A good example of why you can’t count on local DA’s to enforce the laws!
Bio | Email WFAA Posted on March 5, 2013 at 10:05 PM Updated today at 9:54 PM
Dallas County District Attorney Craig Watkins accepted — then returned — a 2009 campaign donation from the wife of Medicaid dentist Dr. Richard Malouf, who was under investigation at the time by Watkins' office for allegations of Medicaid fraud.
The Texas Attorney General’s Office says Watkins’ settlement of the case was a "sweetheart deal."
Dallas dentist Dr. Richard Malouf is the founder and former owner of All Smiles Dental Centers in Dallas. From 2008 through 2010, All Smiles billed the state of Texas more than $20 million for putting braces on children under Medicaid.
For the past five years, federal, state and local officials have been investigating Malouf for Medicaid fraud.
The Dallas County DA's office was one of those doing the investigating. Watkins' office received a criminal referral from the AG about Malouf.
In 2009, Malouf's wife, Leanne, wrote Craig Watkins — who was running for re-election as Dallas County DA — a $10,000 campaign donation, News 8 has learned.
Soon after, Watkins was asked to attend a meeting at the office of one of Malouf's attorneys, according to Heath Harris, the first assistant in the DA's office. News 8 wanted to talk to Watkins himself about the sequence of events. His office said he was ill and unavailable. Heath Harris spoke on behalf of Watkins.
At the meeting at the attorney's office, Heath Harris said, Watkins was introduced to Malouf.
Malouf wanted to talk to Watkins about his criminal case, Heath Harris said.
"This Malouf person is trying to talk to him about a criminal matter," Heath Harris told News 8. "It's my understanding he [Watkins] immediately shuts him down. And he leaves."
Watkins returned $10,000 to Leanne Malouf with a cashier's check in January, 2010.
March 4, 2013 The answer can be found in court documents filed during their bankruptcy proceedings over the last year. According to Affidavit of Chief Restructuring Officer of Martin McGahan, 100 were on file in February 2012. More recent documents filed by their malpractice insurance carrier states 1100 are "working” so to speak and more lawsuit likely to come.
“Since January 2010, approximately 11 lawsuits on behalf of over one hundred plaintiffs have been filed against the Company and certain of the Dental Centers, in primarily three states, Ohio, New York and Oklahoma.”
“Subsequent to the Debtors’ settlement with the DOJ and the various states, a number of lawsuits were filed throughout the country by or on behalf of the Dental Center patients against certain of the Debtors, Dental Centers and Dentists, alleging claims for damages based upon treatment received at the Dental Centers. In addition to the Patient Litigation, the Debtors contend that “at least approximately 1100 additional patients or former patients” have retained counsel to assert similar claimsagainst the Debtors, the Dental Centers and the Dentists.”
Dentists and auxiliary employee of Small Smiles Dental Centers (current or former) are not likely to be able to exhale for a very long time.
For a list of the 600 plus pleadings and filing of this case see in United States Bankruptcy Court – Middle District of Tennessee, see: Church Street Health Management Docket Report
In other Small Smiles Dental Centers news. I’m told the morning huddles continue and production numbers remain a major topic of discussion.
Texas Dentists for Medicaid Reform has all the trappings of a public interest group: The State Capitol is featured prominently on its website; the Texas star is in its logo; the word "reform" is in its title.
But TDMR, as it calls itself, acts like a private interest group.
Last month, the organization held a dinner at the Omni Southpark Hotel in Austin. TDMR's website invited the public, but the event was not public after all.
An e-mail informed News 8 we would not be allowed to attend.
Board member Dr. Juan Villareal would not disclose who the organization's donors are. "Donors can be anonymous, and a lot of them don't want their names mentioned," he told WFAA, adding that TDMR does not have members, only donors.
"We basically take donations from people who are interested in our cause," Villareal said.
So what is the cause? "Due process" is a phrase overheard in the hallway outside the dinner venue. TDMR offered News 8 an interview with a lawyer — presumably on its payroll — to explain the term "due process."
A look at the name tags outside the dinner show many of of the invited guests have had their Medicaid payments suspended under a doctrine called Credible Allegations of Fraud (CAF). Under CAF, physicians and dentists can have their Medicare or Medicaid payments withheld if the government believes they've committed fraud.
Dr. Villareal had $1.2 million in Medicaid dental payments to his clinic, Harlingen Family Dentistry, suspended under CAF. He appealed his case and won in an administrative hearing, but says he still hasn't received his money.
TDMR's board consists of Villareal, his partner, and another dentist who was charged with Medicaid fraud.
TDMR's website traces to an office labeled "SLS Worldwide Transportation" at a strip mall in Austin. The same address is also home to a website for Dr. Richard Malouf, a Dallas dentist who's being criminally investigated for fraud by the state of Texas.
And the SLS Limousine office is home to the website of Harlingen Family Dentistry, Villareal's dental office.
"TDMR is not so much about the money, as it is about denying due process" Villareal said. "That's the main concern."
"Due process" may summarize Medicaid reform for TDMR's donors.
But Dr. Morna Staffel said that doesn't speak for a Medicaid system she and many other dentists wrestle with every day.
"I don't think there is a group that's speaking out for the legitimate and the ethical dentists... either general dentists or pediatric dentists," she said.
Dr. Staffel's office regularly has to re-do work done by some of the dental chains supporting TDMR.
"Yesterday, in fact, I had to do dental treatment on three different children who'd been treated at another dental clinic during a 12-month period," Dr. Staffel told News 8. "Eighty percent of the restorations that had been placed either were improperly placed, or done incorrectly, or failing."
That work will need to be redone, she says, but getting Medicaid to pay for it is a slog.
"It's very time-consuming. It requires a great deal of my office staff time." Dr. Staffel said. "In the end, if we don't do the treatment, the child gets hurt."
She said her office often ends up doing the work for free.
Dr. Staffel wants parents — even those on Medicaid — to know they have a choice in dentists. And if they feel their children are not getting treated properly, they can go elsewhere.
So who really is Texas Dentists for Medicaid Reform? Thirty-nine dental chains have had their Medicaid payments withheld under Credible Allegations of Fraud.
As for many other Texas dentists, reform means something else.
The attorney for a dentist accused of gross negligence in treating patients said in a statement Friday that he and his client are "pleased with the progress" of an administrative hearing on the allegations this past week and that they "look forward to presenting Dr. (Robert) Tupac's side of the story" when it resumes later this year.
"We expect Dr. Tupac will be fully vindicated at the conclusion of the evidence in this matter," Jason Friedman wrote in an email.
An accusation filed by the state Attorney General's office on behalf of the Dental Board of California alleges that Tupac fitted patients with improper-sized implants, altered patient records, billed a patient for an implant he never delivered and allowed dental assistants to do work beyond the parameters of their license.
It’s complicated to liquidate a company operating illegal dental clinics. As of February 21,2013 there have been 630 various pleadings filed in the bankruptcy case of Small Smiles Dental Centers. The Docket report is dang near 70 pages. Even it is an interesting read.
If you currently work for Small Smiles Dental Centers or have EVER worked for Small Smiles Dental Centers you need to read this carefully. I realized they mass mailed a “Summary” of the Liquidation and Trust Agreement, as well as a “Ballot” but the key word is “summary”.
This junk company is an albatross that will forever more hang around the neck of every executive, every regional or sub-regional manager and every dentist who ever worked there. You will constantly be looking over your shoulder for the next 10 years or longer.
The last time I took the bar exam was… uh… NEVER, so read it and draw your own conclusions.
This the the current PROPOSED Plan of Reorganization and not approved by any means as of yet. There are objections by their malpractice carrier on file, and that’s where the dentists come into play even more I suspect.
[Now, if I found myself in the middle of a malpractice lawsuit and being represented by an attorney assigned to me by a malpractice insurance company who didn’t want to cover claims because they got hoodwinked by some slick willy system scammers, I’m not sure I’d feel that particular attorney had my best interest in mind. Think about it.]
4.17(h) Claims Against Former Affiliates. Each holder of a Class 5(a) Claim will retain any and all claims and legal rights such holder may have against any of Danny DeRose,Edward DeRose, Michael DeRose, William Mueller, or Adolph Padula. All holder of Class 5(a) Claims will be entitled to initiate and prosecute any such claim against any or all of Danny DeRose, Edward DeRose, Michael DeRose, William Mueller, or Adolph Padula without restriction in the tort system. To the extent the automatic stay in these Chapter 11 Cases or any other limitation imposed by these Chapter 11 Cases would limit any such action, such automatic stay or limitation will be lifted thirty (30) days after the Effective Date of the Plan
The American Dental Association is taking it’s cue from the Texas Medicaid dental mills, offering $100 bonus to bring in a patient member. When words like – bonus, recruit and incentive are used in dentistry, I get real nervous.
"While we're recruiting about the same number of members each year, the total number of active, licensed dentists continues to grow, translating to a decrease in the overall market share," said Dr. Bauman. "If every dentist tapped into the value ADA provides to all members, they would see the immediate impact on their practices and within their careers."
Any ADA member dentist is eligible to participate in the Member-Get-A-Member Campaign, and members will be rewarded with a $100 American Express gift card for each new, active member brought in (up to five members or $500 in American Express gift cards). Members may also decline the incentive and the ADA will contribute $100 to the ADA Foundation.
On February 21, 2013, Cheryl Rye filed a lawsuit (Cause 201310522-7-in Harris County Texas District Court against Dr. M. Jerome Holmes, DDS. Cheryl's daughter went to Dr. Jerome Holmes for a scheduled cleaning and received the standard dental abuse treatment – restraining, child abuse, mom in the waiting room hearing blood curdling screams from her daughter, bodily injury and lies to cover it all up. They staff actually told the mom all the red marks on the child was an allergic reaction!
The treatment of this little girl sounds all too familiar. Wonder if Dr. Jerome Holmes worked somewhere else prior to his own practice? As we’ve seen, there is never just one child, there are usually many children that have suffered at the hands of dentists like this.
A huge round of applause for mom suing and a special thanks to the attorney who took the case - Tami Pierce of Kingwood
Checking Dr. Jerome Holmes Texas dental license shows no disciplinary actions, which means he could have murdered 10 patients – Texas State Board of Dental Examiners are not exactly known for their pro-action to protect public health.
Dr. Holmes picture from his website, speaks volumes as to his attitude doesn’t it? Looks like a creepy marionette to me.
Dr. M. Jerome Holmes 9815 FM 1960 Rd. W. Humble, TX 77338 Phone: (281)548-3384 Fax: (281)548-7336 info@jeromeholmesdds.com
No Way to Treat a Child, Mom Tells Dentist
By CAMERON LANGFORD
HOUSTON TX - In a horrifying trip to the dentist, a little girl "screamed frantically for her mother," but the dentist kept drilling, with his staff "grabbing her legs and restraining her head," and threatening to call police when the mom tried to check on her daughter, the mother claims in court. Cheryl Rye sued Miner Jerome Holmes DDS and his dental office on behalf of her daughter, Katie in Harris County Court. Rye claims took Katie to Holmes' office for what she thought was a routine cleaning. "Plaintiff was administered nitrous oxide and the dental procedure began," the complaint states. "Plaintiff began feeling intense pain and screamed frantically for her mother. Instead of stopping the procedure or administering any additional nitrous or allowing her mother to enter the room to calm her Dr. Holmes continued to drill into the minor child's tooth. "Dr. Holmes, and his agents and/or employees, physically restrained Katie in a prison like manner by holding her down, grabbing her legs, and restraining her head in such a reckless fashion that it caused bodily injury. "Plaintiff continued to scream for her mother so loudly that her mother, Cheryl, heard her scream while she was sitting in the waiting area. Cheryl pleaded with the office staff to go and check on her daughter. "Cheryl was instructed to sit down, was refused access to her minor child and told the police would be called if she attempted to go back. "After several minutes of nerve-racking screams of pain and fear, little Katy finally emerged from the back area sobbing with large red marks on her head. "Cheryl inquired as to what happened to her daughter and why she had the injuries that were not present prior to the procedure. Dr. Holme's staff tried to cover up the negligent acts and told Cheryl that it was an 'allergic reaction.'" But Rye says she took Katie to her pediatrician, who determined that the marks "were not any type of allergic reaction, but were in fact injuries she sustained by being forcibly restrained." An emergency room physician confirmed the pediatrician's diagnosis, Rye says. She says Katie is still scared to go to the dentist, months later, and will require sedation to go to the dentist from now on. She seeks medical expenses and punitive damages for negligence, gross negligence and breach of duty.
If anyone gets a copy of the complaint, I’d appreciate a copy. cckaddie@yahoo.com
On February 7, 2013 the newly organized Texas Dentists for Medicaid Reform Fraud issued a press release stating the Texas Office of Inspector General had dropped its case against one of their poster-children, Diane Malone, DDS – co-owner along with husband, Dr. Scott Malone in M & M Orthodontics in San Antonio.
The TDMR stated the Texas HHSC-OIG had filed a motion to drop all claims against Dr. Malone, stating it was a “hopeful sign that Medicaid Fraud enforcement agency is seeing the light on due process and provider rights.”
Disgraced former Texas Representative, Tara Rios-Ybarra, DDS, an executive of the Texas Dentists for Medicaid Reform Fraud was tickled pink, saying, “We are very concerned about Medicaid provider rights. These impact the security with which providers can practice their professions and deliver effective help to Medicaid patients. Due process is a cornerstone of these rights and we are happy to see at least a harbinger of change from the OG on this issue.”
What they didn’t say in their fancy-dancy press release was HHSC-OIG had "Motioned" for the withdrawal of its nonsuit against Diane Malone, DDS – “Without Prejudice”. Meaning, OIG can bring this same action against Diane Malone at anytime in the future. No “Motion” was made to withdraw the action against M & M Orthodontics.
The OIG had alleged Dr. Diane Malone and M & M Orthodontics had failed to meet the dental standard of care in treating patients and owed the state 8.2 million of dollars – basically they were delivering “worthless services”. In addition, the Texas OIG had assessed a $6.6 million dollar fine, according to an April 2012 story by KSAT-TV. Malone’s panties were in a wad about having to fork over the $14.8 million dollars. Malone decided to fight the law – so her as well as her company – M & M Orthodontics – appealed. (The “worthless services theory” is something everyone in the Medicaid dental community should get to know well.)
February is “National Children’s Oral Health Month”. Normally Small Smiles Dental Centers lead dentists (or fake owner dentists) slither from under their rock and hit local morning TV talk shows, claiming they are having free services that very morning for a couple of hours. So far, I’ve not seen hide nor hair of them in 2013. Kool Smiles Dental centers at least announced they gave away toothbrushes this year. (Geez, I hope they weren’t those chemical-laden ones from China that leave blisters in your mouth.)
Small Smiles “free services day” were a sneaky ploy. The dentists would appear on local talk shows about 6 AM announcing they were having free services that morning; from 9AM-11AM for example. They would invite the public, telling them they needed to call for an appointment; failing to mentioning the schedule was already packed tight as sardines – as they were everyday.
It was last year about this time they were preparing documents to file bankruptcy in Nashville’s Federal Court and closing several clinics (updates on that coming soon). By June the OIG forced them to divest in at least one clinic; personally I think it was more than one, Manassas, Virginia clinic for sure. (Let’s just say, whoever took over Manassas, also took the Pueblo, Colorado clinic as well. See: Violations of Corporate Integrity Agreement Triggers Divestiture Action by HHS OIG.
“It is clear that the defendants’ actions constituted more than just malpractice.” –Judge John Cherundo, Onondaga County Superior Court
By August 2012, Small Smiles Dental Centers were taking serious hits in the malpractice cases file against them. In 2011, families of at least 75 children had filed lawsuits in New York against the Small Smiles Dental Centers. Judge John C. Cherundo denied the companies request to dismiss the cases saying,“This intentional misconduct was part of the of the alleged scheme to generate revenue as quickly as possible”.
A bill that could potentially improve New Mexico’s bleak dental health issues if approved will be reviewed on Feb. 23.
New Mexico currently ranks 49th in the United States when it comes to the number of dentists per 1,000 residents ratio. The Dental Therapist-Hygienist bill that could help change this poor position has been unanimously passed by the House Health, Government and Indian Affairs Committee and will go to the House Business and Industry Committee this Saturday, Feb. 23.
“We believe that everyone should be able to get quality, affordable dental care in their own communities,” said Barbara Webber, executive director for Health Action New Mexico.
Sterling Partners has invested an undisclosed amount of private equity into Kids Care Dental Group, a pediatric dental care practice with six office locations in the Sacramento, Calif. area. www.kidscaredentalgroup.com
I’m not sure where the breakdown is, but there is no doubt a breakdown; a big one! Either agencies are failing to report, or the OIG is failing to add criminals to their list. Which ever the case, the free flow of tax dollars from your pocket to fraudsters bank accounts goes unchecked.
In checking to see if Dr. Robin Lockwood is at least excluded from defrauding taxpayers from any more money for her employer, Ocean Dental, I find she still has access to our tax dollars; she’s not on the governments List of Excluded Individuals and Entities (LEIE).
According to the OIG, if a criminal conviction is related to – Fraud, Obstruction of an investigation or misdemeanor conviction relating to controlled substances and should be reported as soon as the defendant is sentenced - even if appealed - there is supposed to be a “Mandatory Exclusion”. Maybe mandatory means something difference in government-speak.
Mandatory exclusions: OIG is required by law to exclude from participation in all Federal health care programs individuals and entities convicted of the following types of criminal offenses: Medicare or Medicaid fraud, as well as any other offenses related to the delivery of items or services under Medicare, Medicaid, SCHIP, or other State health care programs; patient abuse or neglect; felony convictions for other health care-related fraud, theft, or other financial misconduct; and felony convictions relating to unlawful manufacture, distribution, prescription, or dispensing of controlled substances.
The sources who are supposed to report to the OIG are the USAO’s, MFCU’s (Medicaid Fraud Control Units), Local Prosecutors, State Medicaid Agencies and Licensing boards and should include the judgment, plea agreement, final actions, indictment information, investigative report or narrative, aggravating factors, mitigating factors, and a cover letter with a brief summary.
There are numerous acts under which the government should stop the massive fraud, one being under the Social Security Act 1128(b)(4), where Michael DeRose, DDS and William Mueller, DDS the founders of Small Smiles Dental Centers are listed.
The Senate Health and Human Services Committee gave its endorsement Tuesday to legislation that tackles Medicaid fraud and could save the state millions of dollars.
Senate Bill 8 will “reduce the epidemic levels of fraud waste and abuse that are plaguing our health and human services,” said Sen. Jane Nelson, R-Flower Mound, the author of the bill and chairwoman of the Senate health committee. She added that “no amount of fraud is tolerable, but given our recent budget challenges it is inexcusable” that the Office of Inspector General has identified more than $6 billion in fraud from 2004 to 2011 tied to Medicaid, the state health program for poor residents.
The legislation will now go to the full Senate.
The committee approved a substitute of the original bill. The approved measure would set up a data analysis team within the Texas Health and Human Services Commission to detect trends in Medicaid claims and take a proactive approach to identifying potential fraud; ensure providers found guilty of Medicaid fraud in Texas or other states would be barred from participating in the state’s program; strengthen prohibitions against directly soliciting Medicaid patients for treatments; and reduce transportation fraud by adding medical transportation services to managed care and setting up a relationship between the Texas Department of Transportation and the Health and Human Services Commission to verify the eligibility of a Medicaid patient for transportation services.
How many more mommy’s are going to go to the slammer before they stop participating in the fraud at dental clinics across the country.
GoEarie.com is reporting Dr. Kristi Ayn Liebau-Grassi is going to be spending 4 months in federal prison, 8 months of house arrest then 3 years of supervised release. She admitted guilt to defrauding Medicaid out of $289,000 between 2008 and 2011.
After the Medicaid fraud in Pennsylvania, suspiciously, Kristi moved her family to Texas to practice dentistry. Did she hear that’s where to make the big bucks in Medicaid dental fraud? She ended up working for Pacific Dental’s Sienna Modern Dentistry in Missouri City, Texas.
I bet she would like to go back and rethink all those decisions she made back then, don’t you? It’s not just the fine, the restitution, the prison time, etc., it’s the pain and stress of her entire family which will continue well past the time her supervision ends, something in 2017.
Counting the 3 years of waiting for the Feds to come knocking, it will be a total of 7 years by the time this is tragedy can even begin to heal. Her children’s lives where thrown away, for $289,000!
What a shame Kristi didn’t think about her children, all under 7 years old including a 2 year old who has a serious heart problem, BEFORE, she decided Medicaid fraud was the path to wealth.
It’s ironic she tried to use the needs of her own children to stay out of prison, when screwing over other people’s children sent her there.
Dentist gets 4 months in prison, plus house arrest, for fraud in Erie
A 40-year-old dentist who defrauded Medicaid while treating children in the Erie area asked a judge to consider her own children at her sentencing.
The judge took Kristi Ayn Liebau-Grassi's concerns into account on Wednesday as he ordered her incarcerated for four months, followed by eight months of house arrest.
Liebau-Grassi, a married mother of five children who now lives near Houston, faced a recommended sentence of a year to 18 months in prison under the federal sentencing guidelines.
Texas Dentists for Medicaid Reform (TDMR) testified before the Texas Senate Finance Committee recently. The group was "singing the blues", saying all the reports of any such fraud taking place in Texas are lies. .
Despite recent reports of $1billion dollars in Medicaid monies being recovered by the Texas Attorney General’s office in the last 10 years, the group’s attorney, Greg Ewing, all but called it hogwash at the hearing.
Their press release contained the mother of all Freudian Slips and guess who was lucky enough to find it?
The original link to their website contained in the press release read “Texas Dentists for Medicaid Fraud.” In that entire press release there were two truthful statements: the speaker was in fact Greg Ewing and their mission is Medicaid Fraud
Within three days after this blog pointed it out, the PRWeb press release had been changed. Now there is only one honest statement, Greg Ewing’s name, and that might be in question at this point. Do they read this blog, you bet!
This group has the fingerprints of savvy political operatives all over it. You know what I mean; call it one thing even though it’s something else.
Their name gives the illusion they are for “reform”. I suspect in reality they are for “fraud”, as their “fraudian” slip (above) indicated. Their actions indicate the only reform they support is for the Texas OIG or AG to disband any investigations in to Medicaid fraud. See their January 2013 testimony in front of the Texas Senate Finance Committee.
Anyone want to take bets on whether their web presence will appear they are middle of the road, trying to fix what’s broken, etc.? Truth is, they don’t want what’s broken fixed at all!
I bet Dr. Richard Malouf’s ears perked up yesterday when he heard good ole Dr. Goodwin had to fork over $1.5 million, beside a fine of $250,000 and facing up to 10 years in prison. But come to think of it, Malouf has already agreed to pay up over $1M to settle fraud charges. Hmm…
An Amarillo orthodontist must forfeit $1.56 million he fraudulently gleaned from the Texas Medicaid program by billing for dental work he never performed, an Amarillo judge has ruled.
In a preliminary order issued Monday, U.S. District Judge Mary Lou Robinson said the government presented “credible evidence” Michael David Goodwin, owner of Goodwin Orthodontics, 3629 Wolflin Ave., reaped $1.56 million in ill- gotten gains between 2008 and 2011.
Goodwin, 63, pleaded guilty in December to one count of health care fraud. He faces up to 10 years in federal prison and a fine of up to $250,000 when he is sentenced. Under the plea, Goodwin agreed not to challenge the forfeiture.
Prosecutors allege Goodwin frequently billed for work he never performed and scheduled up to 100 patients daily. Employees and patients likened the scheme to “herding cattle,” court documents show.
A phone message Tuesday at Goodwin Orthodontics said the office was temporarily closed.
Tomorrow is supposed to be the big day for Dr. Kristie Liebau-Grassi, who pled guilty to Medicaid fraud in September 2012.
She has agreed to pay restitution of $289K and faces 12-18 months of time in federal prison. Maybe Dr. Robin Lockwood has a bunk in her cell for Dr. Kristie.
This 35-question survey is intended to measure patient attitudes and knowledge regarding the level of medical emergency preparedness in dental offices. A general dentist (also called a family dentist) is a primary dental care provider that provides a wide range of dental services such as check-ups, exams, cleanings, fillings, crowns/caps, dentures and possibly other dental services. Many general dentists treat children as well as adults.
Please answer the questions based on your experiences with your current general dentist.
Florida Attorney General Pam Bondi has announced that her office has arrested a West Palm Beach dentist -- Dr. Thomas Floyd, 61 -- on charges of Medicaid fraud, grand theft, and employing a person to perform duties outside the scope of their license.
“Employing a person to perform duties outside the scope of their license and billing Medicaid for those services is endangering patients and stealing from the Medicaid program,” Bondi said in a press release.
February 11, 2013 I'm hearing rumblings of a Kool Smiles investigation going on by a federal agency but its not the one I have would expected; although I'm not surprised to hear is taking place.
There are literally thousands of complaints from parents and patients online about the Kool Smiles call center, for example:
404-781-0512 "Kool Smiles continues to call my cell phone and harass me almost daily...even after I've told them numerous times to stop..."
"They are so pressed to get your business that they disregard your privacy.."
"...I receive several phone calls a week from Kool Smiles to both my cell phone and my husband's..."
"These callers call me again and again..."
I'm told their automated system was a train wreck and Kool Smiles is fully aware of it.
Essentially set up as an appointment reminder it soon turned into high pressure sales calls to get parents to bring their child back for more torturous dental care. As long as the number was a "good" number Kool Smiles would continue the harassment. Same as they are with children's teeth, as long as there is prospective tooth to treat, it got treated, needed or not.
Apparently there has finally been enough complaints and the FCC is investigating. This is not confirmed by the FCC but my sources are solid.
In further Kool Smiles news:
I'm told Kool Smiles in Texas are being converted to their latest brain child - Resolution Dental. All expansion plans for new offices that were scheduled to open in 2013 have been cancelled.
El Segundo, CA (PRWEB) February 10, 2013
The Layfield Law Firm, on behalf of its client Dr. Kianor Shah, has filed legal action against Wal-Mart Stores Inc. and Comfort Care Dental Management (CCDM), a registered Dental Service Organization (DSO) in Delaware, in addition to several other individuals. Filed in the Superior Court of California - County of Riverside on December 21, 2012, (Case # 1218772) this suit alleges counts of civil conspiracy, misappropriation of trade secrets, breach of contract and confidence, tortious interference with prospective economic advantage, and violation of laws, requirements, and regulations.
According to court documents, in late 2008, Dr. Shah came up with the innovative idea of opening low- cost, full service dental offices in big-box retailers. Dr. Shah pitched the idea to Wal-Mart, who committed to put-into-action his clinics; however, Defendant Wal-Mart reverted back stating that it was no longer interested in having dental clinics inside their retail stores.
WFAA’s Byron Harris must be fed-up with his reports and statistics being questioned by folks hoping to keep the Medicaid dental spending unchecked in Texas.
Here is Byron’s latest:
Bracing Ourselves: How Texas spent $705 million on Medicaid braces
by BYRON HARRIS Bio | Email WFAA Posted on February 4, 2013 at 6:35 PM Updated yesterday at 2:32 PM
Until last year, the Texas Medicaid Dental Orthodontic program was spending money like a Christmas shopper on Black Friday. Between 2008 and 2011, Texas spent $705 million on Medicaid orthodontics, which experts say many children don't even need. That's because the state was paying the bills without adding them up, or even seeing if the money was well spent.
It was what Doug Wilson, the Inspector General of Texas Health and Human Services, calls a "pay and chase" environment. Texas now is earnestly in the "chase" mode. It has between 300 and 400 open investigations. Wilson took over the Office of Inspector General in 2011, and after a series of WFAA stories exposing questionable Medicaid payments, the state is beefing up its investigation of Medicaid fraud.
"Texas is a huge state. There are a lot of kids out there," Wilson told News 8 in a lengthy interview last month. "Some of the things we're seeing are just errors and other things that we're seeing are more intentional. And we're taking appropriate actions and making referrals as necessary."
The state now is holding payments back from 91 Medicaid providers for Credible Allegations of Fraud. Dozens are dentists and orthodontists.
The first signs of trouble were in 2008. That's when an audit by the OIG revealed problems.
"The volume of prior authorizations (for spending on braces) was extremely high," Wilson says.
The OIG warned the state that applications for braces (orthodontics) were not being inspected carefully enough, and that the state should consider beefing up its staff.
"We thought things were going to get better," Wilson says. "As we now know, they didn't necessarily get better. The volume of orthodontia in our state was extremely high. We warned them, and I think they tried to act but they didn't go far enough."
In 2011, News 8 began asking for Medicaid records under the Freedom of Information Act (FOIA) and the Texas Public Information Act (TPIA) to see how much Texas was paying to put braces on kids under Medicaid, and how it compared to the rest of the nation.
Data obtained by News 8 from TDHHS showed that Texas spent $184 million on orthodontics for Medicaid kids in 2010. News 8 had to pay for this data because the state did not compile them on its own. TDHHS has now adjusted the total upward to $200 million.
To get a national picture, News 8 obtained total spending figures from the federal Medicaid Statistical Information System (MSIS). These numbers, which took weeks to obtain, had never been compiled until News 8 asked for them. The most recent totals available were, and still are, from 2009. The entire nation spent $355,550,331 in 2009.
Texas alone spent about 70 percent of the rest of the nation combined.
Aurora Illinois - An Aurora woman faces charges of illegally practicing dentistry at a North Aurora dental office, police said.
North Aurora police and the Kane County State’s Attorney’s Office have obtained a criminal indictment against the woman for illegal dentistry practice at the North Aurora Dental Associates office on the 100 block of North Lincolnway (Route 31).
The defendant is Silvia Hernandez, 37, of the 400 block of Iowa Avenue, Aurora. Hernandez was indicted last week by a Kane County Grand Jury on the following charges:
Theft, a Class 3 felony
Deceptive Practices, a Class A misdemeanor
Unlawful Practice of Dentistry, a Class A misdemeanor
The charges come after an investigation of over seven months by North Aurora police detectives.
Charging documents allege that Hernandez knowingly took control of more than $500 but less than $10,000 from someone by portraying herself as a licensed dentist in the State of Illinois, when in fact she was not a licensed dentist, according to a news release.
This investigation began on July 5, 2012 when a female came to North Aurora Dental Associates to report a problem with her braces. When the office staff could find no record of the female ever having been a patient there, she reported that she paid “Doctor Silvia” to put her braces on in this office about four years prior. Staff at North Aurora Dental Associates contacted North Aurora Police immediately.
Last week some whacked “organization” had their “President” testify before the Texas Senate Finance Committee singing the blues over dentists being investigated for Medicaid fraud in the state.
Well, it’s not really an “organization” per se, it’s more like 3 highly questionable dentists and a general counsel for a controversial law firm.
Greg Ewing, president of Texas Dentists for Medicaid Reform Fraud (you will understand this later) group said dentists were unfairly having funds withheld by the state because of a “2 years of disinformation” – did he mean by the media? If so, that means the media has mucho power! He further stated “evidence of fraud does not exist”. Ewing actually insinuated to even investigate the possibility for Medicaid fraud would be a waste of taxpayers money, saying “the State will lose money because the level of investigation will end up costing taxpayers millions more".
Was he really telling the Senate Finance Committee, “look guys, they have already stolen it, let ‘em keep it and while you’re at it, tell HHS and OIG to leave them alone?”
Ewing also sat there with a straight face and told the Finance Committee that the Texas Medical Association did an independent review of Carousel Dentistry operations and found the clinics “highly efficient”. Why Carousel was even mentioned in beyond me. More on Carousel later.
Who is Texas Dentists for Medicaid Reform?
The president of TDMR is Greg Ewing, an attorney for Asbahi Law Group. Asbahi Law Group is more or less a lobbyist started in 2009 by Mazen Asbahi, a former community organizer, but best known for his appointment by the Barack Obama campaign to head up outreach efforts in the Arab American and American Muslim community. Asabahi later resigned after it was revealed he served on the board of the Allied Assets Advisors Fund with Jamal Said which supposedly raised money for Hamas. Currently it’s reported Mazen Asbahi newest lobby efforts are to get guns to Syrian Rebels.
Wonder why this Mazen Asbahi guy is so interested in Texas Medicaid fraud?
The only other people mentioned on their website are 3 members who are dentists., Dr. Tara Rios, Dr. Juan Villareal, DDS and Dr. Vivian Teegardin, DDS, both of Harlingen Family Dentistry in Harlingen, Texas.
Dr. Tara Rios, DDS Brownsville Family Dentistry 1601 E. Alton Gloor Boulevard Suite 108 Brownsville, TX 78526 Phone: (956) 542-1956 Fax: (956)542-3672 office@drtarariosdds.com 2010 –D2930 Crowns = 82
In the bios of the “members” of TDMR, they fail to use Dr. Rios’s complete name – Dr. Tara Rios Ybarra. In 2010 then Texas State Representative (D-South Padre Island) was taken into federal custody for Medicaid fraud which also involved Texas dentist Gary Morgan Schwaz and six others. Schwaz, owner of Valley Oral and Maxillofacial Surgery was accused of paying dentists to received referrals for Medicaid recipients.
Appears it’s not the first time Rios-Ybarra has been used as a patsy. While a Texas Representative it appears she sponsored bills that were actually put forth by “special interests”.
Comment: “Well, we can all see that she was basically elected to her district because she is Hispanic and nothing more. I guess this is what happens when you are corrupt. She had no business being elected to any office in the united states. She would be great in Mexico though. Worthless piece of trash!”
You might want to reconsider. Below are just a few points made by current or former employees of Aspen Dental - Pros: Free Lunch w/ meetings, plenty of employees to "vent" with. Cons: No morals from corporate headquarters, illegal, company is a joke, over worked, all about sales, unethical, money driven, no real concern about patient care, high stress Read all the reviews here: Aspen Jobs
Attorney General Chris Koster said today that his office has awarded $8,239 to a Medicaid fraud whistleblower who alerted the state to fraudulent billings by a group of dental clinics. The award money is 10 percent of $82,000 that the dental provider is paying in restitution and penalties to the state of Missouri, as allowed by Missouri law.
“Medicaid fraud tips are an important part of our efforts to investigate and punish Medicaid fraud,” Koster said. “We encourage anyone who suspects a health care provider is engaged in Medicaid fraud to contact our office so we can investigate.”
Koster said the whistleblower contacted his office in January 2011 with concerns about Ozark Family Dentistry, and the clinics’ owner, Dr. Arrash Ahmadnia. Dr. Ahmadnia, based in Rolla, owns dental clinics in Rolla, Thayer, Osceola and Springfield.
The whistleblower, who worked briefly at one of the clinics, alerted the Attorney General’s Office that Dr. Ahmadnia had instructed him to perform unnecessary work on patients, presumably to bill the costs to Missouri Medicaid. The Attorney General’s investigation found that the clinics had billed Medicaid for treatments under the code for dental fillings, but had actually performed different procedures – preventative resin restorations – which are not covered by Medicaid. The investigation also found some instances of double billing and billing for ineligible adults.
Under a settlement, Dr. Ahmadnia is required to pay more than $208,000 in restitution and penalties to the state and federal Medicaid programs. He is also required to immediately stop submitting reimbursement claims to Medicaid for the preventive resin restoration treatments. The agreement is a compromise of disputed claims and does not contain an admission of wrongdoing by Dr. Ahmadnia. The Attorney General’s Office is continuing to review billing procedures at the clinics.
In all the raw data I’ve seen out of Texas, this one would nearly always fall in the top 5. This one alone is said to have stolen $18 million from taxpayers. Just imagine the hundreds and hundreds of millions, if not billions stolen from scam dentists and dental companies in the state of Texas! Perp walk please!!
Carousel Pediatrics began shutting down its Austin dental practice Tuesday night, displacing about 28,000 low-income pediatric patients, after state health investigators cut off Medicaid payments over allegations of fraudulent activity.
Carousel’s owner, Dr. Glenn Wood, who disputed the fraud allegations, said the loss of about $400,000 a month in Medicaid payments required him to shut down his dental affiliate, Trueblood Dental Associates, and lay off about 40 staff members and six dentists.
A story by the Bakersfield Californian, reports the California Dental Board has filed a complaint against Dr. Robert Tupac, DDs to the state’s department of consumer affairs.
Dr. Tupac reportedly told one patient “not to worry about a thing, I wrote the book on (dental) implants,"
The report says, the complaint was issued by the state Attorney General raises numerous issues that should result in his licenses being revoked or suspended: for discipline" against Tupac, including gross negligence, altering patient records, aiding and abetting an unlicensed person to practice dentistry, incompetence and obtaining fees by fraud. The document requests that the Dental Board revoke or suspend his license and pay restitution.
According to the report, his dental licenses remain squeaky clean, despite his own professional regulatory board having multiple complaints against him on file AND have filed their own complaint to the California Department of Consumer Affairs!!
“The Dental Board issued Tupac's dental license in 1974. The board's website does not show any previous disciplinary actions against him.”
In a report on KGET-TV’s website it says “The California Dental Board wants to suspend or revoke the license of…” Well, then why don’t they??
This situation with Dr. Tupac sounds much like a situation with an implant dentist in Texas who says their office “specializes” in dental implants – Dr. Li Skelton. Heck her new clinic even promotes tourism dentistry, just to see her.
Of course crowing about the recovery and actually recovering the money are two completely different things. Personally, I read it as “We found $50M we were snookered out of and have they con artists an invoice.”
Of interest to me was this part of the statement:
Comfort Dental (3 cases): Comfort Dental – a franchise dental chain based in Colorado with offices in the Kansas City area – billed Medicaid for services provided to individuals who were not eligible for Medicaid, resulting in a total loss to Medicaid of more than $17,000. Additionally, the Attorney General’s investigation revealed that each clinic double-billed services to Medicaid, resulting in a loss of more than $4,200, and also charged Medicaid recipients for services paid for by the program.
In three separate settlements, the entities paid $66,265.22 to resolve claims of both the Medicaid Fraud Control Unit and the Consumer Protection Division. The Consumer Protection Division sent checks totaling $6,265.22 to those Missouri citizens who were improperly billed for Medicaid covered services.
New York Attorney General, Eric Schneiderman released a statement this week saying the state had recovered $335M in Medicaid that has been fraudulently obtained in 2012.
The part I found interesting was the dental, of course. Media outlets are reporting $1.6 million recovered from Kaleida Health’s – Buffalo Women’s and Children's Hospital Dental Clinic.
Amazingly, Dr. Joseph Bernat, DDS — who is was so highly respected; who supposedly carries such influence — now has two organization nailed for Medicaid Fraud under his belt: Small Smiles Dental Centers in 2010 and Women and Children’s Hospital of Buffalo in 2012.
Kool Smiles continues its dirty practices and children still suffer the previous trauma this company brought to millions of children over the last 9 years according to posts over on Topix.
NINE YEARS!!!
That’s a long time for authorities and dental boards to allow this. How can any of them explain their lack of action? I have to assume they think it’s OK. What a screw up way of thinking!
Wednesday January 23, 2013 - Be very leery about fraudulent diagnosis from this office. This facility is only interested in taking advantage of low-income families who have access to Hoosier HeathWise and/or Medicaid ... preying on the fact that most of these parents will not question any diagnosis given; ultimately, this facility is billing the government for services NOT needed.
My personal experience: First of all, parents are not allowed in the back (a BIG red flag), nor shown x-rays, nor consulted in any way. Took my son to this dentist and was "told" that he had FIVE cavities (mind you, I was never shown his x-rays). The office tried to keep us there to do the fillings right then and there. I had an extremely uneasy feeling; therefore, I declined, and stated that I would schedule another time.
We have since consulted another pediatric dentist. Imagine my surprise being told that my son had NO cavities. None. Zero. Zilch. In fact, they told me that he had done an exceptional job keeping his teeth clean and healthy.
My recommendation: Do NOT give your business to a fraudulent business such as Kool Smiles in Terre Haute. Any facility taking advantage of low-income families and the Indiana state government should be audited and shut down for fraudulent business practices.
Tuesday January 15, 2013 - My daughter went to Kool Smiles when she was four for fillings. They put her in a straight jacket and she screamed until her nose bled.
Remember the Erie, Pennsylvania dentist who headed to Texas for a more lucrative position with Pacific Dental d/b/a Modern Dental? Well, she’s not wanting to go to jail. Didn’t work very well for Robin Lockwood in Oklahoma, however Lockwood’s dental license still appears squeaky clean! Amazing!
Published: January 22, 2013 12:01 AM EST Updated: January 22, 2013 1:38 AM EST
By LISA THOMPSON, Erie Times-News lisa.thompson@timesnews.com
A former area dentist who pleaded guilty to defrauding Medicaid is hoping a judge will spare her a term in federal prison so she can better care for her family.
Federal sentencing guidelines recommend a prison sentence of a year to 18 months for the dentist, Kristi Ayn Liebau-Grassi, who admitted in September that she repeatedly billed the government for dental work that was unnecessary or never provided.
Her lawyer, however, is hoping to convince a judge to give her a lighter sentence because of her clean prior record, her family's needs and she accepted responsibility.
"The defendant is a loving and devoted parent whose maternal responsibilities may be greater than almost anyone who has stood for sentencing before this Court," the lawyer, David Ridge, wrote in a sentencing memorandum filed in U.S. District Court in Erie.
So it was announced last week that Florida State Representative Michael Bileca’s Towncare Dental Partners d/b/a Towncare Dental and Main Street’s Children Dentistry and Orthodontics is now “affiliated” with Dental Care Alliance based in Sarasota, Florida. Of course that means he unloaded the clinics. Who knows he may stay on as CEO, President or whatever he claims to be. Wonder if Mr. Bileca has bigger political ambitions and needs to rid himself of the DSO?
So, who is Dental Care Alliance? Beats the hell outta me! There’s a timeline after the press release. You figure it out.
What I do know is Steven Matzkin and Michael Bileca , their respective CEO’s are founders of that nasty group the Dental Group Practice Association (DGPA). So swapping control of dental clinics they illegally operate among themselves is akin to one of those underground “swingers” clubs.
Dental Care Alliance Press Release
Dental Care Alliance Acquires Towncare Dental Partners
Sarasota, FL – Dental Care Alliance (DCA) announces the affiliation of Towncare Dental Partners (TDP).
“Towncare is an outstanding, well regarded company, and we are excited to have their team join DCA and expand our administrative resources to better support the needs of our affiliated dental professionals,” says Mitch Olan Co-CEO/COO of Dental Care Alliance. “Both DCA and Towncare place the same emphasis on quality care, provider support and patient satisfaction.”
The Florida-based companies have similar operating philosophies and more than 40 years of combined experience supporting the dental profession. The combined company will now manage the administrative services of 145 dental practices in 8 states.
It’s almost that time of year again; February “Children’s Dental Health Month” or as I’ve come to call it “Chop Shop Victim Month”. Like so many things, what started out with good intentions became a way for the crooks and unsavory dental mills to increase patient volume. I suspect with their business model taking such a financial hit this past year, patient shopping is high on their list of priorities.
Here’s how it works.
Schools and daycares in low income areas are called by the dental mill and asked if they would like to have a free dental screening day. All it is, a dental assistant doing a quick visual in each child’s mouth, no instruments used.
By Matthew Waller Scripps Texas Newspapers Published Wednesday, January 16, 2013
AUSTIN — Texas lawmakers are looking at ways to cut down on billions in fraud and waste in Medicaid, health funding for the poor, they announced Wednesday.
The question is whether the proposed laws will discourage medical practitioners from operating or accepting Medicaid as payment, a Texas Tech professor said.
Medicaid fraud and waste cost Texas $6 billion from 2004-11, lawmakers said Wednesday.
Sen. Jane Nelson, R-Flower Mound, and chairwoman of the Senate Committee on Health and Human Services, plans to tackle that number with two pieces of legislation aimed at reducing Medicaid fraud and improving Medicaid services based on quality of care.
"It's depressing," Nelson said of the reports of Medicaid fraud. "I feel like we're playing Whac-A-Mole. We have one problem uncovered, and we try to deal with it, and then we see another one emerge. … We have to assume our responsibilities and head off some of these problems before they begin. … It's infuriating to hear report after report of the kind of abuses that are taking place."
Earlier this month, for example, the attorney general announced a $36 million settlement with pharmaceutical companies Pfizer and Endo on claims that the firms overcharged Medicaid for drugs.
I’m guessing Texas is not exactly the best market anymore for the Medicaid dental mills and DSO’s in general.
by BYRON HARRIS Bio | Email WFAA Posted on January 16, 2013 at 6:48 PM Updated yesterday at 9:55 PM
NEWS 8 INVESTIGATES
AUSTIN — State Sen. Jane Nelson (R-Flower Mound) put it simply Wednesday, speaking to a group of reporters at a news conference in Austin:
"It is infuriating to hear of the kind of problems that are taking place... problems that are particularly serious in Medicaid dental, orthodontia and transportation for Medicaid patients," she said.
For the past two years, News 8 has been investigating the Texas Medicaid Dental program and hundreds of millions of dollars the state has spent on orthodontics under Medicaid.
Sen. Nelson specifically mentioned the parents of Medicaid children who had been solicited by "marketers" bearing free gifts and cash, the subject of several News 8 stories.
Senate Bill 8 is designed to cure some of those abuses.
"It strengthens the prohibitions against solicitation of Medicaid clients," Nelson said. "We heard story after story about that. We are going to prohibit that and make sure it doesn't take place."
So far, the bill does not specifically prohibit handing out gifts and cash to parents to induce them to take their children to certain dentists. Nelson says hearings over the next two months will flesh the bill out.
The legislation also articulates the Inspector General's role in uncovering and reporting fraud, and bans a dentist from participating in Medicaid if found guilty of fraud.
The bill moves Medicaid Transportation into managed care, and directs the Department of Health and Human Services to reduce inappropriate ambulance use.
Even though the specifics of this bill haven't yet been hammered out, there's already huge opposition to it. That's a sign, Nelson says, that as it is, some dentists are making lot of money.
Dr. Tara Rios, DDS
