign contributions!

Yes, average wait time is 7 minutes!  Yes, 100% approval rating.  Since the asked two people, whom they probably paid!!! 

Senator, you may be a fine man, you may be a smart man.  But no one would know by listening to what you are saying today.

What are you going to say when this company ends up under Federal investigation like Small Smiles?  Will you tell us how great the place is then?  Did you even check to see if they were being investigated before stepping up to that podium? 

Since you want to take credit for this house of horrors, are you going to take the blame as well? 

Maybe we should send all the complaints to your office!!

See: Hey Senator Ben Cardin

Hey Senator Ben Cardin–WAKE UP!

•  

Senator Cardin’s boastful public statement from August 18, 2011. 

Maryland Ranks First In Providing Child Dental Care
Armando Trull

August 18, 2011 - Four years ago, 12-year-old Diamonte Driver from Prince George's County died from a brain infection created by an abscessed tooth because his mother was unable to get him adequate dental care. This death spurred Maryland to address this inadequacy, and now, things in the state are vastly different.

Maryland was ranked first in providing dental care for children in a recent Pew Center study.

Another dentist charged with possession of child porn

White Plains NY

August 12, 2011

A former Mount Kisco resident and Greenburgh dentist is accused of possessing child pornography.

Dr. Henry Webster, of Greenburgh-basedWebster Dental Group (Scarsdale P.O.), was arraigned in Mount Kisco Justice Court on Thursday because he lived in the village when the alleged offense took place, according to DA spokesman Lucian Chalfen.

Now a resident upstate in Elizabethtown, NY, Webster was released on $5,000 bail, the Westchester County District Attorney's office announced.

Webster, 56, was charged with one felony count of child pornography possession (the official term is "Possessing an Obscene Sexual Performance by a Child").

The DA's office announced that it received an external hard drive belonging to Webster on May 6 of this year. After an investigation, the DA office claims, images of children under 16 years old were found. The DA's office also claims that Webster was interviewed on July 22 and admitted to downloading and storing the images.

Webster could not be reached for comment. His next court date is Aug. 25.

Link is here

Mechanicsville, Virginia Kool Smiles still receiving complaints about lies, fraud, root canals, and stainless steel crowns; It’s 2011 folks! Is anyone listening to the people? Apparently not!!!!

I took this pictures in the summer of 2008, 6 months after I began hearing of these dental mills abusing children.

This is the Kool Smiles in Mechanicsville, VA.  Located in a strip mall on Mechanicsville Pike.

Appears they are still using the same ole tactics; make mom feel guilty.  This disgusting!!!

 

 

To see all the reports on Kool Smiles click here

What should mom do?

Below is an email from the mom of the child who had 9 root canals done on Thursday at Kids Dental Place in Phoenix. Now what? The child is sick and traumatized.

Tuesday August 16, 2011

Hi Deb,
My son is not doing good he now has a fever of 102 since 6:30am.

My mother and I took him to the Phoenix Children's Hospital ER department and they did not do anything.

They wanted to strap him down to look in his mouth & I refused. I explained what happened to him & they could not careless.

I do not know what is going on with these doctors! This is horrible. The doctor just refused to help & so we left!

He said there is nothing he can do since my son won't open his mouth. I am so frustrated you have no idea! The doctor literally walked out on me & told me to go back to the dentist! Who the heck does that?!?!

K

UPDATE. 8:00 CST
August 16,2011

Deb
I just got out of his pediatrician office all he did was look in his mouth & see the inflammation & drooling and he already knew. He even called the hospital and asked what happened & gave them a piece of his mind!

He said those young residents don't know what they are doing & should never put a child thru that! His fever was 104!!!

He prescribed him antibiotics for the infection. Let's hope that helps. If not he might need an IV. I feel so helpless again!

Thank you for ur kind words & all ur helo u are such a life saver I don't know what I would do if I never found ur blog!
K

Kids Dental Place under fire by upset mom after child received 9 root canals–Here is info on Kids Dental Place

Kids Dental Place – Kids Dental Place is a trade name for NBA Dental Group P.C. with offices in Phoenix, Glendale, and Mesa Arizona.

NBA Dental Group
d/b/a Kids Dental Place
3910 E. Equestrian T1
Phoenix, AZ 85044
714-651-6719
kidsdentalplace07@yahoo.com

The address on NBA Dental Group belongs to:

George R. and Aramouni Ayoub
3910 E. Equestrian T1
Phoenix, AZ  85044
Valuation - $349,000
The dentists’ bios mention their “passion” and “interest” in treating pediatric patients, one dentist has a father who treated children. However, only one dentist in the group is an actual Pediatric Dentist. I have to ask if they are/were so passionate why only one spent the extra 2 years of training to become a pediatric dentist?
Dr. Amy Heil
Dr. Walter Villanueva – pediatric dentist
Dr. Wissam Ayoub (George) (Manta website says this dude is the Principal of the business)
Dr,. Joseph Nielson
Dr. Jay Ayass

Comment from a Small Smiles patient

I went here and I'm 16, this dumb old whore kept making me bleed all over the place and when i jerked she would say shit like "dont move , maybe if you cleaned more often this wouldnt happen" umm bitch maybe i should stab you in your fuckin gums and see if you dont jerk your damn self.... its pititful and on top of that they did all the wrong shit to my teeth and now im paying for it

Orthodontic treatment increased nearly 50%. Why? Marketing?

From the Wall Street Journal- November 16, 2010
by  Nancy Keates at nancy.keates@wsj.com

The number of children 17 and younger getting orthodontic treatment has grown 46% over the past decade to 3.8 million in 2008,... figure available from the American Association of Orthodontists

The association doesn't break the number down further by age, but Lee W. Graber, the Association's president, estimates that in his own practice 15% to 20% of the 7- to 10-year-olds he sees get treatment.

"Fifteen years ago we rarely saw kids until they were teenagers," Dr. Graber says...

In the U.S., the shift to earlier treatment dates back to around 1990, the year the orthodontists association began encouraging the screening of 7-year-olds, with magazine ads and videos aimed at parents. Better diagnostic technology also has led to more early treatment. Increased insurance coverage has played a role, too...

[ Basically saying a market was created to rake in the dough?  Shocking! 
Question: Who created the market?  Answer: The American Association of Orthodontists. 
Question: Who convinced insurance companies to increase their coverage?  Answer: The AAO?  Question: How did they convince insurance companies to start picking up more of the tab? Answer: False or misleading information, junk science? 
Same questions to go out to Medicaid. ]

Dentist trades drugs for sex

I’m not really sure who is the most disgusting, the dentist or the women.  Geez.

Boston Herald
August 12, 2011
Larue J. Sweet
A disgraced dentist who “lost everything” because he overprescribed prescription painkillers and anxiety medication to at least nine female patients in exchange for fondling their breasts and slapping their bottoms avoided prison but drew six months on house arrest at his sentencing yesterday.

“I left my staffers suddenly unemployed. I left my patients without care. My children are in counseling because of my actions. My grandchildren are embarrassed and have distanced themselves from me. I have lost everything,” Dr. Steven Miller, 69, of Wareham yesterday told U.S. District Court Judge George A. O’Toole Jr. in a breaking voice.

 

Read full story here

Arizona–New laws go into effect July 20, 2011

Business Entities (ARS 32-1213(N))
The following language was added to Business Entities. No individual currently holding a surrendered or revoked license to practice dentistry or dental hygiene in any state or jurisdiction in the United States may have a majority ownership interest in the business entity registered pursuant to this subsection. Revocation and surrender of licensure shall be limited to disciplinary actions resulting in loss of license or surrender of license instead of disciplinary action.

Investigation/Complaints (Arizona Revised Statutes (ARS) 32-1263.02)
Investigative Interviews have been eliminated. All cases will be investigated through the chief investigator or an outside dental consultant. The Board will review the summaries of the investigations and if it appears that the licensee engaged in unprofessional conduct the dentist may be invited to attend a formal interview before the Board. Additionally, the Board may resolve more cases through consent agreements.

Powers and duties; executive director; immunity; fees; definition (ARS 32-1207(C))
Language was added to allow the Executive Director or the Executive Director’s Designee to issue and renew licenses, certificates and permits to applicants who meet the requirements; initiate an investigation if evidence appears to demonstrate a licensee may be engaged in unprofessional conduct or unable to safely practice; initiate an investigation if evidence appears to demonstrate that a business entity may be engaged in unethical conduct; subject to Board approval, enter into a consent agreement with a licensee if there is evidence of unprofessional conduct; and subject to Board approval, enter into a consent agreement with a business entity if there is evidence of unethical conduct.

To read all the new changes, click here

Cashing In by Cashing Out–Small Smiles and the Corporate Practice of Medicine

Listen up!  If you currently work for a dental mill in any capacity this is a must read for you.  If you work for a “chain” dental clinic, it’s for you too.   It lays it all out for the “fake” owners and exactly what can and may happen if you continue to cooperate filling the coffers of Private Equity firms, like Arcapita and FFL.

Excerpt:     

…Children are strapped down to a papoose board to eliminate the time it takes to calm and reassure them before a procedure. Parents are banned from the clinic rooms because they might want to slow the procedure if their child is fearful or in obvious discomfort.

     Unnecessary procedures are performed because the corporation gets paid by Medicaid for every procedure performed, not just the necessary ones. And children get rushed, inadequate, and botched dental work because it’s faster than taking the time to do each procedure properly.

      As the blurred face of the stricken ex-Small Smiles dental assistant explains, it’s all about “production, production, production.” It’s a good mantra for a widget factory. It’s a torture sentence in a dental clinic.

      How are such practices permitted in this day and age? The simple answer is they aren’t –and haven’t been for over a hundred years. Unfortunately, the laws that prevent such practices aren’t systematically enforced, and private equity firms with desires for outsized profits are taking advantage of that fact. They’ve discovered a veritable gold mine in the systematic bilking of Medicaid for their corrupted brand of dental “care”. By inflating the profit margins of these clinics with shoddy and abusive practices, private equity firms can sell the business at an extraordinary profit, with the only fallout being traumatized children who are often too poor to seek recourse – or know that any is due to them…

Click here to read the rest of this brilliant piece!

Dentists Warn of Risks Associated with Sports Drinks

Yes, Church Street Health Management has found a new subject matter to comment on, in order to get press I suppose.

Dentists Warn of Risks Associated with Sports Drinks

1.  One of the founders of the Small Smiles Dental Centers was instrumental in  putting soft drink machines in our schools.  Dan DeRose

2.  Since Church Street Health Management and their illegal Small Smiles Dental Centers target the “underserved” (preferably Medicaid children under 10)I doubt those same individuals are heavy into sports drinks.

“As children of all ages engage in outdoor activities during the summer, there is a growing tendency toward the consumption of sports and energy drinks instead of water,” said Dr. Steven Adair, Chief Dental Officer of Church Street Health Management, which manages more than 70 dental centers for low-income families in 22 states.

Choking on the above statement-They illegally own and operate, not manage, 73 clinics in 22 states and the District of Columbia.  It appears CSHM will do what they can to put their “two cents” out there on a subject matter, press is press I suppose.  :

 “Cashing In by Cashing Out" – It’s a must read!!!

Church Street Health Management’s New Members for 2011

Church Street Health Management finally filed their annual report July 17, 2011 with the Kentucky Secretary of State.

Noticeable changes are the “Managers”,  A Carlyle Group member finally emerges from the shadows.

Two family homes; each profit from taxpayer dollars-Medicaid.

When it comes to discussion of these illegal dental mills, I get so dang sick of all the remarks about “Medicaid moms” and blaming them for the pure existence of these disgusting places.

I have a question for you.

Which one of these homes leave the worst taste in your mouth?  They both live off your tax dollar.

 

Carlyle Group’s Susan Kasser, board member of Shari’s Management Corporation, joins the board of Church Street Health Management/Small Smiles Dental Centers

Kasser has been with the Caryle Group since 2004, prior to that she was at Goldman Sachs, surprise  surprise.

Here is her profile from the Carlyle Group website:
Susan Kasser is a Principal with Carlyle Mezzanine Partners, focusing on junior debt investments in support of leveraged buyouts, growth capital, and recapitalizations, primarily in North America and Europe.  Ms. Kasser is based in New York.

Since joining Carlyle in 2004, Ms. Kasser has been actively involved in current portfolio companies American Achievement Corporation, BioReliance Corporation, Church Street Health Management, Hudson Products Corporation, INC Research and Shari’s Restaurant Group.  Ms. Kasser was also actively involved in the investments in Applied Systems Inc, Sanitors, Inc, and US Investigations Services, which have been fully realized.

1-800-Dentist Patient Shopping for Kool Smiles? Sounds like it.

These criminal are so brazen.

Group Practice Leaders Accelerate Growth with Marketing Expertise From 1-800-DENTIST®

1-800-DENTIST’s Dental Marketing Summit will be held on July 18th & 19th at 1-800-DENTIST’s headquarters with two of the nation’s leading group dental practices, Midwest Dental and Kool Smiles.

Los Angeles, CA (PRWEB) July 12, 2011

Two of the nation’s leading group dental practices, Midwest Dental and Kool Smiles, will share proven marketing strategies that increase production and profitability at 1-800-DENTIST’s Dental Marketing Summit. The summit will be held on July 18th & 19th at 1-800-DENTIST’s Los Angeles headquarters.

The Dental Marketing Summit features key industry experts with 50+ years of combined experience in marketing: Fred Joyal, Co-Founder of 1-800-DENTIST®, Gregg Coccari, CEO of 1-800-DENTIST®, and including Ralf Tomandl, 1-800-DENTIST’s Director of Business Development.

Small Smiles Holding Company, LLC -Directors, Executives and Members

 Morning. 

I've always wondered the names of the people who are hiding behind the "Mother Ship" of the Small Smiles Dental Centers and Church Street Heath Management.  Last week I was poked to dig deeper.  I was more curious than ever to find the names of those people who hide behind 100 or more corporations, public service companies, and limited liability companies. So I decided to send off for some information.

By looking at the names on this list it appears Small Smiles Holding Company, LLC is a mashup of every health "service" that bills Medicaid rooted in Nashville,Tennessee including, Ameris Health System, LLC; Children's Comprehensive Services (CCS);  the old Pricor; Corrections Medical Management; Ccs/Gulf Pines; Keystone Youth and Education; Ccs/Altacare  and more. Also the same bunch at Ameris Aviattion; Ameris Realty of Flordia, LLC;  Maderia Bay Marina, LLC; and Maderia Bay South, LLC.

Honestly, by the time I got to page 3 I expected to see my own name on the list.  (Just kidding)

Top 5 Ways Small Smiles Dental Centers has violated their Corporate Integrity Agreement

I knew they would disregard each and every word of the Corporate Integrity Agreement.  I said so right here, the very day it was announced.  As for the $24 million paid to the Federal government, and just over $2 million to the state of New York, to them it was going to be nothing more than the cost of doing business.  Pay to play-simply another business expense.  Hey, do they get to deduct that from their income tax return?

The current CSHM crew took over the operation of the Small Smiles dental clinics after they purchased all of them in the fall of 2006-actually they hired the old bunch to do it for a while. 

The arrogance shined like a beacon from the start. The investigation by the Justice Department started in the fall of 2007, just about the time Alberto Gonzales resigned.  All the while, thumbing their very long-and continually growing-nose directly at the entire United States Department of Justice, the US Attorney General and about 23 state Attorneys General and the public at large. No settlement was announced and signed until January 2010.   During which time, they didn’t slow down, skip a beat, miss a step-or any other idiom you want to use.  The child abuse and Medicaid fraud continued-business as usual. 
I originally planned to take all 65+ of the Corporate Integrity Agreement (CIA) that Church Street Health Management (CSHM)- formerly FORBA – signed in January 2010 and mark all the ways, I knew for sure, CSHM had violated said agreement.
I had not got past Section III before I was overwhelmed. No, that’s not right, I was pissed off! Why? Because of the continued arrogance.
So I decided to pick out my top five
1.  Continue with bonus program that is based on “production” or in CSHM speak, “Collections”  To this day, everyone gets bonus if they meet “collections” goals, and it gets bigger if they meet set intervals, no max they can make.  See below.  BTW the Lead Dentist gets 12.5 times the said amount.  Lead Dental Assistant gets 1.5 times set amount.

2.  They are not supposed to base any compensation that would create an atmosphere for overtreatment and fraud, i.e. no % based pay.  Well, continuing with the bonus program didn’t thumb their nose to the CIA enough, no, they created a whole new contract for new and current dentists called “Collection Based Compensation”.   It’s all set out in a 30+ page contract that most CPA’s can’t figure out.
3.  Compliance Officer is not supposed to be the Chief Financial Officer – so they put the SVP of Financial Operations, Lorri Steiner in that position.  No, she’s not the CFO, but c’mon!
4. Appoint Compliance Liaisons at each center who are not afraid to report compliance breach to the board of directors, the compliance officer or anyone else.  So, what dose CSHM do, they make the Compliance Liaison the Office Manager!  Guess who gets a nice size bonus if all things go well at the center and they make their production goals, yep, the Office Manager!!!

5.  Hire an Independent Monitor to “monitor” their misbehaving.  So what does CSHM do, they have amazing made sure that N. Sue Seale, DDS, a great buddy and colleague of their Chief Financial Officer, Steven Adair, is the “pediatric dental professional” to check in on things with the Independent Monitor.   Reports to me are Sue and Steven come to some of the centers together and are quite cozy!
There you have it, my top five.  Well, the top five I picked out in the first few pages of the CIA anyway. 

Dental Care At Wal-Mart ? Coming soon!

 

 

Boston reporter investigates disciplined

The Boston Channel-See the video report here 
May 25, 2011
BOSTON -- A Team 5 investigation is raising questions about the state board in charge of disciplining dentists in Massachusetts. NewsCenter 5’s Sean Kelly reported Wednesday how difficult it is for the average patient to find out the details of why their dentist was disciplined.

“I just felt helpless,” said Sarah, a patient who admits she should have done research on her dentist first.

“I was livid, beyond furious,” said Sandra, another patient who was unsatisfied with her treatment and left her dentist’s chair complaining. She said she didn’t do research either, selecting her dentist from the phone book.

Sole Practitioner v. Corporate Dentistry

Calling a Spade a Spade! It’s amazing how few want to refer to the dental chain by what they really are-corporations practicing dentistry!  Instead they are referred to as “large dental practice groups”.  Huh? 

 

September 1, 2009
by Thomas A. Climo, PhD

For more on this topic, go to www.dentaleconomics.com and search using the following key words: dental practice management company, dental service delivery, Thomas Climo.

The American Dental Association has published an annual “Survey of Dental Practice” since the 1950s. Not until the ADA's forthcoming 2009 publication “Survey of Large Dental Group Practices” will any alternative to a sole practitioner office have been subjected to ADA review.

---

In some respect, the ADA can be forgiven this oversight. After all, as of 2006, dentists using their dental degree in some fashion other than as an active private practitioner in the United States comprised only 8% of the dental population. It sounds comprehensive to account for 92% of the means for delivering dental services in the United States.

It is for that reason the forthcoming 2009 publication takes on greater significance. There must be a movement afoot, a trend if you will, that has led the ADA to consider an alternative to the usual means of delivering dental services, and that this alternative must be making the industry stand up and take notice.

This report will canvass the current market conditions of the dental service industry, highlighting why the sole practitioner office is now meeting a challenge from larger group, centralized managed dental centers.

• Sole practitioner office

It is extremely capital intensive to open a dental practice, and operating costs are high. If there is only 25% to 35% of revenues left to reward the sole practitioner from distributions ($18,000 per month) while holding working capital constant at $40,000 to $60,000, plus holding back a suitable 5% to 7% reserve for depreciation and replacement of old equipment with new, the sole practitioner is generating a little under $600,000 of revenue without showing much of a profit.

[Distributions to himself/herself in the form of salary cannot be considered “profit,” otherwise the sole practitioner is working for nothing. Distributions beyond salary would be considered “profit,” but, at $600,000 per annum of revenues, the typical sole practitioner office won't have a lot of that to go around, possibly enough to reward himself/herself and staff a modest holiday bonus.]

And don't think we are being conservative in this projection of sole practitioner revenue. For a dentist in a private practice, the ADA 2002 Survey of Dental Practice estimates adjusted net income of $183,050, practice expense of $295,890, and a total nominal income of $532,850. Let's lay this out and see what is left:

Total Nominal Income $ 532,850
Less Practice Expense $ 295,890 Total Disbursable Income $ 236,960
Less Owner Salary $ 183,050 Net Disbursable Income $ 53,910

Put $10,000 of the net disbursable income into topping off the working capital, set aside another $35,000 for capital replacement reserves (at 7%), and the sole practitioner has a whopping eight or nine grand to share with himself/herself and staff associates for a holiday bonus. Shake out these numbers any way you like, and you cannot turn around the salient fact that far too much capital goes into generating too little revenue for the sole practitioner dental office to be considered anything other than a means of income for the dentist.

At a 1.1% return on capital investment (of $500,000), the sole practitioner office is not set, nor framed to become, an investment vehicle that performs favorably when judged against other endeavors with similar capital costs that either drive down operating expenses or increase revenue in order to be competitive in their respective markets.

The sole practitioner dental office is a professional business with an outstanding record of debt servicing, but also one with an abysmally low return on capital investment. If it were up to an outside Board to determine how much to invest in a dental practice when judged against other available endeavors, capital to dentistry would go wanting. For that reason, dentists buy and sell from fellow dentists, and the merry–go–round of high capital and high operating costs with low margin of returns continues.

• Larger dental group practices

When faced with the kind of circumstances and results from above for any kind of business in any kind of industry, economists counsel the quick and immediate adoption of a competing business model rather than one of convenience for the practicing professional.

If capital costs are high, develop a scenario that reduces capital costs. If operating costs are high, develop a management model that reduces these costs. If profit margins are low, while keeping operating costs low, develop a marketing program that will increase revenues.

This is the business model behind larger dental group practices, or what is now being referred to as Dental Practice Management Companies. They are the new subject matter of the upcoming study from the ADA.

If raising $500,000 of capital that the sole practitioner would otherwise seek from the local bank competes with other investments, it might make more sense to combine general and specialty services and raise (instead) $2.5 million spread over both general and specialty practices. This is kind of a five–offices–in–one, economies of scale approach to dental practice.

In so doing, the operating costs of one practice are basically spread over five. Capital costs are shared between practitioners, and referrals from general dentist to specialist no longer take patient revenue away from the practice. Toss into this mix the allocation of accounting, other administrative tasks, marketing to a centralized management company, and staffing to accommodate up to 10 dental centers, and you've created a model that has systematically addressed high operating costs while spreading capital costs over a larger revenue base.

The return on capital moves from a low to a high margin basis. You might not be able to raise outside capital with a 1.1% return on investment, thereby limiting your options to a local bank, but you certainly can raise outside capital when you can show a 20% to 40% return on investment.

Repeating the Net Disbursable Income table we produced for the sole practitioner office, let's recast the ADA numbers as they might look for a large practice management dental center:

Total Nominal Income $ 4,000,000
Less Practice Expense $ 2,000,000
Total Disbursable Income $ 2,000,000
Less Professional Salaries $ 1,200,000
Net Disbursable Income $ 800,000

Whereas we used $500,000 as the capital base for the sole practitioner, in the larger dental practice management center we assume a capital base eight times this, or $4 million. It will include, in addition to top–of–the–line office and dental appurtenances, a suitably large budget for front–end management programs, and a sizable marketing campaign.

Indeed, in a dental practice management start–up, it is not unreasonable to spend $250,000 for installing and assuring sound management, and $750,000 for marketing. Even with this, the return on capital investment is 20%. This return will grow as the managerial and marketing investments are spread over more than one year.

The larger dental practice management center shows a drastically different result from the pittance left over for disbursement in the sole practitioner office.

The significantly improved size of the leftover net disbursable income confirms and substantiates the installation of a modern business model that basically remedies the weaknesses of the sole practitioner model. Although capital costs have grown in the larger dental practice management center, they have fallen with respect to each dental practitioner as well as with respect to revenue earned. Revenues have increased due to the increase in the size of the practice.

Combined, this means that for every dollar earned, the practice keeps more of it in a disbursable form. The ratio of operating costs to revenue has fallen from the sole practitioner's 65% to 75% to be more in the 50% to 55% range. The mission of reducing operating costs as they compare to capital costs and revenue has been accomplished. This will feed into a positive, healthy, and competitive return on capital. The return for our hypothetical large practice management dental center is almost 20 times greater than the hypothetical one demonstrated by the ADA for the sole practitioner.

The commotion surrounding the rise of a new dental service to the dental consumer has been solved. It goes by the name of capital and operating cost efficiency, and can be coupled with the advantage that marketing has for the larger practice management dental center. Competition is driven on many levels, but contrasting top–of–the–line dental offices with the compromised budget of a sole practitioner tells anyone aware of economics that a new form of delivery for dental services has arrived and will become the mainstream within five to 10 years.

The dominance of the sole practitioner circa 1919 to 2009 will give way to the era of the larger dental practice management company beginning in 2010. The ADA, in its forthcoming publication is wise for getting itself on track and ready to embrace this change.

• Capital markets

If there is truth to the inevitability of the takeover of large practice management companies in the future, then we would expect this to have evidence in the markets which provide funding to competitive endeavors. This leads to how large dental practice management companies are perceived by the two major forms of capital acquisition, private equity and public capital markets.

• Private equity market

The Committee on the Global Financial System in a July 2008 working paper, titled “Private Equity and Leveraged Finance Markets,” accurately describes the emergence and importance of private equity:

“Private equity, which was relatively unknown in the early 1980s, has become an important asset class in global financial markets. Private sector estimates indicate that, as of 2006, there were 2,700 private equity funds, which accounted for 25% of global mergers and acquisition activity, 50% of leveraged loan volume, and 33% of the high–yield bond market. These statistics demonstrate the close links between private equity and leveraged finance markets. A rationale for private equity transactions is better alignment of shareholder and management interests and improvement of the operational efficiency of firms. Private equity firms attempt to achieve this through a number of measures, including higher leverage and greater incentives for management through significant pay–for–performance packages.”

In other words, private investors who are represented by private equity firms are saying if it is money you want, provided you can give us the kind of performance package we require, then it is money we have.

Large dental practice management companies have put their hat in the private equity ring, as it were, and have found an accepting and willing avenue for funding their operations both as start–up or growing those operations through acquisition.

Here's an abridged list of current successful transactions:

• Thoma Cressey Bravo Leads Recapitalization of Midwest Dental Holding Company
• American Capital Invests in Dental Practice Management Company
• RBC Centura Advises on Recapitalization of Dental Management Company: Investment Banking Group Offers Expertise in Healthcare Field
• King & Spalding Represented Arcapita Inc. in its acquisition of FORBA, LLC, a dental practice management company, for $435 million
• Freeman Spogli Acquires a Majority Interest in Bright Now! Dental, Inc.

• Public market

There have been no major inroads to date of dental practice management companies in the NYSE or NASDAQ. Public ownership is highly unusual for the medical or dental world. The data that we do have comes from a spurt of companies that went public in the 1990s but expanded too quickly, burdening themselves with debt that drove them into bankruptcy or into the arms of private equity buyers.

The sensitivity of dental practice management companies to market, and their corresponding decline in share prices that fall in line with market forces, is not an attractive forum for investment. Private equity appears to be the more common and superior form of investment for dental practice management companies.

Thomas A. Climo, PhD, is a former professor of accounting and finance at the University of Kent at Canterbury, England. He is currently assisting in the financial structuring for a large dental practice management group. He is also an expert witness in Las Vegas, Nev. E–mail him at thomas.a.climo@cox.net.

Source:

Dental Economics