Story of child abused by ReachOut Healthcare America Big Smiles Mobile Dental Van pulled from MyFox Phoenix website. Why? Someone’s got some ‘splainin’ to do!

On June 12, 2012 MyFox Phoenix aired a nearly 10 report on ReachOut Healthcare America’s mobile dental clinic abusing a Camp Verde, AZ special needs child.

Below is what the webpage looked like the day the story aired.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

This is what the website looks like today, no video investigation to be found.

POOF! GONE!

They did manage to leave up some comments from an under-educated person who calls himself Dale Earnhardt, which is slanderous, to DE, by the way.

The promotional post MyFox Phoenix put up on their Facebook page about the story also seems to be missing.

Just after this story aired, I heard that many parents called in with similar complaints, even some insiders contacted Fox 5 ready to blow the whistle on ReachOut Healthcare. So many in fact that MyFox Phoenix was doing a follow-up story with more damning news about ReachOut . It was so explosive they thought it would be picked up by the National network.

What happened, MyFox Phoenix? What did you do with all that evidence of child abuse that came pouring into your station? Why will you not return the Gagnon’s phone calls.

There may be good reason it’s gone, but I’m not finding it!

I think MyFox Phoenix might have some ‘splainin’ to do!

Yeah, it’s quite a story, just wondering if the pulling of this story from the Internet is an even bigger story!

It’s not like this was some little 45 second news story about a fender bender at the corner of Walnut and Main. This was (is) a HUGE story that had been worked on for a very long time! 

So who pressured MyFox Phoenix to remove it…?  Let me guess….

To contact MY FOX Phoenix:

KSAZ FOX 10 & KUTP My45
511 W. Adams Street
Phoenix, AZ 85003
MAIN LINE: (602) 257-1234
NEWS ROOM: (602) 262-5109
WEB SITES:
www.myfoxphoenix.com
www.my45.com
www.mydatingplacephx.com
MOBILE SITE:
wap.myfoxphoenix.com

 

Viewer Comments & "Had Enough?" Segments:
viewernews@myfoxphoenix.com

(Love this one, “Had Enough”, just not too much it appears!)

Someone unemployed?

 

The state of Texas is not done with Dr. Richard Malouf–Orthodontics Fraud King of Texas - and his All Smiles Dental Centers

 

 

FOR IMMEDIATE RELEASE
Contact: Brandy Dietz
bdietz@waterskraus.com
800.226.9880

Waters & Kraus Client Takes on Dental Medicaid Fraud in Texas

Texas AG Joins Whistleblower Lawsuit Against Dallas Dentist and Dental Clinics
DALLAS — July 9, 2012 — Dallas-based law firm Waters & Kraus, LLP announces that Dr. Christine Ellis has sued Dr. Richard Malouf and several All Smiles clinics, alleging violations of the Texas Medicaid Fraud Prevention Act.
Dr. Ellis is represented by Waters & Kraus and Jim Moriarty of Moriarty Leyendecker in Houston. Her lawsuit was recently joined by Texas Attorney General Greg Abbott.

"We at Waters & Kraus are proud to represent Dr. Ellis and to be a part of the fight against dental Medicaid fraud," said Waters & Kraus attorney Dan Hargrove. "Whistleblowers like Dr. Ellis represent our best chance to fight serious fraud that drains the public funds and puts important services at risk."

After serving as an auditor for the Office of Inspector General of the Texas Medicaid Program, Dr. Ellis became concerned about dental fraud she had uncovered. When she spoke before the U.S. House Oversight and Government Reform Subcommittee in April, Dr. Ellis testified to a “flagrancy of fraud that is truly unbelievable." Shortly thereafter, Dr. Ellis filed her whistleblower lawsuit.

The lawsuit alleges that the defendants misrepresented to Medicaid the dental and orthodontic treatment they provided, causing Medicaid to overpay them by many millions of dollars. They allegedly submitted claims for services that were not actually provided or were poorly performed, billed for services that were not medically necessary or were more expensive than those actually provided, and unlawfully recruited patients or paid kickbacks to those who did.

Jim Moriarty, of Moriarty Leyendecker, said, “The courage of Dr. Ellis has shown in reporting these allegations deserves the attention and respect of anyone who cares about public health and the responsible stewardship of taxpayers’ funds. We’re honored to work with Waters & Kraus and Dr. Ellis on this important case.”
If the lawsuit is successful, Dr. Ellis will be entitled to 15 to 25 percent of the recovery, in addition to her costs and attorneys' fees. Whistleblower awards encourage people who know about fraud to come forward. The government relies on citizens like Dr. Ellis to identify and fight fraud.

About Waters & Kraus
Waters & Kraus is a national firm with highly skilled lawyers practicing qui tam whistleblower litigation as well as complex civil litigation in four offices, including Dallas, Los Angeles, San Francisco, and Baltimore. Our attorneys have decades of experience successfully representing whistleblowers in a variety of fraud cases. Contact us or call our attorneys at 800.226.9880 to learn more about our practice and how we can assist.

About Moriarty Leyendecker
Houston-based Moriarty Leyendecker has represented thousands of consumers in cases involving allegations of healthcare fraud, consumer defects, and securities fraud during the past 20 years.

Brandy C. Dietz | Public Relations Coordinator
3219 McKinney Avenue | Dallas, TX 75204
Toll Free 800-226-9880 | Phone 214-357-6244 | Fax 214-357-7252
www.waterskraus.com

Kool Smiles Frick and Frack together again…

Appears they have reunited! Unlike Martin and Lewis who never reunited Frick (Tu Tran, DDS) and Frack (Thien Pham, DDS) have found their way back into each others arm.

Tran and Pham broke away from Small Smiles in Colorado back in 2002 and started Kool Smiles. A few years ago, Pham broke away and went off on his own. I heard he was “bought out”.

Thein Pham went on to open a couple of clinics in Arizona called Molar Magic. I hear he scouting out locations in New Mexico to open some clinics. 

 

 

 

Tu Tran, DDS stayed in the Atlanta area and slapped his name on the door of every Kool Smiles in the nation. I’m guessing he must spend his time taking CE’s and renewing his dental license since he has one in nearly every state.

 

 

 

Now, Tran and Pham are reunited and I have proof! I have proof they had “split the sheet” in 2010 and in 2012 they are sharing the sleeping bag so to speak. Maybe sharing a cell.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

You have to admire the copy paper taped to the door these days. It says:

“Kool Smiles Doctors Available to Care for Your Dental Needs Today Are…

Dr. Tu Tran, Dr. Mayfield, Dr. Nkashama, Dr. Jackson,Dr. Duckswork, Dr. Khan, Dr. Ogundipe, Dr. Twardy, Dr. Kalra.

They emphasized “Today”…  but I know dang well all these dentists are NOT available to see to anyone’s dental needs..not today, not tomorrow and not yesterday!

I don’t know what all this means, but you can bet they are up to no good.

Kool Smiles Dental–NCDR,LLC-FFL Partners’ written response to Senators Grassley and Baucus

Anyone buying this load of crap? Of course not. I can’t imagine sitting in my office reading this fairy tale and not getting angry as a wet hen (whatever that is). My blood would be boiling.

Kool Smiles Dental Centers Letter to Senators Grassley and Baucus 02-03-2012

Does your dental malpractice insurance have a $75,000.00 per claim deductible? If you work for Small Smiles it does!

Dentists currently employed by Small Smiles know they are open to lawsuits. The hundreds of malpractice suits on file in three states should make that crystal clear. What might not be so clear is exactly what kind of malpractice coverage they have. It’s not at all what it used to be.

Are you aware you have a $75,000.00 deductible per claim?

 

 

 

One single claim could ruin you and once again, Small Smiles the company, walks away unscathed.

The current policy is set to expire in September. I’m thinking getting your own coverage might be the best option. Never trust that wolf in sheep’s clothing.

Indiana AG filed complaint against Allcare Dental and Dentures

 

Complaint filed against Allcare Dental & Dentures

Jul 06, 2012 WNDU.com

The Indiana attorney general's office has filed an administrative complaint against Allcare Dental & Dentures President Robert Bates for multiple licensing violations.

In January of last year, Allcare Dental & Dentures, which is a national chain of dentist offices, abruptly closed its locations including one in Mishawaka.

According to the complaint filed before the Indiana State Board of Dentistry, the president gave a two-day notice to his Indiana employees that offices would close for two weeks.

Days before the offices were supposed to re-open, he notified his workers that the offices would be closed permanently.

Indiana's attorney general says patients were left without their dentist, their records, dental devices and did not get a refund.

The Indiana State Board of Dentistry will decide if a violation occurred and if so, what disciplinary action there will be.

The board is tentatively scheduled to hold a hearing on the complaint in October.

“We’re finding that these dental practices, under pressure from owners who are not licensed dentists”–Sen.Chuck Grassley.

Senator Grassley says the problem is rooted in the structure of these chains, “I’m finding in this investigation that there are people that know nothing about dentistry are saying you got to see so many people, you got to do so much work for each one, and in a sense, gaming the system,” There are legitimate concerns that children are receiving unnecessary care, sometimes in a traumatic way, and taxpayers are paying for it.”³– Sen. Charles Grassley (R) Iowasaying that it claims that dentists own the practices but in reality they do not have control.¹

The Senator also states, “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,” ²

Ghost owners, fake owners, throw away owners, call them what you like.

They are, in truth, are criminals, assisting, aiding and abetting the commission of serious crimes. Crimes against children and crimes against American citizens. Not for free, but for a piece of the pie. They willing lend their name, their professional license and their signature to assist in child abuse, insurance fraud and Medicaid fraud.

On June 21, Robin Lockwood, DDS of the Ocean Dental chain was arrested for Medicaid fraud. She could face up to 10 years in Federal prison.  Robin looks to be about the same age as the Small Smiles dentist below.

As Robin Lockwood, of the Ocean Dental Chain, can attest, when the law comes knocking, they are not going to be knocking on the door at 618 Church Street, Nashville, Tennessee or at NCDR, LLC’s headquarters in Atlanta…

Here is one of Small Smiles Dental Centers “ghost dentist”, that Senator Grassley was referring to – Dr. Jodi B. Kuhn

Doesn’t look much like a criminal does she? She looks like she could be a very loving and protective mom.

Wrong.

She seems to not be loving enough to make sure she is not the next Robin Lockwood facing 10 years of prison time. 

Dr. Jodi B. Kuhn claims to own 7 dental clinics, quite a feat to be so young. She claims to own:

1. SMALL SMILES OF AKRON, LLC - JODI KUHN, DDS AND ELIZABETH GEIER, DMD
2. SMALL SMILES OF CINCINNATI LLC - JODI KUHN, DDS AND ELIZABETH GEIER, DMD
3. SMALL SMILES OF COLUMBUS, LLC - JODI KUHN, DDS AND ELIZABETH GEIER, DMD
4. SMALL SMILES OF DAYTON, LLC - JODI KUHN, DDS ELIZABETH GEIER, DMD
5. SMALL SMILES OF ROSELAWN, LLC - JODI KUHN, DDS ELIZABETH GEIER, DMD
6. SMALL SMILES OF TOLEDO, LLC - JODI KUHN, DDS AND OLIVIA CROOM, DDS
7. SMALL SMILES OF LOUISVILLE, PSC

Small Smiles of Louisville PSC 6-13-2012

  (I see they are still using her rubber stamp signature…and even with all eyes upon you swearing you don’t own the Louisville dental center…this was just filed 2 weeks ago!!)

Dr. Kuhn worked at the Roselawn clinic until October of 2011 when she transferred to the Denver clinic. The Denver clinic was having production issues after a little x-ray scam went belly up and Kuhn is a top producer. Being a top producer, Dr. Kuhn got VIP  tour of the Colorado clinic by Mike Lindley in the flesh. She agreed to the deal and moved to Colorado.

Dr. Elizabeth Kay Geier, another “ghost owner” is the newest co-owner with Dr. Kuhn-there have been others. Dr. Geier comes from the Albuquerque –1 clinic. Geier has been with Small Smiles since August 2007 and was granted a dental license in Ohio in July 2010.

Hey owner dentists, like Jodi Kuhn, Gloria King, Monica Switzer, Randy Ellis, Karen Chu, and others you need to see this. YES, they will throw your butts under the bus in heart beat!!

 

Small Smiles Letter to Senator Grassley 11 29 2011

Small Smiles letter to Senator Grassley's investigators -12 16 2011

 

 

 

^1,2,3 Heath, David. (2012, June 30). “Evidence of overtreatment at dental clinics serving poor children”. Center for Public Integrity - iwatchnews.org

No one has stopped the “Child Abuse for Medicaid Fraud” scheme; not yet anyway.

1997 – Drs. Michael and Eddie DeRose along with Dan “put coke machines in schools” DeRose started opening dental centers to abuse children so they could defraud Medicaid, then build a football stadium in their own honor.

2001 – Dr. Tu M. Tran and Dr. Thien Chi Pham were dentists working at Smile High Dentistry in Colorado. Smiles High Dentistry is part of the Small Smiles Dental chain.

2002 – Tran and Pham were convinced to move to Atlanta and open up Kool Smiles, starting with 2 centers.

2004 – Friedman, Fleishcher and Lowe bought the centers and established NCDR, LLC to be the dental management division of FFL.

2006 – First Islamic Bank (aka Arcaptia aka Crescent Capital) gave the DeRoses $435-million for the dental centers.

2007 – In Georgia two companies who over saw Georgia's Medicaid benefits kicked Kool Smiles out of their network of dental providers for it’s Medicaid patients. Kool Smiles said it was because Wellcare wanted to cut it’s own costs! Wellcare said it was because children being abused for profit and fraud. Georgia agreed with Wellcare, and found over 6% of all Kool Smiles patients files didn’t need the care they received and over 3% of the treatment was substandard.

2012 - We are still where we were in 2007 with Kool Smiles – children abused, substandard treatment, fraud.

With Small Smiles nothing much has moved either. Pretty close to the same as in 2003 when reports of its child abuse first surfaced – 11 very long years have passed and we are zooming toward year number 12.

Kool Smiles continued to grow to over 120 dental centers today Small Smiles topped out at 72 or 73. Hundreds of dentists, who likely worked for one of these mills, broke off and opened their own smaller versions of this business mode- Abuse and Defraud for Profit. Adventure Dental and Vision is just one example. Their “owner” also worked for a Small Smiles Dental Center.

Small Smiles alone, treats 1-million children a year.

There have been numerous news reports on Kool Smiles Dental Centers since it’s beginning. There have been at least 72 73 news reports on Small Smiles Dental Centers since 2003.

Each report, from coast to coast, contained the exact same allegations:

• Children being restrained and physically assaulted.
• Unnecessary overtreatment.
• Parents filing complaints and nothing being done.
• A State or Federal Agency is Investigating.

There have been a few letters mailed out scolding the business practices, a tiny weeny fine or two – (that has not been paid yet) and a couple of Corporate Integrity Agreements that the executives wiped their asses on. (well, it’s true!) An a few “official” reports. Personally I’m not sure what a “report” actually accomplishes.

Here is reporter, Sydney Freedberg's report for Bloomberg, published just last week!

Today is July 4, 2012 and hundreds of these little houses of horrors will open their doors tomorrow.

So far Small Smiles has seen:

• $24-million dollar fine they have not paid
• A 66 page Corporate Integrity Agreement they have not followed
• A few scolding letters with no bite
• A $230,00 fine – they have not paid. (the actual fines for all the violations amounted to millions, but they got a discount)
• One measly dental center in Manassas, Virginia they swear they do not own had to be transferred to a new owner
• The Oxon Hill dental center closed for two days of training! I’m NOT kidding!!
• Checks from the Medicaid fund still arriving in their bank accounts daily.

Hell, no wonder everyone wants in on the action.

CSHM Breach of Corporate Integrity Agreement March13 2012 <p>&nbsp;</p>

On March 7, 2012, just days after filing bankruptcy, their independent monitor did a check of the Oxon Hill Small Smiles and turned up all kinds of problems. On May 15, 2012 HHS once again sent out another letter, telling them to shut Oxon Hill down for a two day training session.

The letter stress HHS’s concern that just days prior to the March 7, 2012 monitor visits, that the Chief Compliance Officer – Lorri Steiner,- the Chief Dental Officer, Steven Adair or Gus Ghassen or both – the SVP of Operations, Kevin Reilly,- the Executive Director of Operations,Lisa Mullinix or Scott Nearing maybe- the Compliance Attorney, Sheila Sawyer, and the Regional Director, Dr. Marlene Navedo had been to Oxon Hill Small Smiles and couldn’t find a thing wrong. NOT ONE THING! How can that be???

Are they incompetent or criminals, it has to be one or the other. Are the same folks still running the show down there? Yes indeed…several of them are still there.

Something big happened that was quite serious, I don’t know what, by the Oral Surgeon at the Oxon Hill Small Smiles on February 20,2012. I don’t know if I want to know either.

CSHM Agreement with Office of Inspector General May 15 2012

Next Wednesday, July 11, 2012 is the dead line for CSHM to have reviewed and report past overtreatment at the Manassas clinic. As Bloomberg Businessweek reported, with 42% of all the root canals checked, (104 unnecessary root canals out of 244) deemed unnecessary I’m guessing that report will not look good for the dentists working there, or the company.

This company has been under the watchful eye of government regulators since 2007, when the investigation first began. Can you get your head around the fact they have not changed their ways in 5 years!!!! 

Arrests next week?

Ontario Municipal Employees Retirement System (OMERS)–Raising capital for more dental center purchases?

July 3, 2012
Today OMERS is in the news because it sold a hunk of it’s private equity funds investments to AXA for $850-million.  OMERS says it likes “direct” investment much better. Citing – “direct investments give it more control over its assets than investments through third-party private equity funds, and keep investment costs lower.”

 In October 2011 Canadian OMERS purchased Great Expressions Dental Centers (GEDC) from Audax .

In March 2012, OMERS again put its money where your mouth is, with the purchase of Exceldent. Which added another 19 private equity owned dental centers to NY, CT and NJ.

Related -

About OMERS Private Equity
Operating under the OMERS Worldwide brand, OMERS Private Equity manages the private equity activities of OMERS and has over $6.3 billion of investments under management. The group’s investment strategy includes the active ownership of businesses in North America and Europe. OMERS Private Equity is headquartered in Toronto, with offices in New York and London. For further information visit: www.omerspe.com.

About OMERS
OMERS is one of Canada’s largest pension funds with over $55.1 billion in net assets. It provides first-class pension administration and innovative products and services to almost 420,000 members. Approximately one in every 20 employees working in the province of Ontario is an OMERS member. Through the OMERS Worldwide brand, our team of investment professionals uses a direct drive, active management investment strategy to invest in public and private market assets, including publicly-traded equities, fixed-income, infrastructure, private equity and real estate. For more information, please visit www.omers.com, or www.omersworldwide.com

 

21 Oct 2011

US private equity firm Audax has sold Great Expressions Dental Centers (GEDC) to OMERS Private Equity for an undisclosed sum.

Headquartered in Bloomfield Hills, Michigan, GEDC is a dental practice management company that provides general and specialty dental services through 152 affiliated practices in Michigan, Georgia, Florida, Massachusetts, Ohio, Virginia and Connecticut.

The company was founded in 1982 by Dr Knysz, who served as chairman. Audax acquired a majority interest from Dr Knysz in May 2008 and, along with management, subsequently sourced and integrated ten add-on acquisitions.

Geoffrey Rehnert, co-CEO of Audax, said, “Rich Beckman and his management team did a terrific job working with us to build the company through add-on acquisitions and by establishing best practices across the company.

“We implemented financial controls and reporting systems to improve operating efficiencies, enabling affiliated dental providers to remain focused on patient care and clinical excellence. We wish Rich and his team continued success,” he added.

Small Smiles Dental Changing It’s Ways… HA! –that’s what they said the last time they changed their name, and the time before that and the time before that…

Small Smiles is saying it’s changed it’s ways, I beg to differ, since we’ve heard that before…several times. This company has been under the watchful eye of government regulators since 2007, when the investigation first began. Can you get your head around the fact they have not changed their ways in 5 years!!!!
It’s changed it’s name a few times, but not it’s ways!
Struggling dental chain looks to mend its ways
By Rob Goszkowski, Assistant Editor
July 4, 2012 -- Church Street Health Management, a private-equity-backed company managing 63 dental centers under various "Smiles" brands in 21 U.S. states, has emerged from bankruptcy with new owners, a new identity, and a new strategy for staying in the dental game.
Now going by the moniker CSHM, the company has a history of legal problems that forced it to file for bankruptcy earlier this year and prompted additional federal scrutiny.
For example, in January 2010, while still known as Forba Holdings, the company paid $24 million plus interest to settle allegations of Medicaid fraud with 22 states and the U.S. Department of Justice. The fine resulted in part from a policy of "converting" patients, whereby dentists were systematically urged to perform additional procedures and the number of procedures performed was tracked.
Read the rest over on Dr. Bicuspid

Senators Chuck Grassley and Senator Max Baucus inquire into illegal ownership of dental chains.

Did the Senators get nothing but lies from Small Smiles Dental, Kool Smiles Dental, Reachout Healthcare America, and Aspen? I'll let you decide.

Small Smiles Dental attorney's, King and Spalding, respond to Senator Grassley’s Investigators - November 29, 2011

Second response letter from Small Smiles Dental Centers to Senator Grassley’s Investigators - December 16, 2011

Kool Smiles Dental responds to Senators Grassley and Baucus Inquiry - February 3, 2012

Reachout Healthcare America responds to Senators Grassley and Baucus inquiry- February 23, 2012

Reachout Healthcare America's second response to Senators Grassley and Baucus - March 22, 2012

Aspen Dental response to Senators Grassley and Baucus inquiry -February 13, 2012

Aspen Dental's second response to Senators Grassley and Baucus - April 18, 2012

Aspen Dental Defrauding the poor and elderly esposed

 

$2,540 for 2 fillings? Poor hit by high fees at chain

By David Heath

The Center for Public Integrity

updated 7/1/2012 2:41:00 PM ET

Surviving on a meager $1,300 a month, 87-year-old Theresa Ferritto fretted about the cost when her dentist told her she needed two teeth pulled.

She figured an oral surgeon would be too expensive. So she decided to try out a dental chain that promoted steep discounts in its advertisements. She went to an Aspen Dental office just outside Cleveland.

Ferritto said Aspen Dental wouldn’t just pull the teeth but insisted on a complete exam. She was bewildered when they finally handed her a treatment planfour pages long. Total price: $7,835.

Ferritto could not afford it, but Aspen Dental signed her up for a special credit card, with monthly payments of $186 for five years. She blames herself for signing the papers.

“I made a big mistake going there,” she says. “I should have known better.”

After a day of cleanings and two fillings, Ferritto asked her son for help. He called Aspen Dental to complain but said he got nowhere. So they turned to the state Attorney General.

Aspen Dental took all charges off her credit card for treatments she hadn’t yet received. But said the $2,540 she was charged for two fillings and cleanings was appropriate.

Read the rest at MSN.com

Bill Brigham – Chief Operating Officer for Kool Smiles Dental Centers is said to have “resigned”.

Coming two days after scathing exposé by FRONTLINE and the Center for Public Integrity of the fraud, child abuse and corruption at Kool Smiles Dental Centers and NCDR, LLC.

Of course I’m not 100% sure, but I’m “pretty dang sure”, he’s gone.

Bill has been with Kool Smiles since 2007, so his hands are plenty dirty one would suspect. Where was he before Kool Smiles Dental? He was with Kohls, Home Depot, Macy’s and Belk’s department stores.
(me shaking head)

I don’t think there would have been much fan fair as he slithered out the back door, do you?

Should we be on bankruptcy watch? Maybe so.

Bill Brigham - Former COO of Kool Smiles Dental Centers

Academy of General Dentistry and American Dental Association Responces to “Dollars and Dentists” Program on PBS

Considering the Academy of General Dentistry (AGD) and the American Dental Association (ADA) are in the same building in downtown Chicago, my mouth actually fell open when I read this statement from the AGD.

Academy of General Dentistry Responds to “Dollars and Dentists” Program on PBS

Chicago (June 27, 2012)—On Tuesday, June 26, the PBS “Frontline” documentary series aired “Dollars and Dentists,” a special program that investigated what it referred to as the “broken nature of the dental care system” in the U.S. According to the PBS piece, more than 100 million Americans currently do not have dental insurance and cannot afford treatment. “Dollars and Dentists” attributed this lack of patient care to the Medicaid system, stating that it did not provide enough of a profit margin to dentists treating children at Medicaid rates. The segment implied that there are very few solutions available to solve this access to care problem. However, extensive analysis conducted by the Academy of General Dentistry (AGD) and other dental organizations has found that this is not the case.

“Dollars and Dentists” showcased the plusses and minuses of high-production dental franchises, which many claim will help to decrease the cost of care for Medicaid rates. The AGD shares the concerns voiced by “Frontline” that, as a business model, dental franchises that focus on quantity before quality may not be in the public’s best interest.

“I am concerned by business models that emphasize production quotas and do not individualize treatment for every patient,” says AGD President Jeffrey M. Cole, DDS, MBA, FAGD. “The focus becomes the company’s revenue rather than personalized care. Each patient deserves the type of time and attention provided by the traditional dental team business model, which promotes better oral health.”

In the “Academy of General Dentistry (AGD) Barriers and Solutions to Accessing Care” white paper, the AGD renews its call for proven dental care solutions and quality care, which were originally outlined in its 2008 “White Paper on Increasing Access to and Utilization of Oral Health Services.” The AGD calls for an increase in Medicaid reimbursement rates, greater efforts to improve oral health literacy and education, expansion of water fluoridation, and the creation of loan forgiveness programs for dentists working in underserved areas, among numerous other solutions that preserve the focus of providing quality care to each individual patient.

Polly “Wanna Crack Her” Buckey Remix

You can't hide your lyin eyes
And your smile is a thin disguise
I thought by now you'd realize
There ain't no way to hide your lyin' eyes
There ain't no way to hide your lyin' eyes
Honey, you can't hide your lyin' eyes – The Eagles

All joking aside, there is no way you can miss when she’s lying. The corner of her mouth pulls to the left, she looks to the right, and her voice is deep and raspy. (shaky)… and she gets that whacked out look on her face.

What I’m wondering is why Dr. David M. Strange has stopped putting his family at risk by going on TV and lying. Maybe it’s because, even though she sucks at it, she is the one willing to risk it all to do it.

There is a lot of hoopla over the FRONTLINE and Center of Public Integrity investigation, which is well deserved. But all the allegations are not new. These same allegation have been hitting regional and local news stations for years.!

Reports have landed in the local press and on local news stations since at least 2008. It is 2012, right?  Is anyone listening to these parents; to these employees?

Here are some of the reports:

Bloomberg reports on Private Equity Dental Chains thus far in 2012

 

To READ:

by Sydney Freedberg - sfreedberg@bloomberg.net.

Dental Abuse of U.S. Poor Dodges Ejection from Medicaid – June 26, 2012 The latest from Bloomberg demonstrates how the OIG is still turning it’s head to the child abuse for fraud, at Small Smiles Dental Centers. This one is outrageous. They ask CSHM to put the clinic in the name of a third party. Well, according to CSHM sworn testimony on numerous occasions, by various Small Smiles Executives they don’t own the clinics. Their mantra is that they only manage them for already third party dentists. The take away is  that the OIG. HHS and DOJ are fully aware (how could they not be) that the true owners of these houses of horrors is CSHM and it’s Private Equity backers. They must simply give them a wink and a nod to falsifying documents, committing fraud, and perjury, just to name a few illegal acts. These would land you or I in jail, by the way.  I don’t know what else a person could think. Do you? Republicans Hit Dental Bill That Private Equity Hates – June 1, 2012 Dental Abuse Seen Driven by Private Equity Investments – May 16, 2012

Texas Attorney General Lawsuit–Dr. Richard Malouf–All Smiles Dental Centers

Texas AG lawsuits spurred by WFAA dental investigation

 

Posted on June 26, 2012 at 12:38 PM

Updated today at 9:40 AM

Related:

• Dental Investigations

DALLAS - A year-long WFAA investigation into questionable Medicaid dental payments has resulted in the Texas Attorney General filing lawsuits this week.

Greg Abbott charges that a Dallas dentist and his corporate entities bilked taxpayers out of millions for fraudulent orthodontic work on poor families.

Dallas dentist Richard Malouf amassed a multi-million dollar mansion, corporate jets and luxury vehicles through his dentistry, News 8 has found.

He and his former firm, All Smiles, declared bankruptcy following a series of reports detailing how he and other dentists around Texas gamed the welfare system by billing for unnecessary dental work.
WFAA found that over the past few years, Texas has paid out more in Medicaid orthodontic claims than all other 49 states combined.
All Smiles billed Medicaid for at least $15 million over two years, which is twice as much as the entire state of Illinois. The Attorney General’s lawsuits, filed in Austin Monday, seek to recoup “two times the amount of the overpayments.”

WFAA’s findings have spurred outrage among lawmakers and hearings in Austin and Washington D.C.

Madelayne Castillo, a former All Smiles employee, and Dallas orthodontist Dr. Christine Ellis filed separate whistleblower lawsuits in April and May alleging fraud by Malouf and his corporations.
Both lawsuits remained sealed while the Attorney General’s office investigated the claims. On Monday, Abbott’s office joined those lawsuits by refiling them in the state's name.

In April, Dr. Ellis testified before the U.S. House Oversight and Government Reform subcommittee that Malouf and other dentists were responsible for “flagrancy of fraud that is truly unbelievable."
In May, WFAA reported that All Smiles bankruptcy documents showed that Malouf owns 28 percent of the company, and Valor Equity of Chicago had the remaining 72 percent.
A subsidiary of Valor is a named defendant in one of the Attorney General’s suits.

Abbott alleges Malouf and others violated of the Texas Medicaid Fraud Prevention Act.

“The defendants knowingly or intentionally submitted false information, and misrepresented material facts, when seeking prior approval for orthodontic services,” the lawsuit states.
“Defendants submitted claims for services which they did not provide, and misrepresented or concealed the true nature of the services which they provided,” it states.

“Defendants also knowingly paid or received consideration as a condition of the provision of dental/orthodontic services by unlawful recruiting and paying kickbacks for the recruiting of Medicaid clients,” it continues.

The suits allege that Malouf and the other defendants billed for work that was not medically necessary, and in some cases, performed it with unqualified dental workers. They also “upcoded,” or billed for orthodontics which were more expensive than what was actually provided, the suit states.

by BYRON HARRIS and JASON TRAHAN

Bio | Email

WFAA

FRONTLINE–Center for Public Integrity Investigation into dentistry in America

 

WATCH: Dollars and Dentists – June 26, 2012    READ: Sen. Grassley Investigating Abuse at Corporate Dental Chains – July 2, 2012 How The Supreme Court’s Ruling Affects Dental Care -  June 28, 2012 Aspen Dental CEO Bob Fontana: “We’re Big Advocates for the Patient” -June 26, 2012 Kool Smiles Response – June 26, 2012 American Dental Association Response to FRONTLINE “Dollars and Dentists” – June 27, 2012 Senator Chuck Grassley’s Response – Report on Findings Expected – June 27, 2012 Dr. Bill Calnon: Why Dentistry Needs More Prevention, Not More Treaters - June 26, 2012 Dental Professionals Speak Out About America’s Care Crisis – June 27, 2012 How To Fix A Broken Dental Safety Net – June 27, 2012 When the Dentist Won’t See You – June 25, 2012 Do You Live in a Dental Desert? – June 27, 2012 America’s Dental Care Crisis – June 19, 2012

Compromise Reach in North Carolina Dental Board of Examiners v Private Equity Dental Chains: NC residents lose

 

Detente reached in dental dustup

June 27, 2012 2:53 PM

Raleigh, N.C. — A high profile legislative battle -- complete with television ads and attention from federal bureaucrats -- between various groups of dentists has ended in compromise.

The North Carolina Board of Dental Examiners and the state's Dental Society had been pushing a bill that would limit dentistry management arrangements. Under those agreements, dentists affiliate with companies that handle certain aspects of their business.

Some of those agreements ceded too much power to the corporations, members of the board and society said. They worried that corporate officials based in other states would make treatment and scheduling decisions for the dentists. 

But the dental management companies and dentists allied with them said the board was interfering in private businesses. They said DMAs give younger dentists trying to open a practice and older dentists winding down their work options that lone practitioners don't have.

"The DMA organizations are going to grow," Dr. Alec Parker, executive director of the dental society, said today. "We just want to make sure their growth includes patient protections."

The House Health and Human Services Committee approved a much shorter bill than the society had originally sought. Language in early versions of the bill that would have given the dental board sweeping policy powers -- such as being able to scrutinize business records -- were not included in the compromise bill.

Existing dental board rules will be allowed to stand, but both sides agreed to create a task force that would recommend changes that would accommodate new business arrangements. 

Representatives from both sides say they expect that task force and the dental board to hammer out a revised set of rules to the liking of all parties and avoid a return trip to the General Assembly.

Over the past several months, both the dental society and the Alliance for Access to Dental Care, a group funded by dental management executives, aired hundreds of thousands of dollars worth of television ads.

Advocates fighting for the bill painted the fight as one that pitted dentists in traditional practices against big corporations funded by private equity groups more concerned with making money than providing quality care. Dental management firms hit back that old-school dentists were trying to limit competition as thousands of North Carolina residents went without affordable dental care. 

Lobbying was intense and involved well known figures in the national Republican Party such as former Florida Gov. Jeb Bush and Grover Norquist of Americans for Tax Reform. In addition, the Federal Trade Commission weighed in, saying the bill first proposed by the Dental Society would have improperly cut down on competition and consumer choice.

"The tensions between both groups will be considerably less," said Tom Fetzer, the alliance's lead lobbyist in Raleigh.

Making the negotiations even touchier was the push and pull between members of the legislature who were dentists and the stated goal of most Republicans to cut back on regulations. 

"It is in the best interest of all parties that the law be clarified," said Rep. Bert Jones, R-Rockingham, a dentist and one of the members tasked with helping both sides find consensus.

In addition to creating a task force, the bill also redefines terms in dental regulations and clarifies how and when the dental board can exercise oversight powers over dentists entering into dental management contracts.  

The full House is expected to hear the bill Wednesday afternoon.

Private Equity Western Dental opens SmileBest in San Antonio–Sinking Ship before it sales ?

Grand Opening on June 30, 2012 for a new “SmileBest Dental in San Antonio.

SmileBest is really Western Dental - P.O. Box 14226, Orange, CA 92863

The..(clearing throat and trying not to choke)… “owner” is Soumava Sen, D.D.S

See press release here
Media contact:
WesternDentalPR@gmail.com

Kurt Hilzinger, Partner, Court Square – is on the board of Western Dental – see here, pg 11.

May 30, 2012

Western Dental mandates Jefferies for sale process

High quality global journalism requires investment. Please share this article with others using the link below, do not cut & paste the article. See our Ts&Cs and Copyright Policy for more detail. Email ftsales.support@ft.com to buy additional rights. http://www.ft.com/cms/s/2/65a120a2-aa4e-11e1-8b9d-00144feabdc0.html#ixzz1z1mjNHpZ

Western Dental Services, the private dental clinic chain, has mandated Jefferies for a sale process, a source familiar with the matter and an industry banker told mergermarket.

The Orange, California-based company generated USD 71m in EBITDA for 2011, said the source familiar. Books have been distributed to potential bidders, but a first round bid date has not yet been set, the source said.

Western Dental will appeal to private equity firms, said the banker and the source. Jefferies has been reaching out to private equity firms regarding the sale, said the banker.

The company was acquired by Court Square Capital Partners, formally known as Citicorp Venture Capital, in 2005. This news service previously reported that Court Capital was one of the bidders in the final round of the previous process for the company in 2005, at which time Western Dental had USD 45m in EBITDA and was said to be selling for a multiple of 8.2x EBITDA, according to previous reports by this news service.

Read the rest here

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.