Monday, November 18, 2013

Judge Orders Retrial for 1st Small Smiles Malpractice Case in New York–“Creepy” AIG Attorney Stalks Jurors

Syracuse, NY -  In October a verdict for the defendants was handed down by the jury in the 1st of 33 malpractice cases against Small Smiles and their dentists slated to be heard in New York courts.

Just after the verdict, the jury informed the judge they were stalked throughout the 15 day trial by a “creep” and “sleazy” guy who turned out to be a New York attorney by the name of Scott Greenspan.  Greenspan was hired by malpractice insurance carrier National Union Fire Insurance Company, a division of AIG .

Now, “upon examination of the facts”, Judge Deborah Karalunas. has ordered a new trial, concluding “…that Mr. Greenspan made improper contact with the jury.”

In her November 18, 2013 decision, Judge Karalunas finds AIG attorney Scott Greenspan’s conduct “violated the sanctity of the jury, raises ground for suspicion that the decision was found on something other than the evidence and was prejudicial and likely to influence the verdict.”

“This is not a matter of an isolated elevator conversation, cake for juror appreciation day or expression of condolence.  This is a case where jurors over a 15-day period believed that they were stalked, videotaped and closely monitored by a person they believed worked for the defendants,” says Judge Karalunas.

“This is a case where jurors performing their civic duty were made to feel bothered and scared.”

Under questioning by Judge Karalunas, one juror said:

“He followed us everywhere. When we would go to lunch, he’d follow us to where we were going.  One day we had an hour and 15 minutes, a little extra time, so we walked down to the Armory Square to Blue Tusk.  And I told the other jurors, this guy is following us everywhere.  So after the third time I saw him, I said look behind you, that’s what I’d say to them, and he would always be there.

“But when we would go on the elevator, he would always be there.  when we got outside, we would go to have a cigarette right out front, he’s always be standing close by.  When we got back on the elevator to come up,he was always there.”

‘…the only times we did not see him out of the whole time was once we went to Ale and Angus and once we went over to The Mission and we didn’t see him there.”

The juror told Judge Karalunas that Mr. Greenspan was in the elevator “at least half the time, if not three quarters of the time.” 

So there ya have it.  A new trial and I would guess that National Union/AIG would need to pick up the tab for this. Now, wouldn’t it have just been easier to write this child a check for all the hell he’s been put though?!  Just saying…

Small Smiles Dental Syracuse Bohn Malpractice New Trial Decision

Florida Dental Board allows Dr. Michael Tarver access to children after Florida Department of Health says he’s too dangerous

Apparently the Florida Board of Dentistry is more concerned about “saving face” of one of their licensees—Dr. Michael Addair Tarver— than they are about the  safety of the public, most notably, children.

At a board hearing on November 15, 2013, the board voted to reinstate the dental license of Dr. Michael Addair Tarver and agreed to a proposed settlement  with a few changes. Reports say the Dental Board members agreed to “reduce the fine imposed by 1/2;  from $15,000 to $7,000 and to removed a stipulation whereby Dr.Tarver must publish a 2,500 word article. (don’t worry, Dr. T, I think the the 2,500 word article is covered)

In September 2013, the Surgeon General and Secretary of Health, John H. Armstrong, MD, FACS, issued an Emergency Suspension Order for the dental license of Dr. Tarver after an investigation of serious allegations of patient endangerment and malpractice.  (see Background below)

According to the Ocala Post article, Tarver admitted he would sedate children if they misbehaved!  This is far past outrageous!  It’s criminal!!!  What next will happen that sends the message it is acceptable to sedate a child for misbehaving?!  Teachers?  Daycare providers?  Parents?  Grandparents?  Does this not scare anyone but me?!

Tarver must also complete continuing education on Ethics and keeping Dental Records.  By reading the Emergency Suspension Order, Tarver knows all about record keeping, since he was able to go into the computer an altered many of them.  Maybe this required CE class is about how to restrain the urge to alter patient records when investigators come knocking.  Reports also say he must be “monitored” by another dentists, someone other than his wife. 

WSJ - Getting a Grip on Dental Expenses

LOL, ya gotta love it.  There’s a “grip” on it alright.  A damn tight one!

 

wsj

 

 

Getting a Grip on Dental Expenses

Health Law Should Help Children and Some Low-Income Adults

By Kristen Gerencher

Nov. 16, 2013 8:05 p.m. ET

Oral health typically isn't covered by traditional health insurance, but kids and low-income adults soon may have more opportunity to take care of their teeth. As many as 8.7 million children are expected to gain dental insurance through the Affordable Care Act by 2018, according to the American Dental Association, though some experts expect a more modest addition of about 5 million children.

The news for adults is mixed. Medicaid, the federal and state health-insurance program for low-income people, will expand in some states under the health-reform law, providing more adults with dental coverage. While 29 states offer adult Medicaid recipients limited or comprehensive dental coverage, 21 states offer bare-bones, emergency-only coverage—or none at all, according to Oral Health America, a national nonprofit based in Chicago.

Medicare, the federal insurer for the disabled and for adults 65 or older, doesn't cover routine dental care, so many seniors still face hefty out-of-pocket costs. Two-thirds of 407 seniors earning less than $35,000 a year said they couldn't afford a procedure such as a crown, implant or bridge, according to a recent survey by Oral Health America and Harris Interactive.

Here are a few tips for managing dental costs, whether you're shopping for insurance or discounts:

Starting Jan. 1, more kids may find coverage through Medicaid, as 25 states and the District of Columbia make plans to expand the program, and through state or federal health-insurance exchanges. But the options can be confusing. Only two states, Washington and Nevada, require families who shop for health coverage on the exchanges to buy pediatric dental insurance as well, says Evelyn Ireland, executive director of the National Association of Dental Plans in Dallas.

On the exchanges, you need to weigh whether to buy a separate "stand-alone" dental plan or one that is part of a health plan. In some markets, because of the way deductibles are structured and because premiums could exceed the cost of expected care, it may make more financial sense to forgo dental coverage altogether.

If you choose to get pediatric dental coverage through a medical plan, check to see how the deductible is applied, Ms. Ireland says. "We've seen them all over the map," she says. The health plan may require you to pay its deductible before the dental plan will cover routine care such as well-child cleanings, sealants and X-rays. Because dental insurance has traditionally paid the full cost of preventative care, "it will be a big shock if [consumers] go under a medical plan and end up having to pay all of it out of pocket instead of none of it out of pocket."

Sunday, November 17, 2013

Texas Dentists for Medicaid Reform Press Release Re: Antoine Dental Center

Hey folks, it’s not the Office of Inspector General who “lost”, it’s not just the taxpayers of Texas, it’s all taxpayers.  The Medicaid system is funded with state and federal funds.  Taxpayers should be outraged over this ruling! 

Texas Dentists for Medicaid Fraud Reform Press Release Re: Antoine Dental Center:

Judges Finds Another Texas Orthodontic Practice Innocent of Medicaid Fraud and Misrepresentation

Two administrative law judges with the Texas State Office of Administrative Hearings (SOAH) have issued their proposal for decision in the case of Antoine Dental Center of Houston (ADC) SOAH Docket No. 529-13-0997. ADC had been placed under a 100% payment hold in April of 2012 by the Texas Health and Human Services Commission Office of Inspector General (OIG) for "credible allegations of fraud" and willful misrepresentation in their orthodontic billings from 2008 to 2011. ADC had been one of the top 25 billers of Medicaid for orthodontic services in the state. The judges, in their decision, found that ADC had not committed fraud or any willful misrepresentation and ordered the payment hold discontinued.

"I am extremely relieved and happy with this decision," stated Dr. Behzad Nazari, the owner of ADC. "We had been crippled to the point of near bankruptcy by this payment hold and the allegations that had been swirling around the practice. I have been saying for a long time that we weren't guilty and I am thankful that the judges recognized that fact. There is something wrong with the way these cases have been prosecuted by the state."

Oh, I bet Dr. Nazari is happy happy happy.  Just because some judge (or jury)says you aren’t guitly doesn’t make it true.i.e.Casey Anthony, O.J. Simpson.

Judges Howard S. Seitzman and Catherine C. Egan wrote in their decision that "the prima facie evidence failed to support a credible allegation of fraud or willful misrepresentation and failed to show that ADC filed claims for non-reimbursable services. The few non-fraudulent record retention violations that ADC committed were technical violations that do not warrant a payment hold."

Sorry, judges, I 100000% disagree!  Anyone at that hearing could clearly see the fraud, and their expert Dr. Orr, was a joke.

It’s hard to pin fraud on top executives in big complex companies! Poppycock, says Judge Jed Rakoff

This may seem to have nothing to do with corporate dentistry and fraud, but you would be wrong.
Judge Rakoff Blasts Breuer, Prosecution of Companies Rather than Individuals in Bar Speech

Thursday, November 14, 2013

naked capitalismAbsent sitting on the Supreme Court, it is difficult for a single judge to effect much change. Yet Jed Rakoff, in sending the SEC back to the woodshed in two separate cases over its failure to get factual admissions, meaning admissions of misconduct, on civil settlements of SEC cases, singlehandedly embarrassed the SEC and the Department of Justice into seeking these statements (for instance, numerous media reports indicate that the Administration wants that sort of confession as part of its pending settlement with JP Morgan).

Rakoff threw down another gauntlet in a New York Bar Association speech on Tuesday. I’m taking the liberty of quoting it at length because his rebuke is a breath of fresh air and roused the Department of Justice to issue a “we really are doing our job” response.

But if, by contrast, the Great Recession was in material part the product of intentional fraud, the failure to prosecute those responsible must be judged one of the more egregious failures of the criminal justice system in many years.

Rakoff then pointed to the fact that the FCIC and numerous government officials had discussed fraud in connection with the crisis and went further:

While officials of the Department of Justice have been more circumspect in describing the roots of the financial crisis than have the various commissions of inquiry and other government agencies, I have seen nothing to indicate their disagreement with the widespread conclusion that fraud at every level permeated the bubble in mortgage-backed securities.

He then goes through their litany of excuses (his word). Ooh, it’s hard to pin fraud on top executives in big complex companies! Poppycock, says Rakoff:

Who, for example, were generating the so-called “suspicious activity” reports of mortgage fraud that, as mentioned, increased so hugely in the years leading up to the crisis? Why, the banks themselves. A top level banker, one might argue, confronted with increasing evidence from his own and other banks that mortgage fraud was increasing, might have inquired as to why his bank’s mortgage-based securities continued to receive triple-A ratings? And if, despite these and other reports of suspicious activity, the executive failed to make such inquiries, might it be because he did not want to know what such inquiries would reveal?

This, of course, is what is known in the law as “willful blindness” or “conscious disregard.” It is a well-established basis on which federal prosecutors have asked juries to infer intent, in cases involving complexities, such as accounting treatments, at least as esoteric as those involved in the events leading up to the financial crisis. And while some federal courts have occasionally expressed qualifications about the use of the willful blindness approach to prove intent, the Supreme Court has consistently approved it.

The second, “weaker” excuse came out of Lanny Breuer’s mouth in his notorious Frontline interview: that the investors in mortgage-backed securities were sophisticated; it would be hard to prove they relied on ratings and fraudulent misrepresentation. Rakoff basically says that Breuer is a crappy lawyer:

Actually, given the fact that these securities were bought and sold at lightning speed, it is by no means obvious that even a sophisticated counterparty would have detected the problems with the arcane, convoluted mortgage-backed derivatives they were being asked to purchase. But there is a more fundamental problem with the above-quoted statement from the former head of the Criminal Division, which is that it totally misstates the law. In actuality, in a criminal fraud case the Government is never required to prove reliance, ever. The reason, of course, is that would give a crooked seller a license to lie whenever he was dealing with a sophisticated counterparty. The law, however, says that society is harmed when a seller purposely lies about a material fact, even if the immediate purchaser does not rely on that particular fact, because such misrepresentations create problems for the market as a whole.

The third excuse is that prosecution might hurt the economy. Rakoff indicated his discomfort with the “too big to jail” idea, but used that to lambaste the notion of prosecuting institutions as opposed to individuals. No institution would perish if an executive were prosecuted.

Rakoff carefully and pointedly says he’s not accusing prosecutors of revolving-door corruptions and that prosecutors maximize their value in the post-government service market by collecting scalps. Whether of not he actually believes that to be true, he has to say that or risk never hearing a big securities case ever again, in that both defendants and regulators could ask to have cases assigned to other judges based on the notion that Rakoff had said that prosecutors were soft of big corporate crime because they were currying favor with prospective future employers. Notice, by contrast, the cautionary example of Judge Shira Scheindlin, who had a ruling opposing New York City’s stop and frisk rules overturned because she violated the code of conduct for Federal judges by showing partiality.

But he point out other reasons why no one could be bothered to go after the conduct that wrecked the economy. The best US Attorney’s office, the Southern District of New York, was busy on the Rajaratnam case. Any smart prosecutor would ride that horse, which was ready to go, rather than take on the slog of a case that was years away from being files. So basically, with Congress starving the SEC of budget and making it capable only of handing out parking tickets in the form of insider trading cases, SDNY staffers were incentivized to go after the comparatively easy cases the SEC threw over the transom rather than pursue far more important crisis-related cases. Rakoff argues the other reason for the government’s reticence to prosecute is that it would embarrass government officials and expose policy failings.

And Rakoff described why prosecuting companies, rather than targeting individuals, produces lame outcomes:

But if your priority is prosecuting the company, a different scenario takes place. Early in the investigation, you invite in counsel to the company and explain to him or her why you suspect fraud. He or she responds by assuring you that the company wants to cooperate and do the right thing, and to that end the company has hired a former Assistant U.S. Attorney, now a partner at a respected law firm, to do an internal investigation. The company’s counsel asks you to defer your investigation until the company’s own internal investigation is completed, on the condition that the company will share its results with you. In order to save time and resources, you agree. Six months later the company’s counsel returns, with a detailed report showing that mistakes were made but that the company is now intent on correcting them. You and the company then agree that the company will enter into a deferred prosecution agreement that couples some immediate fines with the imposition of expensive but internal prophylactic measures. For all practical purposes the case is now over. You are happy because you believe that you have helped prevent future crimes; the company is happy because it has avoided a devastating indictment; and perhaps the happiest of all are the executives, or former executives, who actually committed the underlying misconduct, for they are left untouched.

Saturday, November 16, 2013

Terrence Ewing Syler, DDS was sentenced to 22 months in jail

A joint investigation between the Feds and the State have landed another Texas dentist in the poky.  70 year old Terrence Ewing Syler, DDS was sentenced to 22 months in jail by U.S. District Judge Thad Heartfield.

Texas dentist sentenced to prison for Medicaid fraud

Dr BicuspidBy DrBicuspid Staff

 

November 14, 2013 -- A Beaumont, TX, orthodontist has been sentenced to federal prison for Medicaid fraud after submitting claims for palatal expanders that were never provided to his patients.

Terrence Ewing Syler, DDS, 70, pleaded guilty in June to healthcare fraud and was sentenced to 22 months in federal prison on November 7 by U.S. District Judge Thad Heartfield, according to a U.S. Department of Justice statement.

Dr. Syler, who owned and operated Syler Orthodontics in Beaumont, submitted the fraudulent claims from January 2007 to October 2012, according to the statement. As a result of the scheme, Dr. Syler received $829,000 to which he was not entitled. As part of his plea agreement, Dr. Syler agreed to forfeit several bank accounts totaling just over $829,000 and pay a $6,000 fine.

Friday, November 15, 2013

Small Smiles Dental Center Attorneys Want “Jury Stalking” Proceedings Sealed

I know a little about creepy attorneys and Small Smiles. See, it was about this time of year in 2008, Small Smiles Dental Centers sent a creepy attorney, named Thor, knocking on doors, of anyone in a 100 mile radius of me that had my same name. (By the way, there are several)  It was well into the night when he knocked on mine.  He was searching for the person (me) who was exposing the secrets of their criminal dental scam, which was defrauding Medicaid from hundreds of millions of dollars. They wanted me to shut the hell up! 

Now, Small Smiles Dental Centers and their malpractice insurance carrier want to silence the post-trial proceedings dealing with their jury tampering in the first malpractice trial in Syracuse, New York.  I’m shocked! (sarcasm)

National Union Fire Insurance Company (NUFIC) a subsidiary of American International Group (AIG) hired New York attorney, Scott Greenspan to “monitor” (a.k.a. “stalk”) the jurors of the first Small Smiles Dental/FORBA malpractice trials in Syracuse, New York.  Mr. Greenspan is a partner at Sedgwick Law, with offices around the world.  According to Mr. Greenspan he was hired by Denise D’Assaro,  AIG Complex Claims Director and it was pure coincidence he was in every restaurant they jurors visited.

Read:

NUFIC/AIG wants State Supreme Court Justice Deborah Karalunas to seal all records and court documents related to the jury stalking event.  Frankly, they would like to wave a magic wand and have the whole incident removed from, not just the record, but the memory of all parties.  I would think they especially want the transcripts where their employee Mr. Scott Greenspan is said to be“creepy” and “seedy” buried under the courthouse. 

They also want the public barred from any hearings about said jury stalking event. Well, of course they do!  They would like it if the jurors didn’t notice they had a creepy and seedy stalker but that ship has done sailed.

Apparently, on October 16, 2013 - shortly after the verdict, Judge Karalunas  called at least one juror back to court for a hearing.  I’m sure this judge wanted to hear more details of the jury stalking incident.   Heck yeah, I want to know just how far Mr. Greenspan went in his intimidating and harassing of the jurors during the 10 day trial.  What line did he not cross?  What lines did he cross without hesitation?  No doubt NUFIC/AIG wants the transcript between Judge Karalunas and the juror marked “Super Duper Top Secret”,

If there is anything that should NOT be sealed it would be this!  The public doesn’t need to know the jurors names or other person information — that should be redacted.  But, boy oh boy, the public sure needs to know the extent NUFIC/AIG will go to in order to deprive young children from being compensated for injury, pain and suffering at the hands of one of their insured.

AAPD Behavior Guidance Symposium Nov 2013

According to the American Academy of Pediatric Dentistry, their Behavior Guidance Symposium “kicks” off today at their headquarters in Chicago.  I can simply not believe I was not invited to this event!  I should pay much closer attention to their event schedule in the future.

AAPD BHM Symposium 11-15-2013

Frankly, I’m not sure why the AAPD even has the event, since apparently the AAPD and their “policy and guidelines” are of little value.  According to testimony from ethically challenged dentists involved in various malpractice lawsuits across the nation, he policy and guidelines are mere “suggestions”.

Attending the event will  garner you Continuing Education credits.  With the massive number of dentists working in the Medicaid dental mills, you would think they would need a venue such as McCormick Place or the United Center instead of the Westin Hotel.

Thursday, November 14, 2013

Inside Edition puts spotlight on Happy Valley Pediatric Dentistry and The Smile Center

I’m sure Dr. Simpton of The Smile Center is popping a cork over this Inside Edition piece.  I’ve been a “victim” of Simpton’s cover-up, his attorney sent me a cease and desist letter, a year or two ago.  Why you ask?  Because I reposted a story or two out of Texas. I’ll be watching my mail for yet another one!

 

Airdate: 11/13/2013  Are Some Dentists Drilling For Dollars?

insideeditionGoing to the dentist is a scary proposition for many people. But imagine what it must be like for a child who goes to the dentist and comes out with a mouthful of metal crowns that may have been unnecessary.

When she was just four-years-old, Savannah’s mother Alicea White says she took her daughter to the Happy Valley Pediatric Dentistry in Phoenix, AZ for a routine appointment.

But Alicea says instead of just filing four cavities on Savannah, dentist Dr. Karan Nett turned Savannah’s mouth into a smile of steel.  

“I was completely shocked,” said Alicea. “All that silver in her mouth. I was like, ‘Oh my God, what happened?’”

Alicea says every single tooth in Savannah's mouth was crowned with metal!

People compared her new smile to the James Bond villain, Jaws.

Alicea said, “It broke my heart. I was in tears right along with her.”

Alicea believes Dr. Nett was just drilling for dollars; doing unnecessary and excessive work to jack up the bill.

INSIDE EDITION’s Lisa Guerrero tried to speak with her outside her clinic.

“I'd like to talk to you about a little girl whose mouth you filled with metal? Would you like to look at these pictures and explain these pictures?” Guerrero asked Dr. Nett as she walked to her car.

Dr. Nett did not respond to Guerrero but has denied any wrongdoing, saying the work was necessary due to Savannah's significant tooth decay.

It turns out that metal mouth cases like Savannah's are not rare.

One look at Maya Anderson's mouth and you can see why she falls to pieces reliving her traumatic trip to this dental chain in San Antonio, Texas called the Smile Center.

“I had 24 teeth worked on. All I have is like five teeth left. I’m sorry. He ground down my teeth so small they were like little stubs.”

The dentist who worked on Maya's teeth for eight hours is Dr. Mark Hong, and Maya's isn't the only patient who claims he drilled for dollars. 

On just five children, parents allege that Dr. Hong performed over 30 baby root canals and crowned over 50 teeth.

Tuesday, November 12, 2013

Maine DHHS may reduce fines for dentists–No danger there!

Paperwork mistakes is the number one excuse for fraud for heaven sake! 

 

portand press

November 12

Maine DHHS could reduce fines for dentists

Dentists complain about large fines by an auditor for minor clerical errors in MaineCare patient cases.

By Joe Lawlor jlawlor@pressherald.com
Staff Writer

The Maine Department of Health and Human Services could reduce or eliminate the controversial fines recently levied against dentists serving MaineCare patients, according to a contract between the agency and the independent auditor who issued the penalties.

Dr. Michael Dowling works on Aiden Serber, 8, of Westbrook, as dental hygenist Trisha Drewry assists at Falmouth Pediatric Dentistry in Falmouth.

Gabe Souza/Staff Photographer

Related Documents
Read Maine's contract with Health Management Services

The fines have been appealed and are in limbo awaiting DHHS rulings.

Dentists have complained to the Portland Press Herald that they were shocked to receive fines as large as $200,000 from new audits required under the federal Affordable Care Act. Statewide, the fines totaled about $800,000, and dentists have said they may have to close or sharply curtail services to low-income patients served under the MaineCare program if the fines are allowed to stand. The fines were based mostly on minor paperwork and coding errors, dentists have said, and the contract gives auditors financial incentives to penalize Medicaid providers for clerical errors.

“This has just been incredibly spiteful and petty,” said dentist Mark Zajkowski, of Oral and Maxillofacial Surgery Associates in South Portland. Zajkowski said his practice is facing a “substantial” fine. “The only thing this is going to do is disincentivize dentists serving MaineCare patients.”

While the ACA requires more comprehensive audits of Medicaid services, the specifics on how the audits are carried out and what types of penalties can be imposed are controlled by the states. In Maine, dental services are the first to be scrutinized by the new Medicaid audits, while hospitals are next on the list.

Monday, November 11, 2013

Dan DeRose–Soda in Schools King

Here is a “Blast From The Past” article on Small Smiles Dental Centers founder, Dan DeRose and his visions of sugar plums – Soda in Public Schools. This article was written during the period his dad, Eddie DeRose, formed DeRose Management, LLC.  DeRose Management, LLC was the precursor to FORBA, LLC — the “test” dental management company of sorts.

New York Times Articles

 

Today's Lesson: Soda Rights; Consultant Helps Schools Sell Themselves to Vendors

By CONSTANCE L. HAYS
Published: May 21, 1999

Dan DeRose, marketing consultant, was busy doing the math for his new client, the Newark Public Schools.

The question on everyone's mind: how much money could the district make if it sold a soft-drink company the exclusive right to vend its products on school grounds? The answer, according to Mr. DeRose: a lot more than it gets right now.

''Let's just say everyone drinks one product a day, and let's just count the students,'' he said. ''At 45,000 times 180 days of school, that's 8.1 million cans. At 75 cents apiece, that's $6 million walking out the front door of your school every year in quarters and dollars.

''Let's get a lot of it,'' he told his audience, a collection of school principals, athletic directors, P.T.A. officials and one student. ''Let's get some of it back to the schools.'' Even $5 million would make a difference in the district's $550 million budget.

With his square shoulders, steady smile and conscientious use of the first-person plural, Mr. DeRose and his company, DD Marketing, are storming a once-quiet backwater in the soft-drink business. Schools regard him as a font of information. Soft-drink companies, which used to make low-key deals on their terms with local school districts, hate him with a passion.

Wednesday, October 30, 2013

Ontario Teachers Union Pension Fund takes over My Dentist Complete Care Dentistry

 

My Dentist Complete logoAccording to reports, including the one at The City Wire, Heartland Dental has taken control of My Dentist Complete Care Dentistry, founded by the late Dr. Rodney Pat Steffan in Oklahoma City, OK. What reports fail to mention is who actually “controls” Heartland Dental.  That would be Ontario' Teachers Union Pension Fund.  According to Business Week, the union pension fund took over in December 2012, to the tune of $650 million.

 

city wire logo“Heartland Dental’s vision and values align perfectly with the principles on which Dr. Steffen founded My Dentist,” stated Kevin Offel, My Dentist president and CEO said in a statement.

That is a scary statement for any and all My Dentist patients! 

city wire logoThe My Dentist locations will continue to use the same branding and signage now used.

 

This is what makes it so shady and hard to determine the ownership and control of these corporate mills. 

city wire logo“Through our affiliation with Heartland Dental, I am confident we will continue operating My Dentist with the integrity and same caring heart we have always demonstrated,” Dr. Jennifer Chambers said. “I am personally excited as both a Clinical Director and a practicing dentist to carry-on the values and practices instilled in us with My Dentist while enhancing our capabilities going forward with our Heartland Dental affiliation.”

There is that word, ‘affiliation” again!  Jot down Dr. Jennifer Chambers’ name, I’m sure someone will need this information in the future.

 

city wire logoThe transaction is subject to certain regulatory and other approvals and is expected to be completed within 60 days. Upon completion of the transaction, My Dentist will be affiliated with a company that provides dental support services to more than 500 dental offices in 26 states.

Wednesday, October 23, 2013

Is CSHM, LLC taking full responsibility for all future legal actions against Small Smiles Dental Centers? You decide.

Update: 10-24-2013 10:58AM

On October 9, 2013 the so-called “new company” who owns and operates all the Small Smiles Dental Centers that have managed to remain open denounced its association with the so-called former owners and management company.  (see statement below)

[image%255B2%255D.png]

In making this claim, they must also be taking full responsibility for any and all illegal activities and/or malpractice issues that could arise in the future, right?  As the below email suggests, those will be coming.


Hi - I have kept up with your site for a while now because honestly it was the only way to find out the "real" news on Small Smiles. I am former employee of Small Smiles in South Carolina. When I took the position I had NO clue what I was getting into. I resigned from my position due to the horrible reputation Small Smiles has and it was mentally exhausting to even go to work.

Friday, October 18, 2013

Small Smiles Dental Centers Release Statement RE: New York Malpractice Case #1

image

 

 

 

 

 

 

 

 

 

 

 

Sorry, there is no mistake or confusion. It's the one and the same.  Creative financing and a few (very few) corporate heads rolling does not a completely different company make. Good try.

I suspect in the future we will see New FORBA and NEW NEW FORBA side by side in court just as we have Old FORBA and New FORBA today.

A dead fish by any other name still stinks.

PS. there is issue with jury being "stalked" so verdict is not set in stone.

Saturday, October 12, 2013

AIG Operative Stalks Jurors in 1st Small Smiles Dental Center Malpractice Case

Remember when the American taxpayers (you) bailed out American International Group (AIG) to the tune of $185 BILLION dollars in 2008?  AIG Bailout[1]Remember the company’s offices were converged upon by angry Americans.  So much so, that in typical bully fashion they actually took the name off headquarters in New York City in order to “hide” their location.  .

The latest victim of AIG’s bullying is an 11 year old boy in Syracuse, New York and the jurors who were to decide how much this child should be compensated for their policy holders misdeeds. 

There were 30 trials on schedule in New York by former patients of Small Smiles Dental Centers.  Many of these patients were 2, 3 and 4 years old when they victims of the clinics formerly located in Syracuse, Albany and Rochester.  There is much information about Small Smiles Dental Centers and their so called “management company” on the web and this blog, so I’m not going to bore anyone with more of that.

The first of the 30 trials finally made it to a jury October 7, 2013.  The complaint was filed in April of 2011 against, Edward DeRose, Michael DeRose, Dan DeRose, William Mueller, Adolph Padula, Michael Roumph, Dr. Naveed Aman, Dr. Koury Bonds, Dr. Yaqoob Khan and more, plus a host of dummy corporations set up to hide the true ownership of the clinics and make it difficult to track the hundreds of millions of dollars in fraudulently obtained Medicaid money they pocketed.

After trying to bury two judges and the attorneys representing the little boy—now 11 years old—in mountains (and I do mean mountains) of ridiculous pleadings, testimony finally began September 23, 2013 in Syracuse. 

The trial lasted for 2 1/2 weeks.  You can read all the transcripts here. I urge you to take time to read them.  It’s more entertaining than anything on television this fall and better read than any book on The Times Best Seller list since 50 Shades of Grey—however I do think the transcripts and the book could carry the same title.  There was a lot of shadiness happening in that courthouse and the testimony from the accused had more twists of the truth than a pretzel factory and there were so many bodies being thrown under the bus, the courtroom could have doubled for a Greyhound bus station.

Friday, October 11, 2013

Texas stepping up its game to recover stolen funds from Medicaid fraudsters


On Dental Claims, State’s Bark Worse Than Its Bite

by Becca Aaronson

Texas WeeklyOctober 15, 2013

Texans discovered nearly two years ago that the state was spending more on orthodontic claims in its Medicaid program than the other 49 states combined, but recovery of millions in purportedly misspent Medicaid money has moved slowly.

After a couple judicial setbacks, the Health and Human Services Commission’s Office of Inspector General has stepped up its game by bringing in the big guns at the attorney general's office and private counsel. The OIG also hired a chief dental director, Dr. Linda Altenhoff, and is making sure that multiple dental experts review cases before they’re brought to a judge. The outcome of those efforts will be apparent when an administrative judge rules on a case testing the state's evidence for withholding payments to Antoine Dental Center in Houston, which was argued in May.

Meanwhile, the accused Medicaid providers have made it clear they aren’t returning any money — or allowing the state to sully their reputations — without a fight. They’ve formed a coalition, Texas Dentists for Medicaid Reform, and filed a lawsuit against the state challenging the OIG’s hardball tactics of withholding Medicaid payments for months on end during fraud investigations with limited evidence that fraud occurred.

[We can’t forget about Texas Dentists for Medicaid Fraud.  See links at end of this blog post.]

After WFAA-TV in Dallas reported in December 2011 that Texas spent more on braces and Medicaid orthodontic claims between 2008 and 2010 than the other 49 states combined, the U.S. House Committee on Oversight and Government Reform released a report that found the Texas Medicaid and Healthcare Partnership, the company contracted by the state to process Medicaid claims, had only one dentist on staff and essentially rubber-stamped dental and orthodontia claims without reviewing whether those services were medically necessary.

Thursday, October 10, 2013

Dentist, Gary Anusavice sentenced to 8 years in prison for Medicaid Fraud

 

CBS Conn

Prison time for a Connecticut dentist who swindled millions from the federal Medicaid program.

Gary Anusavice, 60, used recruiters, to seek poor patients who used Medicaid. Then he would perform unnecessary dental procedures and file fraudulent Medicaid claims that added up to $20 million, $3.3 million he collected for himself from 2008 through 2012.

Anusavice is now sentenced to eight years in prison and has been ordered to pay $10 million in fines, give up his luxurious Rhode Island home, a boat, his Mercedes, and about $90,000 in cash found at his home.

He operated a network of clinics where the fraud went on in the central, southern and western parts of Connecticut.


thecourant

Dentist In Massive Medicaid Fraud Case Sentenced To 8 Years

By EDMUND H. MAHONY, emahony@courant.com The Hartford Courant
9:32 p.m. EDT, October 9, 2013

HARTFORD — A dentist barred from practicing elsewhere in New England was sentenced Wednesday to eight years in prison for operating assembly line-style clinics in Connecticut that targeted poor patients, performed unnecessary dental procedures and collected on more than $20 million in fraudulent claims from Medicaid.

Gary Anusavice, 60, operated networks of clinics in the south, central and western parts of the state from 2008 to 2012 and personally collected more than $3.3 million from the fraud.

Under a variety of settlements with the state and federal governments, Anusavice will pay more than $10 million in fines and restitution, in addition to giving the government his 8,000-square-foot home in Rhode Island, his boat, his Mercedes-Benz and about $90,000 in cash that investigators found in the home.


Anusavice opened clinics in areas where high concentrations of low-income people relied on the federal government's Medicaid program for medical treatment. Medicaid, which is administered in Connecticut by the state Department of Social Services, reimburses physicians for costs they incur while treating patients who are unable to pay.

Monday, October 07, 2013

Fortress Insurance Company v. Ocean Dental PC, Dr. Chad Hoecker and Dr. Robin Lockwood

Case Number:
5:2013cv00322

Filed:
May 2013

Fortress Ins. v. Ocean Dental, Chad Hoecker, Robin Lockwood Amended Complaint  Filed August 23, 2013

Fortress alleges neither Dr.Lockwood, Dr.Hoecker, nor Ocean Dental complied w/ requests for patient records, as their MP insurance carrier, against terms of their contract. They allegedly never alerted Fortress of pending claims, as required under the insurance contract. IMHO- Fortress makes a good point for Declaratory Judgment. That would leave Dr.Lockwood & Ocean Dental "naked", w/out Malpractice coverage.  Yikes!

Dr Lockwood is currently serving time at Federal Medical Center Carswell, in Fort Worth, TX. http://en.wikipedia.org/wiki/Federal_Medical_Center,_Carswell

One big issue is the policy time period for Dr.Lockwood & Dr. Hoecker. Some acts were allegedly made outside the time period of insurance coverage. If so, Dr. Lockwood & Dr. Hoecker were operating "bare" (w/out coverage). Depending on terms of employment w/ Ocean Dental, Dr. Lockwood has a potential counterclaim against Ocean Dental, if they neglected to provide MP insurance coverage to her, as defined under her employment contract.

Dr. Hoecker denies knowledge of the terms in the Dr.Lockwood policy. If Ocean Dental purchased this policy, that would be absurd. BTW- a "claims made" policy will not cover for acts filed AFTER the term period of the policy expires. Thus, a "tail" policy would need to be purchased. Obviously, there was no tail coverage purchased.

Seem just serving time for ones sins is just the beginning of a long life of misery for Dr. Lockwood, while ole Chad Hoecker is singing “Free Bird”. 

I hope all these dentists are paying close attention!

Here is a link to all the documents found on the case-

http://www.scribd.com/collections/4366323/Ocean-Dental-Stilwater-Oklaho

Tuesday, September 24, 2013

Become a whistleblower today. Read why.

Amarillo

Goodwin Orthodontics whistleblowers awarded shares of money

By Jim McBride
jim.mcbride@amarillo.com

September 19, 2013 - 4:57pm 

A Travis County judge has awarded more than $22,000 in legal fees to an Amarillo law firm that helped expose more than $1 million in Medicaid fraud at a local orthodontics clinic.

Amarillo attorney Phil Russ, who represented three former employees of Goodwin Orthodontics, credited Kristen De Los Santos, Sandy De Los Santos and Lissa Eason with exposing health care fraud at the clinic that led to the federal conviction of Amarillo orthodontist David Goodwin.

“The money needs to go to those women,” Russ said Thursday. “This is an example of how responsible citizens can help save our taxpayer dollars from being drained away from government programs by fraud. It takes a whistleblower who sees it happening to sound the alarm, because fraud is a game of stealth and concealment.”

On Wednesday, a Travis County judge awarded the state of Texas and the three Amarillo women more than $4.2 million in damages against Goodwin and the clinic in a whistleblower lawsuit.

Russ said Thursday the women could receive some money from the case if the state and federal authorities collect enough restitution from Goodwin and the clinic. If state and federal authorities collect $4 million from the clinic, the women could theoretically split $630,000 to $840,000, he said.

Dr. Thomas Floyd–More than a decade of complaints

Dentist accused of physically, verbally abusing children he treated

  • Thomas Floyd.

Thomas Floyd. (PBSO, Handout )

sunsentinelSeptember 22, 2013|By Jon Burstein, Sun Sentinel

 

He developed a reputation over three decades as a champion of dental care for poor children.

But behind the walls of Thomas Floyd's dental practice, some former employees said they heard children screaming in pain and terror.

While his September 2012 arrest for child neglect shocked many in the community, hundreds of pages of records obtained by the Sun Sentinel detail a trail of disturbing allegations that the West Palm Beach children's dentist physically and verbally abused patients dating back as far as 2001.

One father said he took his 5-year-old daughter to Floyd in 2011 and the dentist mistakenly pulled three good teeth. State authorities accused Floyd of confusing the girl with another patient.

"It's horrifying that your daughter goes in for a dental cleaning and comes out missing teeth," said the father, Benjamin Rodriguez. "[Floyd] just didn't care."

Floyd and his attorney have argued he's the the target of false accusations leveled by disgruntled employees and difficult parents.

Among the allegations in state records and police reports:

Wednesday, September 11, 2013

Dr. Edward Dove going to be “in and out” of the country, he pays 50% of production.

Opportunity Available 3-18-13

Office Name: Edward E Dove DDS PC
Contact Person: Eddie Dove
Practice Location: Bakersfield and Chatsworth
Address: 3130 Union Ave Bakersfield, CA 93305
Date Needed: Varies
Days Needed: Varies
Telephone:  818 644-7124
Fax: 661 872-9257
Email: pediatricdentist18@gmail.com
Requirements: oral sedation certificate
Information: I am presently looking for part time or on call to cover for me.  I am presently going to be out of the country at various times.  I do have one associate, but she cannot cover all offices.  It is mainly my bakersfield and chatsworth office.  I pay 50% of production and have excellent staff.  For more info please contact me.Thank you.

 

http://www.cspd.org/news/message.asp?news_id=265

Sunday, September 08, 2013

More parents coming forth with complaints about perilous Florida dentists–Dr. Michael Addair Tarver

More critics of suspended dentist come forward

Ocala Star Banner LogoBy Austin L. Miller

Staff writer

Published: Saturday, September 7, 2013 at 9:03 p.m.

Last Modified: Saturday, September 7, 2013 at 9:03 p.m.

 

Days after state authorities suspended the license of a local dentist who allegedly mistreated a young patient, critics of Dr. Michael Addair Tarver continue to go public with their own stories.

One of those people is Kristina Pate, a dental assistant who worked at Tarver's Polliwog Dental for two months before she was terminated, she said, for speaking out about Tarver's methods.

Pate said every child who came into the practice received nitrous oxide, or laughing gas. She estimates roughly 75 percent of the children seen by Tarver also were given Demerol ???.

Some of the children, she said, were strapped onto boards to keep them still. If Tarver felt they were misbehaving in any way, they were threatened, she said.

Those on Medicaid were treated much differently from those who paid out of pocket, she said.

Pate said those who paid up front or had insurance were treated quickly and sent on their way. Medicaid patients, she said, had to wait longer. Parents of those on Medicaid had to wait about three hours before their child was finished.

Saturday, September 07, 2013

Former employee of Dr. Michael Tarver says his wife, Rebecca, is not any better with children

 

ocala

Saturday, September 7, 2013

Polliwog Owner Michael Tarver Still Denies Allegations

Ocala, Florida — The allegations continue to stack up against Michael Tarver,  the owner and operator of Polliwog Dental.

The latest developments in this case do not really surprise parents whose children have attended the pediatric dentistry.

Ivy Castillo, a parent who has taken her five year old to the dentistry said, I have experienced first-hand the ‘Dr. Jekyll’ side of ‘Doctor’ Mike.” Adding, “My son told me a couple days later that during this routine cleaning, they made him drink the ‘icky Spiderman juice’, which I have come to learn was their sedative to ‘control’ my child.

Ocala Post has been flooded with horrifying stories of less than mediocre dental care provided by Michael Tarver.

In an E-mail we received from an employee who does not want to be identified, she wrote, “Dr. Mikes wife is not any betterShe was there when her husband man handled those kids.”  She went on to write, “I can understand a wife wanting to stand by her husband, but this is ridiculous.”

Rebecca Tarvers-profile-sm

 

Rebecca Tarver, DDS, wife of Dr. Michael Tarver.

 

 

One parent, who also does not want to be identified in order to protect her children wrote,

All 4 of my children went to Polliwog because they took Medicaid. From the get go the staff was rude and unorganized. The biggest issue was my six year old son and nine year old daughter at the time, came home with big cheek bruises and unwarranted work done. My son who has healthy teeth, was told every time I went he needed fillings. It’s funny but my two older girls (12 & 15) never had issues, I think because they were old enough to speak up or tell on them. Every time my kids went for any work, even a cleaning they told me they would need to give them the happy juice. I am so glad someone finally listened to all of us!”

The allegations against Tarver range from, placing his hands over children’s noses and mouths, over dosing children with the kiddie cocktail“, altering medical records, to actually inflicting physical injuries to young children.

Tarver continuously maintains he is innocent, using Medicaid parents as an escape goat by claiming their children are just misbehaved.

Tarver was questioned by authorities in regards to allegations that he put his hands over a child’s nose and mouth, causing the child to lose consciousness. Tarver’s  response again deflects to the child’s behavior. Tarver stated he remembered the “extremely misbehaved” child, passing blame on to the small child.

Thursday, September 05, 2013

Dr. Michael Addair Tarver: Four police complaints filed

 

Suspended dentist subject of four police complaints

ocala

By Austin L. Miller
Staff writer

Published: Thursday, September 5, 2013 at 9:52 p.m.
Last Modified: Thursday, September 5, 2013 at 9:52 p.m.

A dentist whose license was suspended Wednesday by the state on allegations of possible child abuse was also the subject of four complaints to Ocala police, but the complaints were determined to be unfounded.

Ocala police detectives investigated the complaints and sent their findings to the State Attorney's Office for review. The criteria for child abuse was not met in any of the complaints, authorities said.

In the four cases, the parents said they took their children — ranging in age from 18 months to 7 years — to Polliwog Dental at 255 SE 17th St., Ocala, for procedures and later said there were signs of abuse, officials stated.

Two of the four cases also were sent to the state Department of Health. That agency ordered the emergency suspension of Dr. Michael Addair Tarver, owner of Polliwog Dental, on Wednesday. Tarver is a board-certified pediatric dentist.

Tarver, in an email to the Star-Banner on Wednesday, vigorously denied the allegations and said he has hired an attorney to fight the accusations.

The DOH concluded that the 33-year-old dentist violated several state statutes and patient trust, and altered patient records. In one instance, the DOH said, a 4-year-old girl stopped breathing during a dental procedure and had to resuscitated, but her parents were never notified about the incident. His actions, the DOH stated, "demonstrates that he cannot reasonably be expected to comply with any sanction short of suspension."

Wednesday, September 04, 2013

Another troubling pediatric sedation dentist loose in Florida–Dr. Michael Addair Tarver

Polliwog Dental Children's Dentistry, is at 255 SE 17th Street in Ocala, Florida  34771Polliwog Children's Dentistry

 

 

 

 

 

 

 

 

 

 

Ocala Star Banner Logo

State suspends pediatric dentist in Ocala

By Austin L. Miller
Staff writer
Published: Wednesday, September 4, 2013 at 7:55 p.m.
Last Modified: Wednesday, September 4, 2013 at 7:55 p.m.

OCALA, FLORIDA — An Ocala dentist whose office was visited in late July by authorities who removed files and interviewed employees has had his license suspended, according to the state Department of Health.

A report by the DOH ordered the emergency suspension of Dr. Michael Addair Tarver’s license to practice dentistry.

The order, dated Wednesday, states that Tarver is a board-certified pediatric dentist. He’s the owner and operator of Polliwog Dental, a children’s dentistry office at 255 SE 17th St.

DOH officials said the emergency suspension order is directed at the individual, not the facility. Therefore, while Tarver cannot practice in the state of Florida, his wife, Dr. Rebecca Tarver, also a licensed dentist, can practice, and therefore the facility remains open, DOH said.

Tarver disputes the allegations against him.

“I am profoundly disappointed and shocked that the Board of Dentistry would take such action without even reviewing the facts or giving me a chance to defend myself,” he said in an email to the Star-Banner, adding that his attorney is “fighting this decision” and that he expects to have his license reinstated soon.

Hailing his wife as an excellent dentist, Tarver said the office is open and “will continue to provide quality care.”

The 10-page document outlined the reasons for the suspension:

Colorado Dentists Who Used Dirty Needles Arrested in Nevada–Cocaine Intoxication

Dr. Stephen Stein - Then and Now

 

Dentist Who Reused Needles CBS 4 DenverFaces First Criminal Case

DENVER (CBS4 ) – A dentist who reused needles and put thousands of patients at risk of contracting deadly diseases has been arrested in Nevada.

Stephen Stein was arrested just after 1 a.m. Aug. 12 for cocaine and driving under the influence near Lake Tahoe in Nevada.

Court documents state Stein was speeding, 48 mph in a 35 mph zone, while intoxicated with cocaine.

Officers said they found “a hollowed out ink cartridge” in the Chevy Traverse he was driving.

In Colorado last year, Stein had been investigated by police in Denver for prescription fraud for alleged practices out of his two offices in the Denver metro area. State charges were never filed.

Stein agreed to surrender his dental license last year after the Colorado Department of Health discovered he had been under the influence of painkillers while treating patients.

Examiners said Stein admitted to being a drug addict. The board also found he had been using drugs intended for patients.

Since Oct. 1, 2012 six former patients of Stein have tested positive for either hepatitis or HIV.

It’s not known whether they contracted the diseases from Dr. Stephen Stein’s office. Stein has since surrendered his license as an oral surgeon.

About 8,000 of Stein’s patients were sent letters asking them to get tested. The health department says it’s impossible to definitively tell if the infected patients got sick from Stein.

Stein had offices in Cherry Creek and Highlands Ranch.

Stein is scheduled for court in the Lake Tahoe area on Sept. 17. Court officials said that is when the results of his blood tests will be released.


Related:

Patients of Dr. Stephen Stein urged to get tested for HIV and hepatitis

Thursday, August 29, 2013

Oral Surgeon accused of sexually molesting 3 teens allowed to open his own “private” “clinic”

I’m sure we will see Dr. Turbyfill in the news again.  It’s just a matter of time.  Clearly the state of Florida learned little from the Dr. Thomas Floyd fiasco.

Aug. 27, 2013

pnj logo

FLORIDA - A Pensacola oral surgeon plans to start a new practice after reaching a settlement agreement with the Florida Department of Health over accusations of sexual misconduct with three sedated teenage patients.

Dr. David “Ty” Turbyfill has denied the allegations, calling them unfounded.

The Florida Board of Dentistry has approved the agreement, which allows Turbyfill to continue his practice. The deal calls for him to pay a $10,000 administrative fine and $4,630 in costs associated with the case. It also requires him to be monitored by a licensed health professional when using anesthesia or conscious sedation.

Turbyfill was formerly a partner of Oral & Maxillofacial Surgery Associates on North 9th Avenue.

His license has been restricted since April, when the state health department issued an emergency order after the allegations surfaced.

The department filed an administrative complaint later that month stating that staff members had seen Turbyfill acting inappropriately with three female patients on four occasions, twice with the same patient, between Nov. 16 and Feb. 20. Among claims in the complaint, witnesses alleged that Turbyville was seen moving his hips and pelvic region suggestively near patients and seemed to be sexually aroused in the presence of some patients — covering his groin and leaving the room on more than one occasion.

Wednesday, August 28, 2013

Dentists BEWARE -Kool Smiles Dental Center dentist thrown under the bus by NCDR, LLC

Looks like Dr. Tuan Truong aka Terry Troung is to Kool Smiles Dental what Robin Lockwood is to Ocean Dental. 
I bet ole Dr. Troung thought he was free and clear since leaving Kool Smiles.  If Dr. Troung thought NCRD, LLC was going to protect him, he was very wrong.  They will NOT! 
If you work for any of these type of places, you’ll be looking over your should for the rest of your life.
To Dr. Troung, and all other dentists working for these Medicaid mills, “I told you so.”.

reporternews logoPublished August 27, 2013
An Abilene dentist pleaded guilty in federal court Tuesday to one count of making a false statement in connection with a health care matter, according to a U.S. Department of Justice spokeswoman.
Dr. Tuan Truong, aka Terry Truong, admitted to falsely billing Medicaid for between $120,000 and $200,000 between June 2008 and July 2009, said Kathy Colvin, spokeswoman for the justice department. Truong practiced pediatric dentistry at Kool Smiles in Abilene.
U.S. District Judge Jorge A. Solis has not yet sentenced Truong, who faces a maximum penalty of five years in federal prison, a $250,000 fine and restitution.
“In summer 2008, Truong began working for Kool Smiles, which paid him a base salary and offered opportunities for bonuses based on additional procedures he performed in excess of daily targets set by Kool Smiles management,” Colvin said.
By falsely billing Medicaid, Truong collected $32,749 in bonuses he otherwise would not have collected.
The Medicaid Fraud Control Unit of the Office of the Attorney General for the State of Texas conducted the investigation.
 
Dr. Tuan (Terry) Truong, DDS TSBDE Action signed April 2011


Senate Report On Corporate Dentistry in Medicaid (includes Kool Smiles)













Monday, August 26, 2013

Antoine Dental Centers tells Texas HHSC-OIG to “Stick” it

Antoine Dental Center (ADC) and owner Dr. Behzad Nazari, was been placed on an administrative Credible Allegations of Fraud (CAF) 100% payment hold from Medicaid reimbursements/payments in Texas in April 2012.

CAF - Federal law defines a “credible allegation of fraud” as an “allegation, which has been verified by the State, from any source.” 42 CFR § 455.2 states that the source of these allegations may include, but are not limited to, “(1) fraud hotline complaints, (2) claims data mining, (3) patterns identified through provider audits, civil false claims cases, and law enforcement investigations. Allegations are considered credible when they have indicia of reliability and the State Medicaid Agency has reviewed all allegations, facts, and evidence carefully and acts judiciously on a case-by-case basis.

Since Dr. Nazari disagreed with this payment hold he filed a suit against Texas Health and Human Services Commission – Office of Inspector General (HHSC-OIG) —State Office of Administrative Hearings (SOAH) Docket No. 529-13-0997; HHSC-OIG Case number P20111316523848911.

On May 28, 2013 four days of hearings began where evidence from both sides was presented to the judges at the SOAH in Austin.

On August 23, 2013 both sides filed their written Briefs and Closing Arguments.  They can be read by clicking the links at the end. 

One Brief and Closing made perfect sense, with facts and logic along with visual aids.  One sounded like a babbling idiot recounting a fairy tale. Guess which was which.

ADC and Dr. Nazari seem to think that division, and possibly the whole OIG office, is completely unnecessary.

In the ADC Brief and Closing Argument they state:

How can the OIG support any credible aggregations of impropriety regarding HDL score sheets when the underlying diagnostic material was made available to the State and the State pre-approved the analysis that was reflected on the HDL score sheets?

Tuesday, August 20, 2013

Why bother?

This is embarrassing on so many levels!  Why even bother?!  Why bother prosecuting?  Why bother reporting it?

 

WHEC-TVThe state attorney general's office says there's a criminal and civil settlement with a Rochester dentist who fraudulently billed Medicaid.


The office says Dr. Samir Khalil previously plead guilty to grand larceny charges. According to the felony complaint, he improperly received more than $480,000 from Medicaid over a four year period. In addition, the office says he "upcoded" and billed Medicaid for claims and services which resulted in more than $3,000 in false billings.


Investigators say he collected the money through his company Parkwood Dental Care on Elmwood Avenue.


"As taxpayers, we rely on a good health care system for all of us," says Catherine Wagner of the Attorney General's Medicaid Fraud Unit. "When a provider defrauds it and takes advantage it's a trickle effect on the integrity of the health care program of Medicaid and other programs."


The office says Khalil completed the last of his payments back to New York State and was sentenced to full restitution and community service on his felony conviction.

Dr. Richard Malouf’s All Smiles Dental has been purchased by another “chain” in Texas–South Texas Dental

Dallas Business JournalBill Hethcock
Staff Writer- Dallas Business Journal
Email  | Twitter  | Twitter  | Google+

South Texas Dental, which operates family dental centers in Houston, Dallas, Fort Worth and San Antonio, has acquired the 12 offices of the All Smiles general dentistry practice in North Texas.

Financial terms of the transaction were not released.

Three of the offices are in Dallas, two are in Fort Worth, two are in Arlington and single offices are in Garland, Grand Prairie, Haltom City, Irving and McKinney.

Each of the acquired offices has been re-branded as South Texas Dental, and staffing levels and hours of operations will remain unchanged. Each office will accept Medicaid, CHIP and most insurance providers.

South Texas Dental representatives could not immediately be reached for comment.

South Texas Dental now operates 38 family dental centers. The centers are owned entirely by their dentist partners, who make all decisions involving patient care.

“This transaction allows us to acquire dental centers with an established base of satisfied patients,” Dr. Chad Park of South Texas Dental said in a press release. “We spent a great deal of time evaluating each center and patient charts before proceeding with the acquisition.”

I don’t know how much real time was spent “evaluating” each of Malouf’s clinics, but I bet they didn’t doing much digging or the bones would have surfaced.

NY Law Journal

 

 

 

Lawsuit Proceeds Against Dental Chain That Left Child in Pain

By John CaherContactAll Articles

New York Law Journal

August 20, 2013

A chain of dental offices geared toward children covered by Medicaid whose employees claimed it was normal for a 4-year-old patient to be "swollen, in pain, crying, visibly shaken, upset and afraid of the dentist" after drillings, often done without anesthesia, has been denied summary judgment.

Read more: http://www.newyorklawjournal.com/PubArticleNY.jsp?id=1202616144209&Lawsuit_Proceeds_Against_Dental_Chain_That_Left_Child_in_Pain#ixzz2cXaRJYQI

Yeah, it requires premium membership which I don’t have, but at least the Small Smiles cases are in the New York Law Journal

Ever wonder just what caliber of dentists the ADA considers distinguish enough to be a District Trustee?

Thomas FloydHere is why their judgment should not be trusted.  

Maybe you remember Dr. Thomas Floyd from his mug shot? No? 

Well, maybe the news reports below about the distinguished gentleman (sarcasm) will jog your memory. Or educate those who are familiar with Dr. Thomas Floyd.

Below is an announcement by the ADA stating what a glorious event the “Medicaid Challenges and Strategies Symposium” of 2008 turned out to be, which included the leaders of each of the ADA’s 17 "trustee districts” 

 

August 04, 2008

Medicaid challenges, strategies examined

By Stacie Crozier

Seventeen private practice dentists—one from each ADA district—who logged at least 1,000 Medicaid and State Children's Health Insurance Program patient visits in the last year gathered at the ADA June 23 to identify challenges and successful strategies for improving access for this population group.

[We all know Dr. Thomas Floyd probably logged that many a week! Wonder what the other 16 dentists “logged”].