Grassley investigates allegations against dental clinics

For Immediate Release

Wednesday, June 27, 2012

Grassley investigates allegations against dental clinics

WASHINGTON – Senator Chuck Grassley is scrutinizing Medicaid-funded dental clinics in response to allegations of abusive treatment of children in clinics controlled by corporate investors rather than dentists.

“We’re finding that these dental practices, under pressure from owners who are not licensed dentists, have been providing services with the highest Medicaid reimbursement levels more often than less expensive, arguably more appropriate services,” Grassley said.  “There are legitimate concerns that children are receiving unnecessary care, sometimes in a traumatic way, and taxpayers are paying for it.”

Grassley has asked questions about ownership structures, incentives, parental notification policies, and participation in Medicaid from Small Smiles, Kool Smiles, and ReachOut Healthcare America.  The companies have been responsive to his inquiries, he said.  All three treat Medicaid children almost exclusively.

“We’re finding that the business model has led to abuses because dentists are under pressure to perform as many high reimbursement services on the maximum number of children on Medicaid as possible,” Grassley said.  “You have dentists under pressure to perform more services than may be necessary – giving a child a crown instead of a filling, for example – because of a bonus payment structure that creates the wrong incentives.”

The issue involves an investment structure that technically meets some state-level requirements that dental practices be dentist-owned but do not, in practice, have dentists in control.  These “owner dentists” are effectively ghost owners who maintain none of the traditional aspects of ownership of their operations, allowing the corporate investors to have control over clinical operations.

A majority of states and the District of Columbia have laws that require owners of a dental practice to be licensed in the state where the practice is located.

Last year, Church Street Health Management owned 70 Small Smiles dental clinics in 22 states and the District of Columbia.  At least five of these clinics have been closed by state regulators.  NCDR, LLC owned more than 130 Kool Smiles clinics in 16 states and the District of Columbia.  ReachOut Health Care America operates mobile clinics that treat children at schools around the country.

Grassley’s review of allegations about dental clinics also has led to Aspen Dental Management, Inc., which doesn’t accept Medicaid patients.  Questions there have been about complaints that the company promotes unnecessary treatment plans with exorbitantly expensive credit arrangements.  Aspen Dental Management, Inc. operates more than 300 clinics in 22 states.

            Grassley said he expects to issue a staff report on his findings involving the companies that serve children in the Medicaid program.  His investigation into credit arrangements offered by Aspen Dental Management, Inc. is ongoing.

Click here to see the June 26, 2012, PBS Frontline piece on these issues.

PR pushback supposedly “after” FRONTLINE aired

Twenty five minutes after FRONTLINE’s “Dollars and Dentists” aired at 10PM Eastern Time, a link to a “rebuttal” landed in my inbox. Amazingly, June Thomas, it’s author, doesn’t know night from day. She watched the FRONTLINE “Dollars and Dentists” tonight, at 12:32PM.  Just saying… 

Hurricane of reports - Private Equity Dentistry in the news– Week of June 25, 2012

Not a good week for criminal dentistry.
 Texas dental Medicaid scandal far from over – Monday June 25, 2012

Dental Abuse of U.S. Poor Dodges Ejection from Medicaid – Tuesday June 26, 2012

March 13, 2012 – Letter from OIG to Sheila Sawyer and Lorri Steiner of Small Smiles Dental
May 15, 2012 – Agreement with OIG Re: Manassas Clinic to Sheila Sawyer and Lorri Steinerof Small Smiles Dental

                                                               Collection of Documents

Dollars and Dentists – FRONTLINE Tuesday June 26, 2012
Check your local listing for air time
Live Chat Wednesday June 27, 2012 @ 2:30 Eastern Time with Miles O'Brien, and Center for Public Integrity reporter David Heath. You can submit questions right now by visiting here.
http://www.iwatchnews.org/2012/06/26/9224/live-chat-dollars-and-dentists

                                                                  Collection of Documents

 

Patients, Pressure and Profits at Aspen Dental – Tuesday June 26, 2012

Truth is a far cry from the reported wonderful benefits of working at Aspen printed last Friday on Dr. Bicuspid, quoting Dr. John Notarianni, DDS 

Complaints About Kids Care Follow Kool Smiles – Tuesday June 26, 2012

Kool Smiles Response fails to address concerns.

Attorney General files lawsuits related to WFAA dental investigations - Tuesday June 26, 2012

Texas AG lawsuits spurred by WFAA dental investigation – June 26, 2012

Corporate dental chains see profitable market treating poor kids and adults – Tuesday June 26, 2012


Anesthesia deaths – Nightline Wednesday June 27, 2012Check your local listing for time

         CANCELED (again)

Ocean Dental dentist, Robin Lockwood accused of Medicaid Fraud–Oklahoma City

…more on the Ocean Dental arrest

KFOR-TV June 21, 2012
Posted on: 5:34 pm, June 21, 2012, by La'Tasha Givens, updated on: 07:41am, June 22, 2012

OKLAHOMA CITY — A local dentist from a popular chain is accused of falsifying documents to cheat the Medicaid system out of money. Officials say they are seeing an increase in this kind of scam. Robin Lockwood, D.D.S. is one of the latest to be charged. While working at an office on the 1600 block of Southwest 74th Street investigators say Lockwood “engaged in a scheme to defraud Medicaid by submitting claims for dental services she did not provide.” She no longer works at the office and the company says it’s cooperating with authorities.

But NewsChannel 4 found another office near Lockwood’s home that bears her name. No one answered the door or returned our phone call. Investigators says Lockwood isn’t the only doctor trying pad their paycheck on taxpayer’s dime. Susan Rogers Executive Director of Oklahoma State Board of Dentistry said, “Medicaid fraud is a very big problem in Oklahoma right now among dentistry. We have one case where a child was diagnosed with having two cavities behind their front teeth and the dentist in question capped 15 teeth within an hour (not typical according to officials). The ex-rays don’t show there were cavities or caries.”

CSHM–Small Smiles Dental May 2012 Operations Report as filed in Middle Tennessee Bankruptcy court.

Church Street Health Management May 2012 Expense/Operation Report Doc 435

OCEAN DENTAL is throwing their dentists to the wolves.

To ALL Dentists!
So you want to work for a corporate dental chain? Better think twice. Dr. Robin Lockwood is now facing 10 years in prison and $250,000 fine all for trying to meet those production quotas. What are you doing to meet yours?

June 21, 2012

OKLAHOMA CITY—Robin R Lockwood, 44, a dentist from Oklahoma City, has been charged with committing health care fraud, announced Sanford C Coats, United States Attorney for the Western District of Oklahoma.

Lockwood is a dentist licensed to practice in the state of Oklahoma and was employed under contract by Ocean Dental at offices located at 1610 Southwest 74th Avenue, Oklahoma City. Ocean Dental’s dentists provided dental care to Medicaid-eligible children. The Medicaid Program is a cooperative program that provides federal and state funds to pay for health care benefits for individuals with insufficient incomes to meet the costs of necessary medical expenses. In Oklahoma, Medicaid is administered as “SoonerCare” by the Oklahoma Health Care Authority (OHCA), a state governmental agency.

 

Ocean Dental Dentist charged with Medicaid Fraud

Let this be a HUGE warning to all you dental mill dentists out there, trying to meet those production goals for your bonus – you are the low hanging fruit – you will be the one charged with fraud.

 

An Oklahoma City dentist has been charged in a complaint of committing health care fraud

Oklahoma City dentist Robin Lockwood, 44, has been charged in a complaint of committing health care fraud at Ocean Dental.

FROM STAFF REPORTS | Published: June 21, 2012

An Oklahoma City dentist has been charged with committing health care fraud, authorities announced Wednesday.

Robin Lockwood, 44, is accused of defrauding Medicaid by submitting claims for dental services she didn't provide, according to a news release issued by U.S. Attorney Sandford Coats.

The news release states the fraud occurred from July 2007 through December 2010 while Lockwood was employed by Ocean Dental, 1610 SW 74. The clinic provides dental care to Medicaid-eligible children and submits claims for reimbursement to the Oklahoma Health Care Authority. The dentists are reimbursed based on the treatment notes they write for each patient.

Lockwood was charged on a complaint that she submitted notes about treatments she hadn't done. Relying on Lockwood's treatment notes, Ocean Dental submitted claims for reimbursement to Medicaid and paid her a percentage of those reimbursements.

If convicted, Lockwood faces up to 10 years in prison and a $250,000 fine.

Read more: http://newsok.com/an-oklahoma-city-dentist-has-been-charged-in-a-complaint-of-committing-health-care-fraud/article/3686174#ixzz1yRAMVaZr

Personally, I wish it had been that nasty woman, Megann Scott, DDS.

Dentist, Dr. Marieve Rodriguez, sentenced to 9 months in jail for Medicaid fraud and loss of license

A prominent Wilmington dentist was sentenced to nine months in prison Wednesday for a years-long fraud that bilked the state’s Medicaid program of more than $71,900.

Marieve Rodriguez, who had negotiated a plea agreement that only called for home confinement, broke down after Superior Court Judge John A. Parkins Jr. announced the sentence, leaning on one of her attorneys for support. Parkins said he was sending a message that such sustained, methodical fraud will be severely punished.

Rodriguez, who operates Gentle Care Family Dentistry on Gilpin Avenue, Wilmington, will lose her medical license for a year. Her sentence also includes a $100,000 fine, repaying prosecution costs of $49,000, paying $71,900 restitution, and 600 hours of community service.

Delaware Online

Byron Harris update on dental Medicaid fraud in Texas

June 20, 2012

Read Byron’s complete report here at WFAA

Two days after a Canadian Private Equity firm buys Orpharma, registered users get email on how to increase sales to fix your gum “pockets”

Valeant buys Orapharma for $312 million. 

I have been told there is no real scientific evidence to any of this Arestin stuff. And if I remember right the American Heart Association came out earlier this year and announced there was no real evidence associated with heart disease as you may be told.

I don’t have a clue either way. What I know is a Private Equity firm out of Canada is suggesting high pressure sales tactics the public should be made aware of.Just like the public needs to be aware of the drug companies and their sales techniques - which are many times very dangerous – the public needs to know this.

Here is just one of Arestin's sales training videos.

Ocean Dental–bomb shelter offices more like sweat shops

From RipOff Report:

Ocean Dental advertises for Medicaid and has commercials that attract children with Medicaid.  They have a call center that takes their calls.  They train these young representatives to not let the caller know they are on the phone with a call center.  Ocean Dental wants the patient or parent to be tricked into thinking they are talking to a nurse in the clinic.  In all actuality you are speaking to someone who knows nothing about your child, nothing about Medicaid, and nothing concerning dental terminology or illnesses caused by tooth decay.  The purpose of the call center is just to real you in onto their schedule, so that they can give you a 7 minute cleaning and take your Medicaid.  Someone from the Kentucky, Louisianna, or Ohio area can call and will get the call center in Stillwater, Oklahoma.  The representatives in this call center, which is located in a bomb shelter and set up under a bank, has never seen the clinics and do not know what they look like.  They have only heard the voices of the people that work the front desk.  How sketchy for a dental practice to take advantage of Medicaid patients because they know that these people are low income and welfare based.  Something should be done about the quality of that working environment.  They seldom have water and have to walk up a large set of steep steps to get to the bathroom which is shared amongst the Ocean Dental reps and the bank workers.  Eight hours of work underground with no breaks.  This place is worse than a Chinese sweat shop.  The best advice from a worker who currently works there is if you care about your child’s dental needs DO NOT take them to Ocean Dental.

Kool Smiles Pre-Frontline Propaganda LMAO

http://www.sacbee.com/2012/06/20/4576945/new-britain-kool-smiles-selected.html

New Britain Kool Smiles Selected as "Best New Dentist" in the Area According to 2012 New Britain Herald Reader's Poll

CBS and Washington Post Scrub Website of NC Dental Society Article

Thought you read something about the fight going on in North Carolina and Private Equity backed dental corporations - like those owned by Michael and Susan Dell - on the Washington Post website? What about the CBS News website?

Well they are now gone. Scrubbed clean, it appears. At least I can’t find them. The WP article was there on Monday (June 18), and had been since June 6. Today is Wednesday June 20 and it has vanished!

 

CBS News – June 6, 2012 – NC dentists at odds over management company rules  GONE!

Here is the cached version, so you know you weren’t imagining things.

Washington Post June 6, 2012 - Dentist trade group, management companies fight at NC Legislature over tighter rules  GONE!

Here is how the WP article started out:

The North Carolina Dental Society is backing a bill to regulate dental service organizations (DSOs) more closely because it says some of these groups are crossing the line and essentially controlling dental practices. State law allows only dentists to own and operate practices and make medical decisions for patients.

Dentists affiliated with these dental service organizations and their patients visited the Legislative Building to oppose a Senate bill containing new rules. They say other dentists are trying to block them from offering services at a fraction of what those in traditional practices now charge. The organizations help control costs by handling things like payroll, human resources and purchasing, backers say.

Proponents of the bill argue DSOs are often out-of-state, investor-owned corporations which come in and exert control in dental practices and get in between the doctor-patient relationship.  They argue that some organizations are imposing production quotas and encouraging dentists to persuade patients that they need certain treatments.

Opponents of the bill argue DSOs offer affordable dental care and alleviate the administrative burden of dentists which allows them to spend more time on patients.  They argue limiting these organizations will limit access to affordable healthcare and are just an effort by traditional dental practitioners to limit the spread of DSOs in North Carolina.

See the pic above, it was there!

So who is scrubbing the Internet?

OIG requesting public comment on changes in protocol for “self reporting” of fraud

Revising OIG’s Provider Self-Disclosure Protocol Solicitation for Information and Recommendations

AGENCY: Office of Inspector General (OIG), HHS.
ACTION: Notice and Opportunity for Comment.
SUMMARY: This Federal Register notice informs the public that OIG:

(1) Intends to update the Provider Self-Disclosure Protocol (63 FR 58399, October 30, 1998) and

(2) solicits input from the public for OIG to consider in updating the Protocol. DATES: To ensure consideration, public comments must be delivered to the address provided below by no later than 5 p.m. on August 17, 2012.

 

Background: In 1998, OIG published the Provider Self-Disclosure Protocol (the Protocol) to establish a process for health care providers to disclose potential fraud involving the Federal health care programs. The Protocol provides guidance on how to investigate this conduct, quantify damages, and report the conduct to OIG to resolve the provider’s liability exposure under OIG’s civil money penalty (CMP) authorities.

Over the past 14 years, we have resolved over 800 disclosures, resulting in recovering over $280 million to the Federal health care programs. Through our experience in resolving Protocol matters, we identified areas where additional guidance would be beneficial to the provider community and would improve the efficient resolution of Protocol matters. Specifically, we issued three Open Letters to Health Care Providers to address some of these issues.

First, in 2006 we announced an initiative to encourage disclosure of conduct creating liability under OIG’s antikickback and physician self-referral law CMP authorities.

Limiting Private Equity Dentistry: A Report by Michael Davis, DDS

The full report with all referenced materials and index can be download here.  A handy tool for fighting these crimes against humanity.

Support for Limiting Private Equity Dentistry- made to New Mexico Board of Dental Health Care

Report submitted in response to request of
Dr. Robert Gherardi, New Mexico Board of Dental Health Care-
June 13, 2012

By: Michael Davis, DDS
Background

It is important to get up to speed, with specific nomenclature of Interstate Corporate Dentistry, and specific factors of related Case Law.

A Dental Management Service Organization (DMSO) controls the operations of their subordinate dental clinics. They pay staff salaries, including doctors’ salaries. They control the supplies available to each dental clinic. They (not the individual dentist) select the laboratory to be employed for lab services (dentures, crowns, bridges, etc.). They set production quotas and bonuses for individual doctors & individual clinics. They monitor and evaluate each clinical service provided, by each Provider they employ. They control the bank accounts of each individual dental clinic, and sweep those bank accounts on a very regular basis. They pay rent on real estate, of the clinic facilities. They select & maintain dental equipment for each subordinate clinic. They are responsible for the Licensure & Accreditation of each employee. They generally supply the Malpractice Insurance for their Employee Dentists, but often will not purchase “Tail Coverage”.

On paper, the DMSO owns very few hard assets, but actually pulls the strings, of the Practice of Dentistry. Their most valuable assets are their contractual obligations, which have been demonstrated by the Fifth Circuit in re: OCA, Inc. December 12 2008 (07-30430), to represent the “Unlicensed and Unlawful Practice of Dentistry”. Increasingly, we are today seeing more DMSOs, which are offshore registered corporations, versus Delaware incorporation.

Michael and Susan Dell–shame on you!

The Dells want your money and want to provide low quality dental care and even lower quality dentures to Americans and they are willing to spend millions to do it. No, not the Wisconsin Dells, the Texas Dells.

Reports all over the Internet about the fight going on in North Carolina where the Dental Society and the North Carolina Dental board are trying to continue to protect the citizens of the Tar Heel state. Here is one:

Dental group trying to keep dental management firms out of N.C.

And here is a report about the wonderful, fabulous and generous Michael and Susan Dell. Michael and Susan Dell Foundation Give Report

He gives so much to Children’s dentistry in his home state of Texas, it’s proclaimed. Dell’s dad, Alexander, is a dentist.

What Michael and Susan fail to report is that while giving with one hand, they are taking with the other.

How do you feel about Swiss bankers pushing your child’s dental treatment?

Union Bank of Switzerland (UBS) has holdings throughout the world, including dental clinics in Phoenix and Mesa, Arizona.

UBS’s subsidiary PDA HoldCo, LLC appears to own and operate Magic Smiles. PDA is the Nasdaq symbol for Perdigao SA, a chicken company in Brazil, owned by UBS. Reports say it is the “Purdue of Brazil”.

Magic Smiles is where at least one parent was referred when Reachout Healthcare America’s mobile dental van preyed upon the children at their Phoenix area school.

I am told, if a child is seen by the Reachout Healthcare America Dental monsters and has private insurance they referred the child to Magic Smiles. RHC must be all warm and cozy with Magic Smiles,

Parents were told by RHC representatives - Magic Smiles will bill their insurance, and Reachout Healthcare will pick up the tab on the rest, or work out a payment plan. It was a payment plan, by the way.

One first graders parents seem to be having problems they can’t get anyone interested in enough to resolve. They are receiving bills for the remainder of the child’s likely over treatment from both, Dr. Ralph Green, the fake owner of the RHC’s mobile van, as well as getting bills from Magic Smiles.

Their calls to Morgan Stanley owned, Reachout Healthcare America have been no help.

[I would like to learn more about this if anyone has anything to share.]

On November 1, 2011, John Momtazee and Chris Ripley of UBS registered PDA HoldCo, LLC. HoldCo is listed as the owner of Magic Smiles, LLC, with Momtazee as the Managing Partner.

There is also a company - PDA Holdings, LLC - registered with the Arizona Secretary of State, which was registered in February 2005. The type of business - “Operation of Dental Clinics”. The company was registered by Craig Frances of Summit Partners. Craig, along John Momtazee are the executives of PDA Holdings, LLC.

Summit Partners once held American Dental Partners in its portfolio.

I can not seem to find a dental licenses for John Momtazee, Chris Ripley or Craig France anywhere. Imagine that.

Chris Ripley

Craig Frances, MD

John Momtazee (see page 3)

Magic Smiles NPI Record

PDA Holdings, LLC NPI Record - Arkadius Jaszcz, from Zurich is listed as President on the NPI Record

Healthy Senior Dental, LTD = ReachOut Healthcare America

I’ve said on here more than once that not only are children in danger, so are grandma and grandpa in the nursing homes.

The same people who mistreated this poor child in AZ are the same names associated with Health Senior Dental, LTD. However, I’m sure nothing like this happens with Health Seniors Dental because they say they have a “perfect legal and ethical background of no liability claims every filed” and “all dental decisions are made by state licensed dentists with perfect ethical records.” (see below)

What are the chances of Dr. Elliot P. Schlang, Dr. Ralph Green and Michael P. Howell having another company unrelated to ReachOut Healthcare and Morgan Stanley?  None, nada, zip, zilch, zero.

• Healthy Kids One More Child Foundation - Reachout Health Care America
  Michael P. Howell
  http://starpas.azcc.gov/scripts/cgiip.exe/WService=wsbroker1/names-detail.p?name-id=10810856&type=CORPORATION
• Healthy Seniors Dental
  Michael P. Howell
  http://starpas.azcc.gov/scripts/cgiip.exe/WService=wsbroker1/names-detail.p?name-id=L10045016&type=L.L.C.
• Healthy Senior Dental website says services are brought to you by Elliot Schlang and others

Healthy Seniors Dental

Report after report claims Congress is investigating- Really?

I’m not seeing any actions being taken other than giving them passes for further abuse of children.

Stop Private Equity owned dental clinics from abusing children for profit and defrauding Medicaid

 

Sign the Petition on Change.org

QUICK AND EASY
It's up to you whether to reveal your name or not.

 

Sign the Petition on Change.org

Dr. Edward Dove of Bakersfield update

June 8, 2012

State of Connecticut vs. Corporate Dental clinics

Here is the complaint the CT Attorney General brought against a very long list of dentists and their illegal corporations. 

STANDING OVATION TO The State of Connecticut!!  North Carolina and 48 more states should watch, listen and learn.

State of Connecticut vs. Corporate Dental Clinics

Four Questions for Insurance Companies–Re: Private Equity Dentistry

It’s getting about time these Malpractice Insurance companies as well as insurance companies such as United Concordia and Guardian answer some questions. I just have three:

1. Why are you knowingly ( and you damn well know it) providing malpractice insurance to illegal operations?

Has no one in the Insurance company ever questioned why they are selling malpractice insurance to a company with 500 dentists working for it?  The fact you do it, means you know it.

Yet, when malpractice cases come a callin’ you don’t want to pay up. But you damn well didn’t mind to take the premiums all these years, now did you?

2. Why are you sending patients to dentists who are practicing dentistry illegally?

It’s beyond me why I pay a weekly (however minimum) premium for dental coverage through employment. I am covered with Guardian. I find the name alone highly misleading, since guarding is not even near the top of their to do list.

I recently did a 50 mile radius search of providers on their website for myself. I was excited to see there were four pages -triple columns- listing a 103 dentists in my area. Then I actually read them.

 

All Smiles Dental Bankruptcy Update 6-4-2012

Wondering what’s happening at All Smiles Dental?  Here is their Schedules A thru H. A inside look at the company that Medicaid built.

Doc 71 All Smiles Dental Schedule A-G

Small Smiles Dental Centers - CSHM, LLC’s executives after the so called “sale” 6-1-2012

Wondering who is deciding the dental treatment, deciding what supplies can be ordered and how much the dentists can spend as well as setting the daily quotas for Small Smiles Dental Centers? As of of 6-1-2012 that would the the following people.

David R. Wilson – (Officer) Chairman, President, and CEO 415 Church Street, Suite 2004 Nashville, TN 37219 david.willson13@comcast.net
Ghassen (Gus) Souri, DDS - Chief Dental Officer 665 Easton Lane Elk Grove Village, IL 60007 gsouri@cshm.com
Steven M. Looney 111 John Street, Suite 1510 New York, New York 10038	Peale Davies
Terrence L. Moore, MD 55 Rock Rimmon Drive Stanford, CT 06903	MD at Garrison Investment Group – formerly at CIT Group
Brad Gardner (Officer)SVP/CFO 618 Church Street, Suite 520 Nashville, TN 37219

Small Smiles Dental Centers - CSHM,LL 2012 KY Annual

Missing in Action is Linda Zoeller’s name on this filing, seems weird not seeing it slapped on the document somewhere…  lol

In 1998, Texas spent $16.5 million on stainless steel crowns, in 2010, 12 years later, Texas taxpayers spent nearly $108 million, up 650% in 12 years!

In 1998, Texas spent $16.5 million on stainless steel crowns, paying for 250,000 thousand of them. In 2010, 12 years later, it spent nearly $108 million, on 700,000 crowns. Up 650% in 12 years! Byron Harris reports on why that could be. Hint: think body snatchers!

June 1, 2012
WFAA

U.S. Senate candidate, Tommy Thompson, is way too interested in North Carolina dental legislation to have clean hands. Just saying…

 

 

The front page of Tommy Thompson’s campaign website. Amazing, he and Jeb Bush both called North Carolina House Speaker Thom Tillis in regards to NC’s dental legislation – Senate Bill 655 – House Bill 698.

 

Tommy Thompson, Wisconsin Senate Candidate, Attacked For Involvement In North Carolina Health Care Bill

Democrats are criticizing Wisconsin U.S. Senate hopeful Tommy Thompson over published reports indicating his involvement with a bill pending in the North Carolina legislature.

[This Tommy Thompson, actually looks like a criminal in my opinion. There is a certain “creep” quality about him. ]

Bloomberg Businessweek reported that Thompson was one of four national GOP luminaries to contact North Carolina House Speaker Thom Tillis (R-Charlotte, picture right)  regarding a bill covering new regulations for dental-management companies. Thompson, a former U.S. health and human services secretary, along with former Florida Gov. Jeb Bush, former U.S. Senate Majority Leader Bill Frist and former Mississippi Gov. Haley Barbour contacted Tillis about the bill, which has been opposed by private equity companies, Bloomberg BusinessWeek reported.

[Thom Tillis’ crooked smile may not be the only thing crooked about him. I believe he might have a problem with telling the truth as well, which of course is how we know he’s a perfect person to be a politician, right?]

Thompson is competing against former Rep. Mark Neumann, Jeff Fitzgerald, speaker of the state assembly, and businessman Eric Hovade for the Republican Senate nomination and the right to face Democratic Rep. Tammy Baldwin in the November election.

A former Wisconsin governor, Thompson is a partner in a New York private equity firm specializing in the health care sector and a former partner in a Washington law firm specializing in the health care industry. In recent weeks he has come under scrutiny for his acceptance of a board chairmanship at a Florida pharmaceutical company, a post he accepted after saying he was not taking on more corporate board seats. Thompson has served on more than 20 corporate boards since leaving the U.S. Department of Health and Human Services in 2005.

Thompson's spokesman told the Milwaukee Journal-Sentinel that he did not contact Tillis to lobby but rather to learn about the bill.

[Liar, Liar, Pants on Fire!]

 

Connecticut AG with Kahunas Files Suit Against Corporations and Management Companies

Standing Ovation! 

AG names 28 in civil complaint alleging illegal Medicaid billing scheme

From ConnecticutPlus.com
Jun 1, 2012 - 9:25 AM

HARTFORD, CT - Attorney General George Jepsen has brought a civil action against 28 individuals, dental practices and corporations alleging an elaborate and illegal scheme, which resulted in more than $24 million in fraudulent Medicaid clams over two years in violation of the Connecticut False Claims Act and Connecticut Unfair Trade Practices Act.

The complaint seeks restitution, treble damages and civil penalties as well as a permanent injunction against the unlawful acts and practices alleged in the complaint.

The individuals named in the State’s complaint are Gary Anusavice (former DDS)of North Kingston, R.I., Mehran Zamani, DDS of Pound Ridge, N.Y. and Stamford; Paul Anusavice of North Grafton, MA; John Gallagher of Manchester, MA; David Wu,DDS of Cheshire and Alphonso Mack,DDS of Bloomfield.

Gary Anusavice and Zamani were arrested last week on federal criminal charges for their alleged involvement in the same billing scheme.

“This is the first case the state has initiated under the Connecticut False Claims Act,” Attorney General Jepsen said. “It gives the State the rightful ability to seek compensation for taxpayers from those who seek to abuse the system with false claims for reimbursements they are not eligible to receive.”

The Attorney General brought the unfair trade practices complaints at the request of Consumer Protection Commissioner William Rubenstein. “The allegations of the complaint are serious, and our consumer laws against unfair and deceptive practices protect state taxpayer dollars whenever medical providers make wrongful claims for reimbursement from the Medicaid program,” Rubenstein said.

Department of Social Services Commissioner Roderick L. Bremby, said “We greatly appreciate the Attorney General’s dedication of both resources and expertise to bring forward this major case of alleged provider fraud. DSS investigators first identified the suspected fraudulent activity and worked with the AG’s Office and federal authorities to develop the case. The role of the Department of Consumer Protection is also important in our collective efforts to root out fraud and abuse on behalf of taxpayers.”

The DSS administers the Connecticut Medical Assistance Program, which includes Medicaid, a joint federal-state program, which provides medical benefits for more than 500,000 low-income Connecticut residents.

The State complaint also names the dental practices and other corporations created or controlled by the various individuals. They include
E.G.A. Mangement, Inc.
Haven Consulting, Inc.
AMZ Consulting, Inc.,
Dental Care of Connecticut, Inc.,
N.B. Dental, Inc.
Electron Marketing, Inc. of Fall River, MA
Dental Group of Stamford, LLC
Dentists Group of Stamford, PC.
Mehran Zamani, LLC,
Mehran Zamani, DDS, PC;
Dental Group of Connecticut, LLC,
Dentists Group of Connecticut, PC;
Dental Group of Waterbury, LLC,
Dentists Group of Waterbury, PC;
Dental Group of Danbury, PC;
Dental Group of New Britain, PC;
Dental Group of Hartford, PC;
Hartford Dental Care, LLC;
Hartford Dental Incorporated, PC;
Arbor Dental Association, LLC;
Alpha Dental Group, PC;
Wintonbury Dental Associates, PC.

 

Bloomberg’s Private Equity in Dentistry Series Gives New Meaning to “Drill Baby Drill” for 2012 Republican Campaign

May 16, 2012
By Sydney P. Freedberg

Dental Abuse Seen Driven by Private Equity Investments

May 30, 2012
Republicans Target Dental Bill That Private Equity Hates
By Sydney P. Freedberg and Jason Kelly - May 30, 2012 11:01 PM CT

The likes of Jeb Bush, William Frist, Tommy Thompson and Haley Barbour aren’t typically heard from in the office of Thom Tillis, the Speaker of the North Carolina House of Representatives.

Yet the four Republican Party stalwarts, none of them a Carolina resident, have contacted Tillis’s office over a little- known bill to toughen state regulation of dental companies. They’ve been joined by Grover Norquist, the Tea Party favorite and anti-tax crusader who heads the Washington, D.C.-based Americans for Tax Reform.

“It’s not terribly common to have these types of names” intervening on a state bill, said Jordan Shaw, a spokesman for Tillis.

Their interest marks the Tar Heel State as the front line in a national struggle over dental management companies. Fueled by Wall Street money, at least six such firms are under scrutiny by two U.S. senators and authorities in five states over allegations that they soak taxpayers through excessive Medicaid billings, abuse patients via needless treatments and run afoul of laws that say only licensed dentists can practice dentistry.

READ the entire article on BLOOMBERG

Closing Day for Church Street Health Management-Small Smiles Dental Centers

No, not closing the doors, but I expect that soon.

Today was supposed to be the closing day for the sale of Church Street Health Management.

Yes, Church Street Health Management, LLC will now become CSHM, LLC with basically the same Private Equity Investors as before, CIT Corporation and others. The Carlyle Group swears they are out of it, I’m not sure. They say the “exited” in the last year. It must have been in the last 6 months!

Sales and Credit Agreement

The investors basically sunk another $25 million dollars into the company in February to keep it afloat while it “reorganized”. Whatever that means. No one else wanted to jump on the sinking ship so …. it became the property of the same folks.  If they aren’t pissed, they should be.

Since then they have ended up the subject of at least two Bloomberg reports. As usual they never come out looking good. But, honestly, how could they? They whole bunch are dirty rotten scoundrels. 

Abusing children and raping taxpayers is NOT exactly the best way to prosperity. These folks are so bad, even Don Meyer, who is notorious for selling snake oil to American’s can spin this one. All he can say is “we are providing care to the underserved”. He says it over and over and over…  If you listened to them, there would be no sex at all, unless you’re raped.

Still doesn’t it make it so. The once “underserved” are the most “overserved” in America when it comes to dental care these days.

I think things may be getting worse for the CSHM, LLC. I know, it’s hard to believe things could get worse-Bankrupt, Congressional Investigations, Corporate Integrity Agreement, and so forth-but they can.

The first few days of the new ownership is probably gonna suck!

According to sources, Met Life and United Concordia/Tricare are canceling their contracts with Small Smiles Dental Centers. 

If true, revenues just went to hell, again. If they couldn’t make it before, they certainly can’t make it now.

PS – If asked to sign some kind of Transition, Separation, Confidential, Severance and General Agreement, in exchange for a week’s pay, I would have an attorney look it over. Personally, unless they removed sections 4, 7, 8, 13 and clarified in writing why it says it’s governed by the state of Tennessee, and why Church Street Health Management is a “Released Party”, I wouldn’t sign it, no way, no how… Just saying…

Dr. Jian-Fu Zhu, loose cannon!

Someone needs to stop this dentist before he kills someone. Other’s have come forward with similar stories, none willing to speak out of course.

Detroit Free Press - Ashton's story: Michigan Child Nearly Dies

26  Comments

Ashton Adler is the subject of "Ashton's story: Michigan Child Nearly Dies," in which his mother describes complications he had with dental sedation. / Photos by JARRAD HENDERSON/Detroit Free Press

 

Rebekah and Jason Adler and their sons Gabe, 5, and Ashton, 7, at their Royal Oak home.

The case of a 6-year-old Royal Oak boy whose family charges he was unresponsive for nearly six unsettling hours after a dental sedation procedure last year is under investigation by Michigan health care regulators.

The allegations by the family of Ashton Adler, now 7, involves one of Michigan's few known cases involving a child experiencing complications from dental sedation. The incident is the subject of a new video by a national nonprofit organization that monitors deaths and serious complications of children undergoing such procedures.

"Ashton's story: Michigan Child Nearly Dies," is a video interview with Rebekah Adler, the mother of the boy interviewed by the Raven Maria Blanco Foundation. The Virginia-based foundation, which has tracked 45 pediatric sedation deaths around the country, recently led its website with the Adlers' story to show parents and caregivers to "trust their instincts" and "walk away" if they question sedation procedures, Executive Director Nicole Cunha said.

The Adlers contacted the foundation after reading a February report in the Free Press on controversies over state regulation of dental sedation. The article described the national controversy over pediatric sedation deaths and regulatory measures under debate by Michigan and other states to increase training and safety in the field.

Michigan has had no known sedation deaths, according to a spokesman for the Michigan Dental Association. And there have been very few complaints involving sedation dentistry practices, said Rae Ramsdell, chief of the Bureau of Health Professions with the Michigan Department of Licensing and Regulatory Affairs.

The foundation's video does not name the dentist, but the couple's complaint to Michigan regulators lists him as Troy pediatric dentist Dr. Jian-Fu Zhu. The complaint, which the Alders filed June 8, 2011, with Michigan's licensing department, is under investigation, Ramsdell said. No formal charges have been filed.

Zhu declined to comment. He referred a call from the Free Press to Lynda Farnen, a Roseville attorney.

"We're involved in an ongoing investigation," she said. "Under those circumstances, there's very little I'm going to say. Dr. Zhu believes that all the care and treatment he rendered was appropriate and within the standard of care." She declined to answer other questions.

The state website lists no violations on Zhu's record.

Credentials seemed fine

The Adlers say a brochure they picked up in his office on the day of the visit gave them confidence they made the right choice.

Zhu also came on good recommendations from their family dentist, the Adlers said.

The brochure identified Zhu as a board-certified pediatric dentist and clinical assistant professor of pediatrics at the Wayne State University School of Medicine, as well as a previous co-director of the pediatric residency program at Children's Hospital of Michigan in Detroit.

WSU medical school records show that Zhu has not worked there since 2005.

He left Children's Hospital several years ago, a spokeswoman said.

He remains a board-certified dentist, a credential that indicates he passed a tough national exam.

Pediatric dentists undergo at least one month of hospital or office training with an oral surgeon or dental anesthesiologist that allows them to perform light or moderate sedation techniques -- drugs that help people rest during a procedure but that allow them to respond to voice commands easily.

In their complaint to the state, the Adlers say they were told to give two different sedation drugs to their son, a skinny 47-pounder at the time, before undergoing a root canal and five fillings.

The Adlers claim that:

• They were left to give the drugs to their son on their own. When Zhu returned and found Ashton apparently had spit out some of the medicine, Zhu gave them a third cup of medicine to give to their son and then left them alone again. The Adlers say they don't know which medicine and how much of it was in the third cup, requiring emergency room doctors at Beaumont Hospital in Royal Oak to monitor Ashton for more than four hours to observe his breathing and vital signs because he was so listless when they arrived.

• Their son was unmonitored for long stretches throughout the dental visit and was sent home asleep. A staffer for Zhu told them, "We can't be with our patients from start to finish of a sedation process," Rebekah Adler said.

• Zhu didn't awaken the boy before sending him home, did not check his vital signs and gave the parents no reason to think there was a problem.

The allegations, if true, would violate standards of the American Dental Association and the American Society of Pediatric Dentistry, of which Zhu is a member.

The guidelines require "no administration of sedating medication without the safety net of medical supervision." They also say that children must recover to pre-sedation levels of consciousness before discharge; that dentists must document the name and dosages of medications given, and if children receive different sedative drugs simultaneously, they might need more monitoring before discharge. The guidelines say a child should be able to remain awake for "at least 20 minutes when placed in a quiet environment."

Before Jason Adler left Zhu's office the day of the visit, he said he asked for his son's X-rays and medical records. He received only a bill, marked "statement for services rendered." Scribbled on it were references to two sedative drugs: "hydroxyzine 50 milligrams and chloral hydrate 1,700 milligrams."

The statement did not mention that Ashton also received laughing gas, or nitrous oxide, the Adlers say.

Dr. Norbert Kaminski, a Roseville dental anesthesiologist and president of the Michigan Dental Society of Anesthesiology, said the dosages exceed guidelines from the federal Food and Drug Administration and standard reference manuals for dentists, such as the "Drug Information Handbook for Dentistry" from Delta Dental and LexiComp's Dental Reference Library.

Kaminski computed dosages for the boy and said Ashton was given five times the dose of hydroxyzine and two to three times the dose of chloral hydrate, and that even lower doses are recommended when the drugs are used together. Combined with the laughing gas, Ashton was pushed into a level of sedation that Zhu, as a pediatric dentist, was not licensed to perform, Kaminski said.

Kaminski has campaigned statewide to toughen Michigan's sedation regulations.

Michigan is one of only two states that do not require permits for dental professionals performing sedation, Kaminski said. Permits help consumers readily identify what level of sedation a dental practitioner can offer, Kaminski said.

The state Board of Dentistry is reviewing whether to toughen standards in the field. So far it has balked at requiring permits, which would tell consumers whether a dentist has the right training to do either awake sedation or deeper sedation. The board had planned to take up the changes at its April meeting but postponed the discussion, possibly until its next meeting June 14.

'I just want justice'

The Adlers say more parents, even people like them who are familiar with sedation, need to ask more questions before and during a visit. The couple has watched a younger child with a brain injury undergo sedation for brain tests. But now they have to relive their fears -- something will go wrong every time he has another sedation procedure, Rebekah Adler said.

"I just want justice," she said. "I want the people of Michigan to know this can happen to them."

Contact Patricia Anstett: 313-222-5021 or panstett@freepress.com

More Details: Questions parents should ask before pediatric dental sedation

• How much training have you had?

• How do you monitor children to see whether they stay properly sedated?

• Does the office have rescue equipment in the room where the procedure is done, and how often does the staff practice using it?

• How long do you monitor a child before discharge?

• Will I receive a pretreatment report describing what is being done and what drugs will be used in the procedure?

By Patricia Anstett
Detroit Free Press Medical Writer

Western Dental for Sale?

 

May 30, 2012 1:00 pm
Financial Times:

Western Dental mandates Jefferies for sale process

Websites:

Western Dental,

 Court Square

Jefferies

Federal Trade Commission implies Private Equity Executives deciding dental treatment will give North Carolina citizens lower costs.

North Carolina Representative Stephen LaRoque called in the FTC when it looked like SB655/HB698 might pass. Is Representative Stephen LaRoque bought and paid for by Corporate CEO’s? Appears so.

Where has the Federal Trade Commission been all these years if this is such a huge issue? Nowhere to be seen, not until brought in by Private Equity and Representative LaRouque.

 

FTC Staff: Proposed North Carolina Dental Services Law Would Likely Reduce the Benefits of Competition for Consumers

Federal Trade Commission Documents and Publications
May 29, 2012

FTC Staff: Proposed North Carolina Dental Services Law Would Likely Reduce the Benefits of Competition for Consumers

Federal Trade Commission staff, in response to a request from North Carolina Representative Stephen LaRoque, stated that a bill proposed in the North Carolina legislature (http://www.ftc.gov/os/2012/05/1205ncdental.pdf) would likely deny consumers seeking dental services in North Carolina the benefits of competition, including the potential for lower prices, expanded access to dental services, and greater choice.

North Carolina House Bill 698 would give the North Carolina Board of Dental Examiners significant new regulatory and oversight authority over Dental Service Organizations (DSOs), which contract with dentists to perform non-clinical, business management functions, allowing dentists to focus more on patient care and less on administrative tasks. According to the FTC staff letter, the Bill would prohibit currently-used DSO management agreement provisions and give the Board exclusive authority to review and approve all DSO management agreements in North Carolina. The Board could apply these new restrictions and oversight powers to prevent DSOs from entering the state, and to dismantle DSOs now operating in the state by refusing to approve management agreements when they come up for renewal.

"Given that the Board already oversees health and safety issues as part of the licensure regime that governs all dentists in the state, and given that DSOs focus solely on non-clinical aspects of dental practice, it does not appear that the Bill would enhance the Board's ability to ensure patient safety," the FTC staff comment stated, noting that underserved communities, including 78 of the state's 100 counties, may be particularly affected if DSO efficiencies cannot be realized. "Therefore, we urge you to consider whether the Bill's restrictions and grants of regulatory power to the North Carolina Board of Dental Examiners are necessary to protect consumers" or whether they risk "merely protecting those dentists who do not choose to use DSOs against competition from those who do."

"In the absence of DSO-specific safety concerns," FTC staff urged the North Carolina legislature to consider the potential anticompetitive effects of H.B. 698 and reject the Bill.

The comment is part of the FTC's ongoing efforts to promote competition in the health care sector, which benefits consumers through lower costs, better care, and more innovation.

The Commission vote approving the staff comment was 5-0. It was sent to North Carolina Representative Stephen LaRoque on May 28, 2012. A copy of the letter can be found on the FTC's website and as a link to this press release. (FTC File No. V120007; the staff contact is Patricia Schultheiss, Office of Policy Planning, 202-326-2877.)

The FTC's Bureau of Competition works with the Bureau of Economics to investigate alleged anticompetitive business practices and, when appropriate, recommends that the Commission take law enforcement action. To inform the Bureau about particular business practices, call 202-326-3300, send an e-mail to antitrust@ftc.gov, or write to the Office of Policy and Coordination, Bureau of Competition, Federal Trade Commission, 601 New Jersey Ave., Room 7117, Washington, DC 20580. To learn more about the Bureau of Competition, read Competition Counts (http://www.ftc.gov/competitioncounts).

MEDIA CONTACT:

Office of Public Affairs

202-326-2180

Copyright 2012 Federal Information and News Dispatch, Inc.

Federal Trade Commission Documents and Publications

Private equity invests in dentists to pull poor kids' teeth for Medicaid dollars - North Carolina Battle Ground

Daily Kos- Private equity invests in dentists to pull poor kids' teeth for Medicaid dollars

Private equity firms have found a profit center in the teeth of poor children, which the firms are getting to by buying or backing dental management firms and getting their dentists aggressively into the business of over-treating kids on Medicaid.

Just as Mitt Romney's work at Bain Capital was about creating investor profit, not jobs (whatever he may claim now), this is about creating investor profit, not healthy teeth. For instance:

On May 2, All Smiles Dental Center Inc., a management company owned by Chicago-based Valor Equity Partners, filed for bankruptcy protection. Its hand was forced in part by a Texas Medicaid action cutting off payment to some of its clinics because of allegedly “excessive” and “inappropriate” orthodontic care, according to an All Smiles executive’s affidavit included in the filing. All Smiles was part of a state audit in which 90 percent of Medicaid claims for orthodontic braces were found to be invalid because they weren’t medically needed, according to Christine Ellis, one of the auditors.

In some cases, the braces may have been put on children's baby teeth. Another dental management services company, ReachOut Healthcare America, which is owned by Morgan Stanley Private Equity, specializes in going into schools and treating kids in bulk. And when quantity is the priority, well, you make some mistakes. Like the case where six-year-old Sabrina Martinez's teeth were drilled "even after the student’s mother, Valerie Davila, told the company she was seeing a family dentist and didn’t need any work." But, see, there was another student named Sabrina Martinez, and if you're just trying to get through the most procedures you can on the most kids you can, you don't necessarily take time to tell one Sabrina Martinez from another. In another case:

When ReachOut called Stacey Gagnon to tell her the mobile dentist was coming to Isaac’s school, she said she explained that he had seizures and other serious medical conditions. ReachOut was told he could have a cleaning and oral hygiene education, nothing else, according to Gagnon.

After that call, ReachOut dentists held Isaac Gagnon down and gave him two steel crowns, two pulpotomies and 10 X-rays.

Cases like this obviously require individual dentists to suck, both as dentists and as human beings. But if it's just about individuals, such stories don't happen to scale. That takes big money—things like private equity involvement pushing dental management services companies to expand the scope of what they do from providing services like billing and scheduling to coming closer to directing actual medical decisions, something that is potentially in violation of "State laws [that] broadly say only licensed dentists or firms they own can practice dentistry."

Some states are cracking down, and the U.S. Senate is investigating possible overbilling by several firms. But while regulating these abuses is an important first step, private equity firms will find the next under-regulated point of entry into profiting off of the massive inequality that leaves poor families vulnerable to such abuses and creates no meaningful disincentives to rich investors doing things like this again and again.

Ain't it the truth! Again and again and some more agains. North Carolina seems to be the battle ground, with Senate Bill 655/House Bill 698.

Private Equity firms are going all out to STOP North Carolina Dental board from enforcing the laws there. If you are a state lawmaker in North Carolina, I wouldn't be shocked if you got a call from beyond the grave from the likes of Leona Helmsley or Kenneth Lay. 

The News Observer reports - Big buck in dentistry's ownership - "Who should make decisions about your dental care: you and your dentist – or a big, out-of-state corporation owned by Wall Street private equity funds? That’s the issue in the fight over Senate Bill 655 in the North Carolina legislature."

Read more here: http://www.newsobserver.com/2012/05/26/2089687/big-bucks-and-dentistrys-ownership.html#storylink=cpy

Orthodontics Offices Closing in Texas

Looks like the spin has started in Texas. I’m hearing many Orthodontic clinics will  close up shop on July 1, 2012.

In the piece below, Dr. Michael Newman's says, "...about 5 percent of them would meet the requirements now."

Fact is, about 5% qualified EVER! Only thing that is changing is maybe, just maybe, stricter enforcement of standards already in place.

Surely Dr. Newman really meant to say, "about 5% is all we can bill for and not get nailed for Medicaid Fraud, now"

TIMES RECORD NEWS - Wichita Falls, Texas

Orthodontist office braces for closure
Practice was only one in area taking Medicaid

Wichita Falls, TX May 26, 2012 -The only orthodontic office accepting Medicaid payments in Wichita Falls has stopped seeing patients and has locked its doors.

Red River Orthodontics set up shop on Euerka Circle in mid-2010. A sign in the door of the vacated Wichita Falls practice directs patients to an office in Fort Worth.

Representatives of Red River Orthodontics declined to comment, and referred questions to an attorney who could not be reached Friday.

The business was registered in the Wichita County Clerk's office under the title John Gremmels, Grill Repair, PA. The address given was in the 3300 block of Monterra Crest Drive in Fort Worth.

Last year Texas paid out $184 million in Medicare for orthodontics. That's more than every other state combined.

Dr. Bill Hendrickson, of Hendrickson Heetland Orthodontics, said he suspects Red River Orthodontics bolted for the door when they realized the Medicaid money was drying up.

"Their words were, 'It's a good investment,'" said Hendrickson, who visited the office personally. "They said, 'This is a very lucrative business.'"

Hendrickson now is in talks with state officials. He said he's trying to take on the patients who were displaced when Red River Orthodontics jumped ship.

Technically, at least one dental office that offers orthodontic services still accepts Medicaid, but is actually kept from doing so because of more stringent, state-mandated requirements.

In 2005 about 80 percent of dentist Dr. Michael Newman's patients were on Medicare. Newman, who operates Texas Orthodontics in Wichita Falls with his wife Denise, practices orthodontics as well as other dental procedures. Until October 2011 he was able to treat most of the patients who needed Medicaid to pay for his services.

But stricter enforcement of Medicaid standards mean that most of them, even patients who have already been fitted with braces, won't receive his care.

"I would say about 5 percent of them would meet the requirements now," Newman said.

In fact, only one of his potential patients received the go-ahead from the state for treatment. Newman wasn't allowed to treat that patient because he isn't a specialist.

A few factors have contributed to this, he said.

One is that some orthodontists have been accused of taking advantage of Medicaid funds. One case, detailing taxpayer money given to All Smiles Dental Centers in Dallas, has drawn significant media attention.

Another factor is the splitting of the third-party entity that paid Medicaid funds to orthodontists, the Texas Medical and Healthcare Partnership. About a year ago, he said, the company was divided into three new agencies, DentaQuest, Delta Dental, and Managed Care of North America. Newman said it hasn't been the same since.

He said the companies have drawn up constricting new rules that makes it virtually impossible to get a patient approved for payment.

"They started cutting back so that we couldn't get the cases approved," he said.

One rule that's being more strictly enforced is that an orthodontist must prove that a procedure is "medically necessarily" to maintain a patient's health. Newman said this is laughable.

"There is no patient I have ever seen who is going to die because of their teeth," said Newman, an officer of the American Orthodontic Society.

America's ToothFairy forms partnership to help at-risk children

America's ToothFairy forms partnership to help at-risk children

DentistryIQ

May 25, 2012

In an effort to expand oral health services for children, My Kid’s Dentist/Every Kid’s Dentist (MKD/EKD) announced a partnership with National Children’s Oral Health Foundation: America’s ToothFairy (NCOHF) through the Students United for America’s ToothFairy (SUAT) Pediatric Dental Residency Program. As a result of this alliance, NCOHF will become the primary charitable partner for the Pacific Dental Services-affiliated MKD/EKD offices.

Designed to provide critical oral health educational and preventive services for at-risk children, this new program also cultivates interest in the oral health field and unites future dental professionals in a concerted effort to break the cycle of pediatric dental disease in their communities. Guiding chapter activities, members of the SUAT Pediatric Dental Residency Program will serve as mentors for dental, pre-dental, dental hygiene, dental assisting and high school student volunteers.

“We are proud to partner with My Kid’s Dentist/Every Kid’s Dentist through this exciting program and applaud their commitment to children’s oral health,” said Fern Ingber, NCOHF President and CEO. “Their support will enable NCOHF to mobilize graduate, undergraduate and high school students throughout the country in an effort to reach thousands of underserved children with the resources, services and education necessary to prevent pediatric dental disease.”

Stephen Thorne, Founder, President and CEO of Pacific Dental Services, will also join the NCOHF Board of Directors. The NCOHF Board of Directors consists of highly respected and dedicated leaders of national and international organizations, universities and corporations concerned with children’s oral health and elimination of oral health disparities.

“I’m honored to be joining the NCOHF Board of Directors,” said Stephen Thorne, Founder, President and CEO of Pacific Dental Services. “NCOHF provides unparalleled oral health care education and support services for at-risk children and I’m looking forward to working with my fellow board members to shed light on pediatric dental disease and to help break its cycle.”

Dental Center Manager Gets Green Light For Sale To Lenders

Nothing really new here…

Law360, New York (May 25, 2012, 12:36 PM ET) -- A Tennessee bankruptcy judge on Thursday approved a credit bid to sell dental center manager Church Street Health Management LLC to a group of its lenders for $25 million plus their debt, just a few months after fallout from Medicaid fraud claims pushed the company into bankruptcy.

U.S. Bankruptcy Judge Keith M. Lundin agreed to the sale to CSHM LLC, an entity owned by some of Church Street's lenders including CIT Healthcare LLC, after no other bids were received at an auction.

Connecticut attorney general to seek restitution from Winsted dentist over billing practices

I’d say if your are a corrupt dentist in Connecticut and have your name on a PC or PLLC you might be a dumbass. Here is what happened to Dr. Doug Macko. So, if you are in a dental clinic there, and pacing the floor with worry, then you know you are doing criminal acts, right? Get your nitro pills ready. (You know who you are)

HARTFORD –Published: Thursday, May 24, 2012
Attorney General George Jepsen said in a statement that he is seeking restitution from a Winsted dentist and his practice for “allegedly violating the Connecticut Unfair Trade Practices Act by illegally billing the Connecticut Medical Assistance Program from April 2002 through October 2009.”

“The state Department of Social Services administers the Connecticut Medical Assistance Program, which includes Medicaid and other programs that pay for medical benefits for certain low-income and disabled Connecticut residents. DSS terminated the provider agreement for (Dr.) Douglas J. Macko ... and on Oct. 26, 2010, suspended him from the program for 10 years,” the statement said.
Macko and his professional corporation, Douglas J. Macko, D.M.D, P.C., in Southington, “had unlicensed dental assistants perform cleanings and other dental services, which may only be performed by licensed dental professionals, and then billed the state as if Macko had performed the services,” the statement said. “Alleged illegal billings were also made for services that were never provided.”
The complaint also alleges that “the acts, practices and course of wrongful conduct by Macko violated public policies against larceny, vendor fraud, health insurance fraud and against a medical provider violating licensing requirements.”
“This action is being brought to seek restitution, civil penalties and other relief authorized by law,” Jepsen said, also in the statement. “It should also send a clear message to other providers that Connecticut will not ignore fraudulent billing and other illegal practices and will vigorously pursue restoration of taxpayer dollars lost as a result.”
Susan E. Kinsman, director of communications for Jepsen's office said Thursday that the action brought by the attorney general is a civil one and, "It is our understanding that criminal charges have not been brought at this time."

Mom takes 6-year-old out of dental chair to protect him

These places are so corrupt they don’t even care to change their ways during the middle of massive lawsuits or Federal Investigations.

Mom takes 6-year-old out of dental chair to protect him

Jack Dennis

San Antonio Headlines Examiner

When  Karla Cardenas took her 6-year-old son Steven to a San Antonio dentist office on Friday, May 18, 2012, little did she know that she would have to take her son off the dental  chair and refuse the treatment to protect him.

“They wanted to put him in a straight jacket type papoose while he was still screaming in pain from the shots they were giving him in his gum,” Cardenas said. ”They were trying to rush it and they heavily sedated him.”

The single mother of four took her son to The Smile Center Family Dentistry on Blanco Road after getting the approval and direction from Medicaid.

“I had no choice but to take Steven to that center,” Cardenas said. “Medicaid required it.”

“I told them to stop, you are not going to do this while he is in this much pain,” Cardenas said as she grabbed her son out of the chair.

Cardenas now said she is glad she followed her instinct because she has since learned that this dental care chain has been under scrutiny by the news media.

Chantel Brewer said “they did the same thing to my daughter “but “she kept getting out of the papoose so they wanted to send us home with her teeth all shaved down without the caps on.”

It was so bad that “even the assistant had scratches all over her face from my daughter kicking her in the face, neck, arms and even kicked her in the eye because she was in that much pain.”

“How can the Medicaid office send us to that office when there is this much bad news about them,” Cardenas asks. “It looks like they are herding children in and out as fast as they can with little concern about the pain.”  

Earlier this year, Brian Collister of WOAI news issued several reports regarding similar concerns from other parents. According to WOAI, the dental chain has earned $23 million from Medicaid since 2007.

One San Antonio law firm, The Crosley Law Firm, P.C. is representing patients against this chain of dental centers who believe their children “have been victims of substandard dental care leading to injuries and requiring additional treatment.”

According to the Crosley Law Firm website, “many of these parents were approached in parking lots and lured into Smile Center with the promise of dental exams for their children at no out-of-pocket cost to them.”

“In most cases we have seen, the children were covered by Medicaid, and Smile Center would bill Medicaid directly,” the website stated. “ Often the dental care consisted of pulpotomies and the placement of stainless steel crowns.”

Crosley says that for some of their clients “the dental work may have been unnecessary, and resulted in a large bill to Medicaid” and in some cases “the injuries caused from the dental care necessitated visits to the emergency room and/or hospitalization.”

Cardenas, who has been a nursing student, indicated she “didn’t see any kind of resuscitation or life saving equipment or a ‘crash cart’ available” in the event of an emergency.

“This doesn’t mean they don’t have any (life saving equipment),” Cardenas explained. “I’m just saying I didn’t see any there.”

Hey, dental office managers, you too can be arrested, face felony charges, and jail time.

I have to ask is it worth it? Is playing along with the fraud worth giving up your life and family?

Office managers out there, know exactly what is happening with all the Medicaid fraud, children being abused and sit on their asses. Why?

Yeah, I’ve heard it, over and over and over again. “I need to feed my family”. Don’t mean to be so cold, but I’m so over hearing it.

OM’s at the dental mills are paid well, very well, too well in many cases. $50 to $60 thousand dollars a year is over the top to manage an office for a dental clinic. The paycheck is meant to hold them hostage as well keep them gagged and handcuffed.

Several times a week I find folks coming to this blog looking for the answer to their question on whether they- office managers, dental assistants, etc.-can be arrested or held liable in criminal fraud or malpractice behavior they see in their offices. They answer is a big fat YES. Ask Claudia Ventura.

CA Dentist Arrested for Insurance Fraud

Insurance Fraud — By Trace America on May 14, 2012 at 4:48 PM

Beverly Hills often brings up images of huge mansions with beautiful sparkling swimming pools, gorgeously landscaped lawns, and several fancy cars in a large driveway. It often does not bring up images of insurance fraud; but one Beverly Hills dentist to the stars may be changing that.

According to the Beverly Hills Patch and the District Attorney’s Office, Tom K. Kalili, 57, was arrested on May 4^th and accused of insurance fraud, grand theft of personal property and filing a false tax return. He was charged in a criminal complaint with 101 felony counts.

Kalili is the owner and operator of Beverly Hills Medical Suites.

It is reported that Kalili and his partners have several celebrity clients, including Jim Carrey, Kathy Ireland, Adam Sandler, Keanu Reeves and Vin Diesel.

Kalili’s office manager and biller, Claudia Ventura, 38, is also being charged, if only with 10 felony counts, including insurance fraud and accessory after the fact.

These charges all come out of a multi-year investigation by the California Department of Insurance, the California Dental Board and the California Franchise Board.

According to DrBicuspid, Kalili directed Ventura to submit fraudulent billing statements to four different insurers for a total of $339,799.99.

Prosecutors are asking for Kalili’s bail to be set at $500,000 and Ventura’s at $25,000.

If Kalili is convicted, he could face over 50 years in state prison, while Ventura could only receive up to seven.