If you’ve not been approached by one of the Private Equity dental companies, then this will be a treat.
Great Expressions Acquisition Solicitation Package
Tuesday, September 04, 2012
Monday, September 03, 2012
WSJ- Texas has eye on Xerox in Texas Dental Medicaid Fraud
By NATHAN KOPPEL
Texas authorities are investigating whether Xerox Corp. played a role in allowing dentists to allegedly overbill the state's Medicaid system by millions of dollars.
Like many states, Texas contracts with Xerox to process forms submitted by dentists, who seek a determination about whether procedures they intend to perform are covered by Medicaid, a federal-state program that insures lower-income people. The company evaluates whether the planned procedures are medically necessary.
The Texas Health and Human Services Commission says it is concerned that Affiliated Computer Services Inc., which Xerox acquired in 2010, didn't dedicate enough trained staff to vet dentists' Medicaid requests, allowing dentists to receive payments for procedures not covered by the program.
Xerox declined to comment on the Texas investigation but said it doesn't face similar scrutiny in other states. The company said it helps administer Medicaid programs in 36 states and the District of Columbia, processing $54 billion in annual Medicaid spending.
"Xerox has more than 40 years of experience working with government health agencies to enhance the efficiency of health programs," company spokeswoman Jennifer Wasmer said.
A 2008 audit by the Texas health agency's inspector general found that ACS had one dentist on staff to review thousands of Medicaid requests, and that the dentist examined only about 10% of them. ACS responded that its contract with Texas didn't require all requests to be reviewed by a licensed dental professional.
The current scrutiny of Xerox in Texas, covering a period from 2008 to 2011, is part of a broader state investigation into Medicaid abuse that has so far largely targeted dentists and orthodontists, who have been accused by state officials of improperly billing the state for procedures including putting braces on youngsters for purely cosmetic reasons and performing unnecessary root canals on small children.
The Texas Medicaid program paid out $1.4 billion to dentists and orthodontists last year—a roughly fourfold increase since 2006. In 2010, the Texas Medicaid program spent more on braces than all other state Medicaid programs combined, according to a report from the U.S. House Committee on Oversight and Government Reform.
Texas dentists and orthodontists note that they are required to obtain the state's approval before billing Medicaid.
The Texas Health and Human Services Commission, in turn, has tried to pin some of the blame on Xerox for allegedly signing off on questionable procedures.
The agency's inspector general is auditing Xerox and will fine the company if it concludes Xerox didn't live up to the terms of its contract with the state, said Stephanie Goodman, a spokeswoman for the agency.
The Texas Attorney General's Office in June also issued a civil investigative demand, akin to a subpoena, against Xerox in connection with the agency's investigation into Medicaid fraud.
At the behest of Texas officials, Xerox hired a new dental director to review Medicaid requests last year, Ms. Goodman said, noting that the current audit of Xerox should be completed later this year.
Xerox's role has been diminished, she added, because in March the state shifted much of the responsibility for approving Medicaid requests to managed-care organizations.
Write to Nathan Koppel at nathan.koppel@wsj.com
Kool Smiles Complaint # 153359
- Date Occurred:08/14/2012
- Reported Damages:$1,300.00
Over a 3 week period of time i had gone into cool smiles for fillings. I was told they couldn't do it all at once and said it was going to take 6 visits. I told them every week for 6 weeks is unacceptable seeing as i have 3 small kids and am new in town and don't have a babysitter! we got it down to 3 weeks by doing top right and bottom left. next visit was top left bottom right, and last trip was the top and bottom front. I knew that we had some bad cavities but the dentist assured me they would do every thing they could to avoid a root canal! well the first dentist who worked on me wasn't the dentist i originally met and talked with. Threw the 3 weeks i was never told how or what they were going to do to my teeth. Never was told a name of my dentist or nurse ( which were different every time). The work was done shoddy so every time i went back i told them of my still growing pain and discomfort. They just kept filing down the fillings. after the 3rd weeks visits i told them i was still in bad pain. they then said without x-rays that m 2 back molars must have gotten fractured and all my insurance would cover was to extract them! No way! They would ultimately end up pulling 3 to 4 teeth if i let them do that. Then after the last visit when i got home i noticed when brushing my teeth something crunchy. It the "filling" they did. they just covered 2 teeth together so i couldn't brush or floss in between and that had fallen out after the 1st day of it being filled. It left a gap big enough to see a cavity that was not cleaned or filled properly at all. I have tried to call the locations manage but the nurse/receptionist that answered the phone kept changing the subject and wouldn't listen to me or help. I then called the call center (which hung up on me 3 times before actually taking my call) and made a formal complaint to the highest up section i could who then forwarded a copy of my complaint to headquarters and the store manager. Going on 8 days past now and still no call backs from any one!!!! I am in excruciating pain and cant eat even with antibiotics for the abscess this drama has causes and pain pills which barely help and make me sick to my stomach! I asked for my x-rays to go to another dentist and was refused them even though i paid for them. The nurse said "what do you need them for" and never would release them! I hate that we chose this place and i hate all the crap and suffering I'm having to go through and they cant even be human enough to call back or see if they can fix it or do any thing to help! We will NEVER go back there ever again!
http://www.scambook.com/report/view/153359/kool-smiles-Complaint-153359-for-$1,300.00
(as taken from website, with typos corrected)
Sunday, September 02, 2012
Dental care in America: A study in austerity, neglect and profiteering
Dental care in America: A study in austerity, neglect and profiteering
By Gary Joad
1 September 2012
A Frontline production on the Public Broadcasting System (PBS) aired in June documented the painful and ill experiences of millions of working class families and their children, the disabled and poor, and retired persons as they seek dental care in the United States.
In the opening scene of “Dollars and Dentists,” hundreds of people with jaw and tooth pain form long lines in the early morning freezing rain of southern Virginia, seeking relief from a volunteer dental clinic. Most patients declare on camera that they are often too sick and sore to eat, and that they are compelled to live with pain every hour of their lives.
As the clinic’s Dr. Terry Dickenson states at the program’s beginning, “Gas, food, and rent compete with dental care for the dollars these persons have.”
Washington, D.C. resident Vanessa Nations, 31, reported that she had been significantly ill with dental and gum infections for many years, until her problems became so severe that she needed all her teeth extracted. She commented, “I feel like little bits of poison are killing me.”
She could not eat sufficiently, and therefore could not maintain a normal weight. Virtually all her teeth were chipped, broken off, and discolored. Poignantly, she brought a smiling teenage photo of herself to show the dentists how she wanted to look again, as they planned the removal of her ruined teeth and the manufacture of her dentures.
Saturday, September 01, 2012
Dr. Li Lu Skelton, DDS–San Antonio, Texas
Dr. Li Lu Skelton – Li Dental Implant & Smile Center – appears to be an habitual offender. It seems landing in front the the Texas State Dental Board of Examiner’s is nothing more than the normal course of doing business.
Dr. Li Skelton’s record at the Texas State Board of Dental Examiners reflects she serves up some substandard dental care pretty regularly. In one case alone, she had to pay an $8,000 fine and $11,000 fine. In at least one other case, she delivered too much anesthesia to a patient, causing that patient seizures and hospitalization, according to the KSAT report.
When KSAT-TV featured one of her mangled patients – Darryl Davis- in a May 2012 report, Dr. Skelton sent this lovely letter to the station when asked for comment.
Li Dental Care, PC
In San Antonio, Texas
18th of May 2012
(The patient) has made several accusations relating to his treatment. He had accepted and signed three agreements which include confidentiality as to the content of these agreements.
[ Note, the very first paragraph in her comment, was to point out she felt as though she had convinced – I call it duped- her patient into signing three agreements to keep quiet about her gross negligence, malpractice and battery.
If threats standard procedure for Dr. Li Lu Skelton, wonder how many patients are out there, that have been mangled, feel intimidated by her and feel they have no place to turn for help.]
Dr. Li and the Dental Practice have made every reasonable effort to satisfy (the patient's) concerns and his continued attempts at demanding money and challenging the professional reputation of this Dental Practice are unfortunate.
[Clearly, Dr. Li Lu Skelton, has NOT made every effort to “satisfy” this patient’s concerns, instead she took him to court to try and shut him up.]
By making this a public issue, (the patient) may be considering our release of this patient information to the public. We will not do so. Patient confidentiality is not something we take lightly and will not ever violate patient confidentiality. Therefore, we cannot respond directly to (the patient).
[Huh? First, considering Dr. Li Lu Skelton’s many complaints from patients, this is a public issue, she could well be a danger to public health.]
Li Dental Care, PC is a professional Dental Practice operating in San Antonio for over 15 years, providing professional dental service to thousands of patients. Additionally, Dr. Li has placed over 6,000 implants and had produced thousands of wonderful smiles for Texans.
As in most matters of human endeavor sometimes things do not work out as planned. Even in manufacturing there is a failure rate. In the matter of implants a small percentage are going to fail. It does happen and sometimes there is no identifiable reason as to why implants fail. The good news is that this is ordinarily fixable.
[So, the “good news” is that this is ordinarily fixable? Really? With all “good news” statements like that, there is always the “bad news” to follow. For this patient, the bad news is:
“I will need to lose all of my back molars a total of 6 teeth, and that's not the best news. I have front teeth that were crowned over teeth with soft tissue and will need them removed as well. So, at a young age I will need to wear an upper denture for at least 6 months so the infections in my sinuses both left and right side can heal. And imagine there is no help for dental patients that have been treated this way. I am left without words!” – Darryl Davis
Li Dental Care, P.C. stands on its very high quality reputation for professional services and patient care. Dr. Li’s goals include helping her patients achieve the new smile they so much desire and deserve.
[High quality reputation, hmmm, just how is that measured and where can I find that reputation? Not on file at the dental board, that’s for sure, not looking good in Bexar country district court records either, see below.]
Darryl was getting “No Satisfaction” from Dr. Li Lu Skelton, so he took it to the public. Like me, he started a blog!
The original name of the blog about Davis’s gruesome experience was Dr. Li Skelton Dental Nightmare, it’s since changed to Dr. Li Skelton – My Dental Experience.
Dr. Li Lu Skelton filed a lawsuit against her former patient, Darryl Davis, on June 
1, 2012 - 13 days after KTSA ran the story of his dental nightmare, with Skelton. I’ve not seen the suit, but I suspect it’s a SLAPP suit of sorts. Texas enacted anti-SLAPP suit legislation in 2011.
For Dr. Li Lu Skelton to be taking some “Holier Than Thou” attitude toward her patient is absurd! Look at Davis’ radiograhphs!
If you have had a bad experience with Dr. Li Lu Skelton, click here, this one needs to be stopped, ASAP. Don’t depend on the TSBDE to do the stopping, they recently renewed her license to practice dentistry for another year. Only plus there, is for the malpractice attorney.
LAWSUITS
Dr. Li Lu Skelton, DDS is no virgin to Bexar County District court either. She has had 6 cases in 4 years filed against her. Imagine her Malpractice Insurance costs!! Hope she has some, what if she’s been canceled?
Dr. Li Lu Skelton DDS Bexar County Lawsuits
According to the lawsuits, it looks like Dr. Li Lu Skelton used to work for Carillon Hills Dental Associates, with John A. Moore, DDS. Dr. Moore doesn’t seem to rate very high either, he has one star and a comment says they didn’t even think he was a real dentist… lol !
Darryl Davis’ attorney is:
Adam T. Froeschl
9045 Grissom Road. Suite B.
San Antonio, TX 78251
210-680-1918
Fugitive on the run–Elizabeth(Dr. Liz) Hinojosa and Monica Salazar Orozco
Mother, daughter accused of posing as dentists in Oklahoma City sought by authorities
Elizabeth Hinojosa and Monica Salazar Orozco, of Oklahoma City, worked in offices where alleged crimes took place after hours, investigators said
By Tim Willert | Published: August 31, 2012
A mother and daughter accused of posing as dentists pulled teeth, performed root canals, injected anesthesia and forged prescriptions, court papers show.
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Elizabeth Hinojosa, 47, and Monica Salazar Orozco, 28, both of Oklahoma City, were charged Friday in Oklahoma County District Court with practicing dentistry without a license, a felony. Hinojosa also was charged with one count each of forgery, medical battery and embezzlement.
Warrants were issued for their arrest Thursday, authorities said.
Hinojosa was a dental assistant and her daughter was a receptionist where the alleged crimes took place between September 2010 and May 2011, according to a probable cause affidavit filed with the charges.
Both worked for Dr. Salam Ramadan, who owns and operates Dental Spa locations at 1211 SW 44 and 3315 NW 63 in Oklahoma City.
Ramadan said Friday she didn't find out about the alleged crimes until she was contacted by the Oklahoma Board of Dentistry. The board started investigating after receiving a complaint.
“I was blindsided by it,” she said. “I had no idea it was going on.”
Thursday, August 30, 2012
With all signs of any relations to the Syracuse Small Smiles Dental Crime Family cut. Dr. Wilson begins anew. Good Luck to you, Dr. Wilson!
Yes, good people will take over, once the people of the community and the Federal, State and Local governments get the criminals out of the way. Dr. Wilson would have been there to begin with, if everyone had not been blinded by the greed, and BS they were being told by the gangsters. I like that this guy cut all ties with Church Street Health Management and Small Smiles, he makes that clear. Go Dr. Wilson!
Binghamton dentist takes over former Small Smiles clinic for kids on city's West Side
Published: Thursday, August 30, 2012, 2:01 PM Updated: Thursday, August 30, 2012, 2:27 PM
By James T. Mulder, The Post-Standard
Syracuse, N.Y. -- A controversial Medicaid dental clinic for children on Syracuse’s West Side that closed in March has a new operator.
Wilson Dental, which established a practice last year at 610 S. Salina St., opened a second office last month in the former Small Smiles clinic at 220 S. Geddes St.
Small Smiles, part of a national chain, closed shortly after its parent company filed for Chapter 11 bankruptcy. The chain had been accused of bilking Medicaid — the public health insurance program for the poor and disabled — out of millions of dollars by performing unnecessary work on children.
The clinic also was sued last year by 10 area families who claimed children treated at the practice were subjected to root canals, tooth extractions and fillings while physically restrained in a dental chair and without sedation or general anesthesia in some instances.
Dr. Michael Wilson, who also practices in Binghamton, said he didn’t buy the Small Smiles practice because he did not want to become liable for any of its problems.
“We didn’t accept any of their old patient records or hire any former employees,” Wilson said. “It was a clean break.”
He said the 6,000-square-foot clinic is a “heck of a facility.”
Wilson will continue operating his South Salina office.
Wilson said after Small Smiles closed his South Salina office saw a big influx of young patients.
“We were booked out for three months and we really needed more space to see the kids,” he said.
Most dentists in Central New York do not accept Medicaid because the program’s fees are so low. “The need in Syracuse is so huge,” Wilson said.
Wilson’s practice has several specialists including a pediatric dentist, an oral surgeon and a pediatric anesthesiologist. “A 3-year-old who comes in with a mouth full of cavities needs to be put to sleep,” Wilson said.
He said about 20 general dental offices and clinics between Syracuse and Binghamton refer patients to Wilson Dental because it is difficult to find other specialists in the region who accept Medicaid.
Wilson, who went to dental school at New York University, moved to Binghamton in 2008 to set up a practice after discovering few dentists there accepted Medicaid.
He expanded into Syracuse after seeing some Medicaid patients drive 70 miles to his Binghamton office because they could not find a dentist here.
On July 1 the state began requiring Medicaid patients to get their dental care through the same private health insurers that handle their other health benefits. Prior to July 1, the state administered Medicaid dental benefits. The state made the change in an effort to curb Medicaid spending.
Dr. Wilson’s approach is unlike Andrew Loomis-Pueblo Small Smiles, now Family and Kids Dental. Dr. Loomis has been at Small Smiles CSHM since May 2011 and Jeremy Hodge-Manassas-now Kids and Family Dental. Hodge is fresh meat out of Idaho who came on board back in March 2012. I doubt ANY ties have been broken with these two. Well, unless some “reties” with the DeRose’s. After all Pueblo is their baby.
Pacific Dental dentist charged with Medicaid fraud.
Here is the story that is out there about Dr. Liebau. As Paul Harvey would have said, “the rest of the story” is at the end.
Former Erie-area dentist charged with Medicaid fraud – GoErie.com
On Aug. 27, 2008, Kristi Ayn Liebau, then a dentist with an office in Lawrence Park Township, billed Medicaid for services she said she provided to a young patient.
That day, Liebau said, she had used composites to repair six teeth of the patient, identified in court records as M.J.
Federal investigators, however, found a problem with the procedures.
M.J.'s teeth were virtually brand new, raising questions about why Liebau would need to fix them.
The bill Liebau submitted for M.J.'s dental work, the U.S. Attorney's Office in Erie said, turned out to be false.
"None of the teeth that were billed for had yet to even erupt in the patient's mouth on July 23, 2008," the government alleged in court records.
Using the case of M.J. and 13 other patients -- most of them children -- the government on Friday charged Liebau with 14 felony counts of false statements relating to health-care matters.
Investigators said the fraudulent billings to Medicaid occurred from January 2008 through March 2011, when Liebau, 39, was practicing at 4010 East Lake Road in Lawrence Park, according to court records.
Liebau, who now lives in Texas, will end the case with a plea deal, her lawyer, David Ridge, said Tuesday.
"My client has decided to take full responsibility for any and all billing problems that existed while she was running her practice in Erie," Ridge said. "That is why we thought the best way to resolve this was by a negotiated plea as opposed to proceeding to trial."
Wednesday, August 29, 2012
Montana grandmother promises to “Stop the Ogres”
This comes from a grandmother in Montana who will be testifying before the state Legislature. She made a promise to her granddaughter and she plans on keeping it. Read on -
Putting a Stop to Ogres
She hopped everywhere as a toddler. Her bright eyes twinkled, her exuberance for life apparent. At her second birthday party, her guests followed her lead, hopping through a lively game of musical chairs. Then one day the hopping stopped and the bright eyes fixed in a dulled stare at something we could not see. Her skin took on a whitish pallor. Her once infectious laughter was replaced by a nervous clacking of her teeth. Instead of a smile, all she could muster was a top lip curled under in an upside down u - the bottom lip sucked in.
Her young mother, unaware, had allowed the child to undergo passive restraint
dentistry in a torturous 5 hour episode. Eight baby teeth were capped with a shiny
silver colored metal. Four top front teeth were given a whitish facade on the front.
All done behind closed doors at Providence Medical Center in Missoula, Montana.
During the five hour procedure the two year old child was wrapped into a strait
jacket like device, her mouth was propped open with a mechanical dam, and the
procedure conducted despite her pain and terror. Although she regained a normal skin tone and laughs and smiles in a normal way, she has never regained the confidence or the exuberance she was born with. The child has never been the same.
Tuesday, August 28, 2012
Timeline reflects increased awareness of dental fraud and abuse
2012 has been a very good year for the good guys. Bad guys, not so much.
(Main stories only, does not include all of them that were picked up by other outlet)
If this graph was turned upside down, I bet it would reflect the favorability in the public’s eye of places like Small Smiles, Kool Smiles, All Smiles, Aspen and ReachOut Healthcare America’s Mobile Dentistry. I pray it would reflect the loss of income for these criminal.
Next, to get the number of arrests to start matching the below graph.
22 year old sues dentist for rotten teeth after braces for 11 years
August 28, 2012
By Erin Tennant, ninemsn
A 22-year-old patient is suing his orthodontist for making him wear braces for 11 years.
Devin Bost from the US state of Oregon said he wore braces from the age of 7 to 18, causing him tooth decay and gum disease, according to this lawsuit.
He filed his lawsuit in a county circuit court last Friday, seeking $150,000 for pain and suffering and a further $35,000 to pay for corrective surgery.
Some of Mr Bost's teeth will need to be removed and replaced with implants, his lawyer said, but it may not be possible in some parts of his mouth because the teeth have rotted through to the jaw.
Reminding the public about ReachOut Healthcare America - Big Smiles Mobile Dental Clinics - One More Child Foundation
School is in, and the ReachOut Healthcare America mobile dental vans are hitting the unsuspecting public schools - which is like turning pedophiles by the dozen loose in each school they visit.
They go by lots of names, including Michigan Mobile Dentists, Big Smiles of Texas, Big Smiles of (name of state) and in Georgia it's, "Help A Child Smile".
If the above van is at a school, you can rest assured children are being overtreating and over x-rayed and you should run to the school and jerk them out immediately! It does not matter if you signed the form your child brough home or not, they WILL and DO treat children anyway!
The clinics in Georgia are operated under Dr. Mark Shurett, DDS. Not only is the hcsga.com website registered to ReachOut Healthcare American, so is Dr. Shurett's general dentistry website - Shurett Dental Group.
Don't miss the forms Dr. Shurett's "forms", exactly like Big Smiles and others put out by ReachOut Healthcare America. If you need confirmation, go to betterwhois.com and check out who owns these websites.
But this is what you will find:
Roberts, Glen itsupport@reachouthealthcare.com
2550 W Union Hills Drive # 202
Phoenix, Arizona 85027
United States
+1.6234349343
2550 W Union Hills Drive # 202
Phoenix, Arizona 85027
United States
+1.6234349343
Stay on your toes, parents - Below are the stories about this nasty place on wheels.
The Gagnon Lawsuit filed against Dr. Ralph Green, Dr. Alvin Coon and ReachOut Healthcare America.
Dental Abuse Seen Driven by Private Equity Investments
Sydney P. Freedberg in Miami at sfreedberg@bloomberg.net
May 16, 2012
Isaac Gagnon stepped off the school bus sobbing last October and opened his mouth to show his mother where it hurt.
She saw steel crowns on two of the 4-year-old’s back teeth. A dentist’s statement in his backpack showed he had received two pulpotomies, or baby root canals, along with the crowns and 10 X-rays -- all while he was at school. Isaac, who suffers from seizures from a brain injury in infancy, didn’t need the work, according to his mother, Stacey Gagnon.
“I was absolutely horrified,” said Gagnon, of Camp Verde, Arizona. “I never gave them permission to drill into my son’s mouth. They did it for profit.”
“I was absolutely horrified,” said Gagnon, of Camp Verde, Arizona. “I never gave them permission to drill into my son’s mouth. They did it for profit.”
Isaac’s case and others like it are under scrutiny by federal lawmakers and state regulators trying to determine whether a popular business model fueled by Wall Street money is soaking taxpayers and having a malign influence on dentistry.
Isaac’s dentist was dispatched to his school by ReachOut Healthcare America, a dental management services company that’s in the portfolio of Morgan Stanley Private Equity, operates in 22 states and has dealt with 1.5 million patients. Management companies are at the center of a U.S. Senate inquiry, and audits, investigations and civil actions in six states over allegations of unnecessary procedures, low-quality treatment and the unlicensed practice of dentistry.
Allegations like Gagnon’s “are not representative” of the more than 500 cases handled by ReachOut affiliates in Isaac’s school district, said Mickey Mandelbaum, a company spokesman.
Private-Equity Purchases
ReachOut is one of at least 25 dental management-services companies bought or backed by private-equity firms in the last decade. Dentists contract with the companies for marketing, scheduling, staff recruitment, supplies and other services. The companies account for about 12,000, or 8 percent, of U.S. dentists, according to Thomas A. Climo, a Las Vegas dental consultant.
Some of them have been riding a boom in Medicaid outlays on dentistry, which rose 63 percent to $7.4 billion between 2007 and 2010, outstripping the 4.9 percent growth in other dental spending. ReachOut and several of its private equity-backed rivals seek patients like Isaac Gagnon, who are covered by Medicaid, the federal-state insurance program for the poor and disabled.
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.
Another Bankruptcy
The All Smiles collapse followed another bankruptcy filing in February by Nashville-based Church Street Health Management LLC, which cited the costs of defending itself against lawsuits and investigations. Church Street is owned by Arcapita Inc., Carlyle Group LP (CG) and other private equity firms and affiliated with the Small Smiles network of dental clinics.
U.S. Senate investigators are examining whether ReachOut, Church Street and its affiliated clinics have overbilled Medicaid, according to Senate documents and people familiar with the matter. Another company under Senate scrutiny is NCDR LLC, which manages 130 Kool Smiles clinics, these people say. NCDR is owned by Friedman Fleischer & Lowe, a San Francisco buyout concern.
‘Assembly Line Service’
Church Street may be abusing patients, “grossly overcharging the United States government in Medicaid reimbursement claims,” and focusing “more on achieving self- imposed quotas via assembly line service than proper patient care,” U.S. Senators Charles Grassley and Max Baucus told the company in a November letter copied to Carlyle co-founder William E. Conway Jr. Grassley, an Iowa Republican, is Ranking Member of the Senate Judiciary Committee. Baucus, a Montana Democrat, chairs the Finance Committee.
One broad issue in the inquiry is whether the management companies merely provide services to dentists, or are breaking the law by directing care, according to people familiar with the matter and letters the Senators sent to state regulators. State laws broadly say only licensed dentists or firms they own can practice dentistry.
Church Street “respects the Senate’s important oversight role” and has provided information about improvements in the quality of care over the past five years, said Don Meyer, the company’s spokesman. He said the bankruptcy isn’t affecting patients.
Reachout’s Mandelbaum declined to comment on the Senate inquiry. NCDR, whose Kool Smiles affiliates had 2 million patient visits last year, is “committed to an open dialogue with regulators and legislators,” said Geoffrey Freeman, a spokesman.
Underserved Children
ReachOut, NCDR and Church Street do not make care decisions or own dental practices, according to their spokesmen. Each company said it is dedicated to helping underserved children get dental care.
After years of complaints that the poor were being deprived of such care under Medicaid, public pressure and class-action lawsuits opened the floodgates. Texas’s Medicaid dental outlays tripled to $1.24 billion between 2007 and 2010, as fees were boosted so more dentists would accept patients. Indiana, Connecticut, Maryland and Tennessee also boosted reimbursements.
At the same time, young dentists with education debt sometimes topping $300,000 “can’t get the loans they need to start their own practices,” said Bryan J. Shanahan, past president of the Arizona Dental Association. “So they look for work in a corporate setting where they get immediate cash flow.”
Working ‘School Hours’
Dental management firms can deliver patients and a six- figure income by sending teams to schools where they can treat Medicaid-eligible students in volume -- as many as 30 children in one visit. A ReachOut recruiting ad last year promised “15+ patients/day” and “$120K/year (+ bonus opportunity)” by working “school hours 1-5 days per week.” The ad appeared on the website of the University of Detroit’s dental school.
The private equity industry has stepped up its investment in dental management in the last five years partly because health care was one of the few areas that grew through the recession, said M. Alec Parker, executive director of the North Carolina Dental Society.
Wall Street buyout firms have also been attracted to dental practices because they are less regulated than physician groups, according to Sandy Steever, an editor with Irving Levin Associates in Norwalk, Connecticut, which tracks health-care transactions.
Cottage Industry
Dentistry is a fragmented, “cottage” industry ripe for management services, said Robert Fontana, chief executive officer of Aspen Dental Management, owned by Leonard Green & Partners, a Los Angeles private equity concern. Fontana and other industry executives said they see no evidence that private equity investment lowers the quality of dental care.
Texas is investigating dozens of cases where dentists, including affiliates of management companies, may have done unneeded work or billed Medicaid for undelivered services, according to spokesmen for the attorney general and other state agencies.
Investigators are looking at allegations that dentists placed crowns on children needing only less-expensive fillings, or put needless braces on 12-year-olds with baby teeth -- at taxpayer expense, said Joy Sparks, general counsel for the Texas State Board of Dental Examiners.
The investigation includes cases involving Kool Smiles and All Smiles, according to Stephanie Goodman, a spokeswoman for the state Health and Human Services Commission, which oversees Medicaid.
‘Unbelievable’ Fraud
Ellis, a Dallas orthodontist, testified in Congress last month that the “flagrancy of the fraud” she found in audits she performed for Texas Medicaid “is truly unbelievable,” with only 10 percent of the paid claims she reviewed actually qualifying for Medicaid coverage.
Texas “has gained a lot of fraudulent orthodontic providers, including many private equity owned dental clinics engaged in the illegal practice of dentistry,” Ellis told the U.S. House Committee on Oversight and Government Reform.
Ellis audited All Smiles claims for the state from 2007 through 2011, and found “overutilization” of Medicaid benefits before and after Valor bought control of the firm in 2010, she said in an interview.
‘Credible Evidence’
Texas’s Medicaid program has put Dallas-based All Smiles on “payment hold for credible evidence of fraud” and referred the case to the attorney general, said Goodman, the state health commission’s spokeswoman.
Texas inspectors have taken “exception” to 63 of 86 All Smiles orthodontic cases reviewed from 2007-2011, according to Michael Lozich, its chief compliance officer. “We’re going to defend ourselves and contest against these claims,” he said.
All Smiles and its founder, Richard Malouf, previously agreed to pay the U.S. and Texas $1.2 million to settle Medicaid fraud allegations between 2004 and 2007, without admitting wrongdoing.
In Michigan and California last year, groups of dentists sued their management company, American Dental Partners, alleging it interfered with treatment decisions only dentists are allowed to make. JLL Partners, a New York private equity firm, completed a buyout of American Dental for about $390 million in February.
Patients Unattended
American Dental refused to replace defective anesthesia equipment, used bill-collection policies that led to “refusal of dental services to patients” and failed to maintain proper staffing levels, the Michigan plaintiff, Redwood Dental Group, alleged. The policies caused patients to be left unattended and their care to be rushed, Mark Bouchillon, Redwood’s president, said in a letter attached to the complaint.
American Dental, which manages more than 280 dental centers in 21 states, declined to comment. The Wakefield, Massachusetts, firm has appealed a judge’s ruling against its motion to force arbitration in the Michigan case. The California case is under arbitration. In a federal filing in November, the company said it intended to defend itself and its subsidiaries “vigorously.”
“How is JLL going to generate a return on its huge investment without further squeezing our dental practices financially?” asked Bouchillon, whose group has about 25 dentists.
After actions taken against affiliates of one management company last year, North Carolina is considering legislation that would subject agreements between dentists and the companies to state approval.
Quota Pressure
The North Carolina Dental Society, which backs the bill, says some management companies bill patients for unneeded care and otherwise operate illegally. Dentists may be pressured to meet quotas and perform more-expensive treatments “instead of focusing on what’s best for patients,” according to a website sponsored by the group.
Opponents say passage of the measure will drive up costs. The two sides have begun lobbying and TV ad wars. Private-equity players Leonard Green, Court Square Capital Partners, and Levine Leichtman Capital Partners own or back companies that contribute to Alliance for Access to Dental Care, a political committee that has raised $1.1 million to fight the bill, according to state records. They say the management companies usually charge less and accept more types of insurance than private practitioners.
In California and Arizona, state investigators are examining complaints that ReachOut-dispatched teams billed Medicaid for unnecessary work on children, according to people familiar with the inquiries.
Program Ended
In Nevada, the Clark County School District ended its ReachOut program earlier this year. School nurses had complained about children returning to classrooms in pain after baby root canals and other work, according to Amanda Fulkerson, a spokeswoman for the district, which includes Las Vegas. Derryl Brian, one of the mobile dentists who worked with ReachOut, said they had treated 80,000 children since 2006 with a high satisfaction rate.
ReachOut’s owners have called the company a “unique” model. In 1997, founders Michael Howell and Daniel Goldsmith started a company to coordinate care to nursing-home residents in Michigan. They expanded to children in schools and by late 2003, were delivering dentistry to homeless shelters, foster programs, group homes and mental health facilities.
In November 2007, ReachOut received private equity funding from Sentinel Capital Partners, of New York. Under Sentinel, it acquired two rivals and increased its patient size fivefold. Last year, as a holding of Morgan Stanley Private Equities, its dentists saw 488,000 children in 8,700 schools.
Mainly Preventive Work
“Many of these children would otherwise go without even the most basic care,” said Mandelbaum, the company spokesman. ReachOut affiliates mainly clean and perform preventive work, with baby root canals and crowns accounting for less than half of 1 percent of patients, he said.
ReachOut’s model is built on the premise that low-income parents often don’t have time or transportation to take children to the dentist. So mobile teams pack equipment in large cases, load up a minivan, head to schools and set up in gyms, libraries or classrooms.
In most states, only a dentist, not a business corporation, can be licensed to control and conduct a dental practice. U.S. Senate investigators are examining whether some dental management companies are actually de facto owners of practices that bill Medicaid, according to letters Grassley and Baucus have sent to state regulators.
‘Embedded’ in Practice
Management companies have “moved from being vendors of services,” such as patient billing, “into increasingly complex arrangements under which some -- not all -- have embedded themselves deeply into every aspect of the dental practice,” said Ken Burgess, an attorney for the North Carolina dental board.
The Big Smiles dentists’ network and others ReachOut serves use “their own professional judgment and discretion,” and share the company’s belief that patients shouldn’t be physically restrained, according to Mandelbaum.
One of ReachOut’s most-ubiquitous affiliated dentists is Elliot Schlang, who has registered dental practices and licenses in at least 16 states. Schlang said he practices in all of them and travels the country training staff and treating children.
“I work day and night,” he said in an interview.
Another ReachOut-affiliated dentist is Ralph Green. Arizona records list him as the principal of a dental practice that has the same Phoenix address as the one shown on ReachOut’s website. The website lists Green as ReachOut’s clinical director.
Unnecessary Drilling Complaint
In August 2010, Green’s lawyer appeared before the Arizona dental board to answer a complaint that ReachOut did unnecessary drilling on a Phoenix student’s teeth -- even after the student’s mother, Valerie Davila, told the company she was seeing a family dentist and didn’t need any work.
The 6-year-old, Sabrina Martinez, suffered “unnecessary pain,'' Davila said. ''Imagine if it was your child.”
There were two children with the same name at the school, and the work was done on the wrong Sabrina Martinez, Green’s lawyer, Jeff Tonner, told the dental board. Although the board agreed that work was done on the wrong child, it dismissed the case, noting Davila had complained about “the business entity,” not a dentist.
Four Teeth Missing
In San Diego, Tina Richardson’s third grader, Alexander Henry, came home in March with four baby teeth missing after a school session with a ReachOut-affiliated dentist that was so painful he “waved his arms frantically,” “pushed everyone off him” and “bled so badly that they had to send him to the nurse’s office,” according to her complaint with the state dental board. Among other things, Richardson said the consent process wasn’t valid.
Richardson said Alexander had seen a dentist nine days earlier who didn’t recommend any teeth pulling. Although she signed a consent form in September covering many procedures including extractions, she said she didn’t sign another one that came in November seeking permission to take out three teeth. No one from ReachOut called to discuss the proposed procedures, she said.
The state board is investigating her complaint, according to a letter to Richardson. Gurgen Sahakyan, listed as Alexander’s mobile dentist on a form brought home from school, said “the original consent was signed” and the work was done well. Mandelbaum said ReachOut couldn’t discuss specific patients.
Dentistry Guidelines
American Academy of Pediatric Dentistry guidelines say “oral discussion between provider and patient, not the completion of a form, is the important issue of informed consent.”
In Arizona, a state investigator subpoenaed the names of children seen by the ReachOut-dispatched dental team on Oct. 4 last year, the day Isaac Gagnon was treated, said Dan Brown, who was then Camp Verde School Superintendent.
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.
Five weeks later, a ReachOut team in the art room at Camp Verde Elementary took X-rays of Isaac, according to preschool instructor Becky Fordham. When Isaac was moved to a corner of the room, he began to gag, Fordham said.
Kicked and Screamed
He kicked and screamed while several adults held him on the dental table, according to another teacher’s aide, Stephanie Shultz. “The dentist man got me,” Gagnon remembers her son saying.
The Gagnons said the school identified Isaac’s dentist as Alvin J. Coon Jr., who works with a ReachOut-affiliated practice registered in the name of Green -- the dentist who answered Davila’s complaint in the Phoenix case. Coon and Green’s lawyer declined to comment.
The root canals were unnecessary and the number of X-rays was “excessive,” according to Bobby Lee Raber, a dentist in Prescott who reviewed the records for the Gagnons. Professional guidelines call for only four X-rays for a child Isaac’s age, Raber said.
Isaac should have been sedated to numb the pain and not held down, Raber said in a written review. He said he ends treatment and reschedules when children cry, and doesn’t sedate or restrain them without parental consent.
Medicaid Refunded
A couple of weeks after Isaac’s dental visit, Gagnon said ReachOut told her the company refunded Medicaid the fees for her son Joel, who was seen at school on the same day as Isaac. The Gagnons say they didn’t complain about Joel’s examination.
Darren Gagnon, Isaac’s father, said he received a visit from Robert Linder, a ReachOut regional vice president, about a month after the treatment. Linder apologized that Issac was treated without consent, and said what happened was “not common practice,” according to Darren Gagnon and a colleague who was also at the meeting.
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DOLLARS AND DENTISTS
June 26, 2012
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July 2, 2012
Sen. Charles Grassley (R-Iowa) says that his investigators have found evidence of abuses by corporate dental chains treating children on Medicaid.
For months now, Grassley’s staff has been asking questions of three dental chains serving poor children on Medicaid. Each is owned by a private-equity firm. The chains are Kool Smiles, Small Smiles and ReachOut HealthCare America.
“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.”
Earlier this week, a joint investigation by the Center for Public Integrity (CPI) and FRONTLINE, revealed that the Atlanta-based chain Kool Smiles’ business model of serving kids on Medicaid has led to complaints that it overtreats children. The company has been accused by regulators in Georgia and Connecticut of overusing expensive stainless-steel crowns to treat small cavities.
Kool Smiles vigorously denies this, saying that it offers quality care to children in dire need. It is the largest Medicaid dental chain with 129 offices in 15 states and the District of Columbia.
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.”
As reported by CPI and FRONTLINE, one of Kool Smiles’ most controversial practices is its dentists’ heavy use of stainless-steel crowns to restore decayed baby teeth. Crowns are more profitable than fillings for dentists, because they can charge more for them. Kool Smiles provided analysis intended to show that it doesn’t overbill Medicaid but offers services at a lower cost than other dental providers.
Grassley said the problem was rooted in the structure of these chains, saying that it claims that dentists own the practices but in reality they do not have 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,” Grassley said.
The senator is also looking at Aspen Dental Management, another corporate dental chain owned by private-equity firms. Aspen Dental does not accept Medicaid, but Grassley said there are concerns that “the company promotes unnecessary treatment plans with exorbitantly expensive credit arrangements.”
CPI and FRONTLINE also investigated Aspen Dental and found that its business model of serving patients who cannot afford a dentist had led to complaints of overtreatment and loading patients who cannot afford it with debt.
Aspen Dental denies this. It says it offers services to people that other dentists ignore.
Sen. Grassley said he expects to issue a staff report on his findings on companies that serve children on Medicaid. His investigation into Aspen Dental is ongoing.
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Jeff Tonner, the attorney representing Dr. Ralph Green, of ReachOut Healthcare America had this to say on Dentaltown after the PBS story:Related:June 26, 2012 Dentaltown (registration required)At Howard's (Farran) email invitation, I watched the PBS broadcast, "Dollars and Dentists," last night. Like most "investigative" reporting, I found the analysis flawed. Let me illustrate with an example.
Suppose three companies manufacture toasters. The first corporation produces one defective toaster for every 100 assembled, the second 1 per 1K, and the third 1 per 1M. Any reporter can locate a few dissatisfied customers for the third company, parade them on TV, and cast the company in a bad light. The best can be made to look like the worst.
All dentists, or dental companies, make mistakes. The true questions is - - how often do these errors occur compared to their peers. This is the analytical component that most new shows don't/won't present. To be fair, such data often can be difficult to obtain. I would argue that without a baseline, the subject is not newsworthy; however, we all know smut sells. Look at the program title. Reading only it, the viewer knows the slant before viewing the content.
The end of the program highlighted an elderly lady who financed $8K for dentures through Care Credit. I am sorry that she had buyer's remorse, but where is the personal responsibility? The program noted her total payments would equal $12K. So would an $8K dining room set purchased on credit. That's how interest works.
I stopped watching 60 Minutes years ago, because the exceptions were showcased without any reference to the majority. IMHO, it elevated "sensationalism" to an art form. My bottom line, the show offends my sense of fairness and decency.
Rarely but occasionally, I represent a DDS associated with some sensational allegations. When the TV stations contact me, I offer an interview but only if it is live. I don't trust them to edit fairly. They always refuse. Surprised?