Non-Dentist dental clinic owner arrested for Medicaid fraud in Indiana

Heads up all you others out there! Round of applause to Indiana AG, however, this is small peas, you have much bigger ones doing the same. Time to put some corporation executives in there with Ms. Metzner.

Anderson Dental Center Busted for Alleged Medicaid Fraud

By Mike Corbin - mcorbin@wibc.com | @WIBC_MikeCorbin

An Anderson-based dental group has been busted for alleged Medicaid fraud and corruption.

The Indiana Attorney General's office says the unlicensed owner of Anderson Dental Center, three dentists and four employees all face charges they bilked Medicaid of at least $300,000. Authorities say owner Sally Metzner and others submitted false and inflated claims to the Indiana Medicaid program for dental service payments. They say some of the documents were forged to get higher reimbursements than they were due.

The dentists 73-year-old Paul Pangallo, 69-year-old Jeffrey Rich and 46-year-old Thomas Dubois are also charged with money laundering, Medicaid fraud and theft. The four office workers are charged with corrupt business influence. A fifth worker is charged with prescription drug fraud. An affidavit alleges the fraudulent billing continued even after authorities executed search warrants at the office.

CSHM press release after Exclusion Agreement

CSHM RELEASE after Exclusion Agreement 04-04-2014

Small Smiles Dental Centers Medicaid Exclusion Agreement

How fitting it was signed on April Fool’s Day.

CSHM - Small Smiles Dental Medicaid Exclusion Agreement

CSHM and Small Smiles Dental Centers sign Exclusion Agreement

OIG Excludes Pediatric Dental Management Chain From Participation in Federal Health Care Programs

April 3, 2014

Related Information

CSHM, LLC Exclusion Agreement

CSHM, LLC, formerly known as FORBA Holdings and Church Street Health Management (CSHM), signed an Exclusion Agreement that bars CSHM from participating in Medicare, Medicaid, and all other Federal health care programs for a period of 5 years, Daniel R. Levinson, Inspector General of the U.S. Department of Health and Human Services, announced today. The exclusion is based on CSHM's alleged material breaches of its Corporate Integrity Agreement (CIA) with the Office of Inspector General (OIG). CSHM manages and operates the national chain of Small Smiles Dental Centers, which provides services primarily to children on Medicaid. CSHM's corporate predecessor entered into the CIA in 2010, as part of the resolution of a False Claims Act case involving allegations that the company had provided dental services to children on Medicaid that were medically unnecessary or failed to meet professionally recognized standards of care.

To minimize immediate disruption of care to the hundreds of thousands of children treated at CSHM clinics and to enable an orderly, controlled shutdown of the company or divestiture of its assets, the exclusion will be effective on September 30, 2014. CSHM waived its right to appeal this exclusion in any judicial forum.

"CSHM has committed repeated and flagrant violations of its obligations under the CIA—violations that put quality of care and young patients' health and safety at risk," said Inspector General Levinson. "This exclusion underscores our commitment to enforcing our integrity agreements designed to promote quality of care and protect patients in Federal health care programs." Mr. Levinson said that this exclusion "makes clear to the provider community that OIG closely monitors our CIAs, critically evaluates providers' representations and certifications, and will pursue exclusion actions against providers that fail to abide by their integrity agreement obligations."

On March 7, 2014, OIG issued a Notice of Exclusion to CSHM based upon numerous material breaches of its obligations under the CIA. CSHM failed to report serious quality-of-care reportable events, take corrective action, or make appropriate notifications of those events to the State dental boards as required by the CIA, OIG found. CSHM also failed to implement and maintain key quality-related policies and procedures, comply with internal quality and compliance review requirements, properly maintain a log of compliance disclosures, and perform training as required by the CIA. Finally, CSHM submitted a false certification from its Compliance Officer regarding its compliance with CIA obligations.

This exclusion marks the culmination of a series of alleged failures by CSHM and its corporate predecessors to comply with its CIA. Under the CIA, an independent quality monitor conducted more than 90 site visits and reviews to monitor CSHM's compliance. Since the 2010 settlement, OIG repeatedly cited CSHM and took actions to address those violations, promote improved compliance, and maintain access to care for an underserved population. These actions included imposing financial penalties and forcing the divestiture of one of the company's clinics.

Despite these actions, CSHM remained in material breach of its CIA and OIG issued Notices of Intent to Exclude to the company in December 2013 and January 2014. In such cases, providers have the opportunity to demonstrate to OIG that they have cured, or are in the process of curing, the material breaches. CSHM represented to OIG that it would cure the material breaches. However, through meetings with CSHM and its Board of Directors and review of its written submissions, OIG determined that CSHM had failed to cure the material breaches and proceeded with the exclusion.

Until the exclusion goes into effect on September 30, 2014, an independent monitor will continue to monitor the quality of care being provided to patients at CSHM clinics. CSHM is required to inform patients at least 30 days before closing a clinic. CSHM is also required to keep State Medicaid agencies abreast of developments and provide monthly status reports to OIG. Any divestiture of assets by CSHM must be through bona fide, arms-length transactions to an entity that is not related to or affiliated with CSHM.

The Inspector General credited Special Agents from OIG's Office of Investigations, Miami Regional and Nashville Field Offices, with assisting in this investigation. OIG was represented in the investigation and litigation of this matter by Senior Counsel Felicia E. Heimer, Maame A. Gyamfi, Robert M. Penezic, and Tamara T. Forys, with assistance from Paralegal Mariel Filtz.

CSHM disputed OIG's determination that it was in material breach of the CIA.

NCDR–Kool Smiles and Resolution Dental says “main concern is financial”

Kristina Dorsey, HR Manager for NCDR, LLC - Kool Smiles PC & Resolution Dental, admits the main concern to the CEO’s and CFO’s is financial; truer words were never spoken. 

 

(Clip taken from interview on why they hired ADP to help them with the UnAffordable Care Act.)

Are you sure you want to work in a corporate owned dental clinic?

HHS-OIG Report - Questionable Billing For Medicaid Pediatric Dental Services in New York–March 2014

This same study could be done in any state these private equity owned dental clinics operate and the results would be the same, if not worse. All of this has been reported right here since 2007, it’s 2014! Just saying…

 

Questionable Billing For Medicaid Pediatric Dental Services in New York - March 2014

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Small Smiles Dental Centers in yet another Federal Report due out today

A new federal report will be released Wednesday showing that shady dentists and orthodontists billed the state's Medicaid program for questionable procedures on children. One dentist claimed to have provided one child 42 tooth fillings in a single visit.

BY Glenn Blain NEW YORK DAILY NEWS ALBANY BUREAU|Wednesday, March 26, 2014, 12:20 AM

The state’s Medicaid program paid through the teeth for questionable billings by shady dentists and orthodontists, a new federal report charges.

One dentist claimed to have provided one child 42 tooth fillings in a single visit.

Another dentist averaged 16 procedures per child, compared with a statewide average of five, according to the report, which is being released Wednesday.

They were among 23 pediatric dentists and six orthodontists in the state who pocketed $13.2 million in Medicaid payments in 2012 for services that appeared unnecessary or may not have been performed at all, according to the report by the Department of Health and Human Services inspector general.

“We found one orthodontist who treated almost 5,000 children in a single year,” said Lucia Fort, an analyst in the inspector general’s office.

“That’s about 10 times higher than the state average for orthodontists.”

“…Seven of the 23 dentists were associated with the Small Smiles dental chain, which shut down its New York operations in 2012 after accusations that it provided unnecessary treatments.”

Read the complete NY Daily News Story here.

 

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CSHM/Small Smiles Dental has been changing the business entity names on file with the Secretary of State in Kentucky and Ohio. Small Smiles of Akron, LLC – Michael Crites, DDS has been changed to Akron Smiles Youth Dentistry, LLC – Michael Crites, DDS. (if you would like a look at the many name changes in Ohio, search the Secretary of State site here using “Prior Business Name”)

Small Smiles of Louisville, PSC was changed to Louisville Smiles Youth Dentistry, PCS on November 27, 2013. Since at least June of 2013,

CSHM has also been changing information contained in their dentists National Provider Identifier (NPI) records on file with the Federal government. The mailing address has also been changed in the individual clinic records. The business mailing address has been changed to a US Postal Service sub-station post office box:16 Arcade Unit 198747, Nashville, TN 37219-1994.

The “manager of licensing and credentialing, Ms. Jenell Stringer is making the changes. I’m sure at the direction of someone at CSHM headquarters.

For instance, on June 11, 2013, Ms. Jenell Stringer, Manager of Licensing and Credentialing changed the mailing address in the NPI record of Small Smiles of Worcester, LLC d/b/a Straight Smiles of Worcester-(NPI number 1487943635) to:

16 Arcade Unit 198747
Nashville, TN 37219-1994
615-750-0343

You can see for yourself by searching the NPI number here.

They did the same thing in May of 2010, just 4 months after the Corporate Integrity Agreement was put into place. At that time I believe they used a US Postal Service sub-station at 208 W. 8th Street, Ste 810,Pueblo, Colorado, 81003-3038

If you would like to check out the dentist records, click here. Below are a few names and NPI numbers:

• Merlin L. Cherian, DMD – 1922348507
• Elizabeth Kay Geier, DDS – 1134251127 (Elizabeth is the “owner dentist” of the Louisville, Kentucky clinic and some in Ohio, along with long time puppet, Dr. Jodi Kuhn, who now has her name slapped all over the clinics in Colorado.)
• Harry Huger Houston, III, DDS – 1003991050
• Todd Bernard, DMD – 1336572791
• Sujani Vellanki, DMD – 1740562610 (apparently she practices dentistry at the post office, since the physical address on her location is also 16 Arcade, Until 198747, Nashville, TN)

Interview with Gary Iocco, President, National Association of Dental Laboratories

Interview with Gary Iocco, President,
National Association of Dental Laboratories
March 2014

By: Michael W Davis, DDS

Dr. Michael W. Davis maintains a private general practice in Santa Fe, NM. He chairs the Santa Fe District Dental Society Peer-Review Committee. Dr. Davis is active in dental care for disadvantaged citizens. His publications are on ethical issues within the dental profession, as well as numbers of clinical research papers.

 

 

Gary Iocco is the current president of the National Association of Dental Laboratories (NADL). The NADL promotes the highest standards in the dental laboratory industry through education of its members, advancing technology, raising standards, and serving the public interest. Communication with dentists and the public is also an important role of the NADL.

NADL Website http://www.nadl.org/home-page.cfm
National Board of Certification in Dental Laboratory Technology http:///www.nbccert.org
The Foundation for Dental Laboratory Technology http://www.dentallabfoundation.org
NADL What’s in Your Mouth http://www.whatsinyourmouth.us

 

Questions

Dr. Davis: Many in the general public may not know the vital role of the dental technician, within the dental team. From my perspective as a restorative dentist, a dental technician can make me look like a superstar, or a nitwit. What exactly does a dental technician do, and why is that so critical in successful clinical results for patients?

Mr. Iocco: As dental laboratory technology professionals we transform the dentist’s directions from the prescription or work order and create the actual treatment option that the dentist has chosen to provide their patient. Quality dental laboratory professionals employ knowledge of modern materials and available technologies to provide our dentist clients with a restoration that is consistent with the high standard of care and esthetics that our dentists expect to provide for their patients.

This is only possible if there is sufficient communication and understanding and a mutual knowledge of and commitment to what is required for a quality outcome.

While good communication is always important, the more complex or involved a case is the earlier in the planning process a dentist should bring their dental laboratory technology professional into the conversation.

Highly skilled and experienced dentists will tell you that to provide the standard of care and esthetics that they seek for their patients restorations, they work closely with a quality dental laboratory.

Oh where, oh where did it go: CSHM’s Press Release

If anyone is looking for CSHM and Small Smiles press release after the media exposed the fact they will be excluded from Medicaid in 30 days, you won’t find it on their website any longer. No need to put out an “All Points Bulletin”, it can be found below.

President and CEO David R. Wilson, released a memo to payors on March 12, it has since disappeared from their website as well. But never fear,it’s still here.

The whole media statement, from start to finish, basically gave the finger to HHS-OIG and every person who has investigated them since 2007; in addition to making highly misleading—if not down right lying—to staff and employees.

Seems their Facebook page has disappeared as well. I imagine they don’t want any comments or questions, don’t you?

Below is the press release.

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CSHM, LLC MEDIA STATEMENT
March 11, 2014

CSHM, LLC & OIG NOTICE OF EXCLUSION

In a letter dated March 7, 2014, CSHM, LLC (“CSHM”) received a notice of exclusion from federal health care programs from the Office of Inspector General of the Department of Health and Human Services (OIG). The notice of exclusion does not apply to any individual employee or the Dental Centers and Practice Owners, but to the CSHM, LLC corporate entity only. If the exclusion should go into effect, it means that CSHM may not continue with some or all of its current responsibilities under its Management Service Agreement (MSA) and this may affect administrative services related to Center operations.

The exclusion notice is based on the OIG’s determination that CSHM has violated some terms of the Corporate Integrity Agreement (CIA) that has been in place for the management company and its predecessors since January 2010. CSHM assumed the CIA in June 2012 and it is well known that it has implemented the CIA provisions within the Centers and generally since that time. Many Center owners and employees have met the Independent Quality Monitor (IQM) and CSHM’s compliance staff over the last 18 months as the company was implementing the CIA’s provisions. Generally, the alleged violations related to certain delayed reporting of a few adverse clinical events, failure to undertake certain training in 2012 before CSHM assumed the CIA, and the omission of two adverse events on the CIA disclosure log, though over 1,200 events were successfully place on the disclosure log for processing.

CSHM believes strongly that it has substantially and in good faith implemented the CIA at a great cost in resources and with the important cooperation of the Centers and its health care professionals, particularly on the enhancing dental clinical standards. The OIG’s proposed determination to exclude CSHM for some non-compliance with its CIA is an unduly harsh and an unprecedented response to expected and common difficulties in implementing a very complex CIA that has a novel and innovative administrative, process and clinical requirements.

CSHM intends to appeal the notice of exclusion and file a request for hearing with the Department Appeals Board. During the appeals process, the exclusion will be stayed and we will continue to provide business, administrative and support services to 53 associated dental centers in 19 states and the District of Columbia, pursuant to our management services agreements. The legal process will take an indeterminate period of time. In the interim, CSHM will continue to perform normal operations and will continue to provide our internal and external constituents with up-to-date information. Should you have questions regarding this matter, please contact a member of our communications team at Lovell Communications:

• Paula Lovell: 615-297-7766 / lovell@lovell.com
• Rosemary Plorin: 615-297-7766 / rosemary@lovell.com
• Perry Hall: 615-297-7766 / perry@lovell.com

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• Link to original media release - http://smallsmiles.com/PressReleases/MediaResponseStatement_LV_20140312.pdf
• Saved copy-
  http://www.scribd.com/doc/212174183/CSHM-Small-Smiles-Dental-Media-Statement-03-11-2014

***********************

• Link to original payor memo -
  http://smallsmiles.com/PressReleases/CSHM_Payor_Memo_20140312.pdf‎
• Saved copy of payor memo -
  http://www.scribd.com/doc/212466391/David-R-Wilson-President-CEO-of-CSHM-Small-Smiles-Dental-Payor-Letter-03-12-2014

Positive proof of no compliance at CSHM–Small Smiles

You have to check out CSHM-Small Smiles “Quality and Compliance” webpage. Past the list of the overseers, you will find a link that says“For more information, please visit: www.smallsmiles.com/compliance.

Go ahead, click it.

NBC — Firm That Manages Dental Clinics for Kids Excluded From Medicaid

 

By Talesha Reynolds

MARCH 12, 2014 - A company that manages a chain of dental clinics once accused of subjecting children to painful and unnecessary procedures and bilking the government for millions of dollars has been notified it will no longer be eligible for reimbursement from federal health care programs like Medicaid, its principal source of revenue.

The company, CSHM, manages 53 clinics nationwide, most of which operate under the name Small Smiles. The clinics treat mostly low-income children in areas where access to dental care is limited.

The Office of the Inspector General of the Department Health and Human Services sent a letter to CSHM on Friday citing multiple breaches to a compliance agreement, which mandates quality of care measures. The breaches included failing to report incidents involving patients at Small Smiles clinics in Tulsa, Okla., and Mattapan, Mass.

The OIG declined to provide further detail on the specific breaches that led to the exclusion.

Sen. Chuck Grassley, R-Iowa, who last year published a report on corporate dental management companies along with former Sen. Max Baucus, D-Mont., said Monday that the CSHM exclusion notice “will protect both taxpayers and vulnerable children receiving dental care in the Medicaid program.”

Read the entire article here

Related:

Dental chain accused of hurting kids, bilking taxpayers December 11, 2012

Dental Group Practice Association installed a new Executive Director last week. Will he work more than 8 hours a week?

Check out the uptick in legal, conference and lobbying expenses. I’m not sure how you can spend that much in a year and not work more than 8 hours a week.

Management fees have also skyrocketed.

 

 

 

 

 

 

 

 

 

 

 

 

DGPA 2007 - 2013 Tax Return Data by Dentist The Menace

CSHM comes out of hiding to issue statement regarding Medicaid Exclusion

CSHM and Small Smiles have been dodging media phone calls for days. They have finally issued a statement; begrudgingly I'm sure.

They say they will appeal. I hear they won't. Hell, they have been appealing since 2010; dang near quarterly.

They have received at least 2 earlier threats to be excluded; maybe three. The report issued last year by Senator Grassley's office basically asked, "how bad do these folks have to be before excluding them. They may appeal just to keep the revenue flowing. But I would think they should be on a Credible Allegation of Fraud pay hold.

CSHM Small Smiles Dental Media Statement 03-11-2014 by Dentist The Menace

Vice Chairman and Ranking Member of House Committee on Energy and Commerce-Oversight and Investigation subcommittee express continued concerns of dental management service companies (DMSOs).

In a letter (see below) to Inspector General Daniel R. Levinson, Rep. Michael Burgess (R-TX) and Rep. Diana DeGette (D-CO) express their continued concerns about “deceptive practices of dental management service companies (DMSOs)”.

They further call on HHS OIG to exclude any corporate dental companies from participating in the Medicaid program, saying, “Based on the report by the Senate Committees and the prior findings of HHS OIG, we concur with our Senate colleagues and recommend that HHS OIG should consider excluding any corporate entity that employs deceptive business practices that result in substandard care, from the Medicaid program.”

Burgess and DeGette are also concerned about the length of time it has taken to bring one of these companies—Small Smiles Dental Centers—to justice.

The letter recounts the history of the Small Smiles investigation, starting with the “2008 investigative news report” by WJLA in Washington. That report actually aired in November 2007; so it’s even worse, right?

The 3 page letter also states:

• “based on evidence undertaken by our offices, we are very concerned that the corporate structure and management of dental clinics often results in a failure to meet basic quality and compliance standards.”

Small Smiles exclusion- Senator Grassley is happy with the “Victory for Accountability”

Grassley: Notice from Inspector General is a Victory for Accountability

March 10, 2014
WASHINGTON – Senator Chuck Grassley, senior member and former Chairman of the Senate Committee on Finance, said the decision of the Inspector General for the Department of Health and Human Services to disqualify CSHM, LLC from the Medicaid program “will protect both taxpayers and vulnerable children receiving dental care in the Medicaid program.”
The Inspector General delivered a Notice of Exclusion (click here to read the Notice) following a year-long investigation by Grassley and then-Chairman Max Baucus of Montana into allegations of abusive treatment of children in clinics controlled by corporate investors rather than dentists.  The senators issued a report and recommendations last July and urged the administration to ban dental clinics from participating in the Medicaid program if the dental clinics circumvent state laws designed to ensure only licensed dentists own dental practices to prevent substandard care.
“Our oversight found that when states can’t hold owners accountable, then clinics are more likely to fail to meet standards that protect the children who should be helped,” Grassley said.  “The actions of some dental practices strained the Medicaid program and put low-income children in traumatic, highly questionable situations.”

 

FINALLY! Small Smiles Dental Centers are EXCLUDED from Medicaid and other Federal health programs!

OMG! OMG! OMG!

After 7 long years of persistence, it’s finally happened! Small Smiles Dental Centers are excluded from participation in Medicare, Medicaid and all Federal Health Care Programs!

Small Smiles Dental Centers - CSHM Exclusion Letter by Dentist The Menace

Let us not forget, the dental centers Quality and Compliance was overseen by:

Dr. Paul Casamassimo
Dr. Arthur Nowak
Dr. Joe Bernat
Dr. Anupama Tate
Dr. Steve Adair

Quality & Compliance - Dental Centers - CSHM by Dentist The Menace

 

I can’t woo hoo and OMG enough—I’m shaking from head to toe with glee!!!!!

Now, where can I locate a bottle of the “good stuff” Champaign!

Do you own your dental practice?

Let’s say you own your patient’s charts, do you own your dental practice?

Antoine Dental calling for a federal investigation into the judge because their win was overturned. Calling his decision “cut and paste”. What a bunch of cry babies.

Since the Antoine Dental Center's favorable ruling was overturned last week, TDMR, is calling for a Federal investigation into the judge. (God, I hate linking to these people! I think this is a ploy to get me to send them web traffic!  LOL Don’t enter a password, it’s a phishing expedition.)

Yes, they want a Federal Investigation into the judge! Talk about cry babies! These guys simply can’t stand defeat. I bet they all got trophies for participation when they were kids. 

However, to read about their game plan, you need a password. That’s right, a password. They have this big headline, then tell you to read it, you need their permission. Maybe it’s only a headline? Think?

I'd say an investigation should look at the previous decision of the administrative judges, but I try to give them a break that they just didn’t know what they didn’t know.

Frankly, the more Federal investigations into this the better. What's really odd, is this particular case is over some $400,000. Who spends $2-5 million in attorney fees to recoup that amount? Yeah, this is much bigger than Antoine Dental Centers. 

 

 

 

 

 

 

 

One thing that crosses my mind, is how Dr. James Orr and Bob Anderton trained these dentists how to cheat the system—in Anderton’s own private law office—and now Orr is the “expert” witness for the dentists and Anderton is their attorney. Talk about conflict of interest! Geez! This seems to be more about Orr and Anderton covering their own butts, than it is about Antoine Dental Center’s pay hold.

Currently Orr and Anderton are touring, teaching dentists about—of all things—record keeping!

There is just no way that this is sliced where the attorneys representing Antoine Dental Center and Dr. Nazari have their clients best interest ahead of their own. I almost feel sorry for Nazari. He could have, reached some settlement, taken his slap on the wrist, paid a little fine, and gone on about his business. At worse, a few months jail time; he would have gotten more sleep there than I bet he’s getting these days. I believe he is being coerced. Pure craziness.

Where’s the popcorn?

Analysis of ADC vs. Texas Health and Human Services Commission

Analysis of ADC vs. Texas Health and Human Services Commission

By Michael W. Davis, DDS, DrBicuspid.com contributing writer

March 6, 2014 -- Why should anyone care about a dental Medicaid ruling from an administrative law court in Travis County in Texas? One reason is that this case involves several millions of taxpayer dollars. Other similar cases brought before this court of alleged dental Medicaid fraud and abuses have and will involve taxpayer money, in excess of $100 million. 

The vast majority of dental Medicaid fraud cases are generally resolved in settlement agreements. Alleged violators usually pay some amount of restitution to the government in exchange for no admission of wrongdoing. Often, the alleged violators return to "business as usual." We, the public and dental profession, receive little or no data on case specifics. Records of investigations are sealed upon settlement.

Public record disclosure of this particular case exposed some of the dark underbelly of the dental Medicaid industry, along with some of its nefarious inner workings.

Read the entire article on Dr. Bicuspid

Dr. R. Quinn Dufurrena named Executive Director of that nasty Dental Group Practice Association (DGPA)

In the Welcome Letter from Dr. R. Quinn Dufurrena as posted on the Dental Group Practice Association (DGPA) and the DGPA’s press release, I think it’s clear what the plan is for the group; more “creative” dentistry —i.e. teledentistry (whatever the hell that is)—and changing state dental practice acts to be more revenue generating friendly, despite any loss in patient quality of care. After reading excerpts of several articles and interviews with Dufurrena published over the years, it appears he’s wishy washy on many issues, other than teledentistry. Other than that, he will be whatever they need him to me. Of course, I could be wrong.

From Dufurrena’s Welcome Letter at the DGPA:

• Nearly 20 years ago, I first learned of the dental support organization (DSO) model.
• DSOs financial benefits, administrative capabilities and group structure truly resonated with me.
• I’ve practiced dentistry in many different arenas, from the military and government to private practices and the non-profit sector.
• …dental professionals are still unable to circumvent the financial and time limits that have restricted them for years.
• …problem that requires collaboration and unity throughout the dental community.
• It has become a mission of mine to help answer the many challenges dentists are facing in this economic and regulatory environment, and my first step is creating awareness on the advantages of the DSO model.
• …my course of action for DGPA revolves around three key contentions: ethics, metrics and innovation.
• …build on the DGPA’s current code of ethics.
• …offer innovative ideas to dentists around the country
• I believe with the help of our member organizations, we can achieve a level of awareness for DSOs that will diminish the misinformation that has plagued our model and shed new light on the success DSOs

From the March 3, 2014 DGPA Press Release:

• “Much as the Affordable Care Act strives to increase patient access to quality care through innovative approaches to the health care system, the DSO model strives to do much the same.” – Doug Brown, co-president of the DGPA
• “…confident that Dr. Dufurrena will lead our association during an exciting period of evolution in the field of dentistry, one where more dentists are shifting from solo practitioners to group practices and the DSO model” – Doug Brown, co-president of the DGPA
• Use of the DSO model has shown success.
• "Dr. Dufurrena's background – ranging from work as a solo practitioner working on policy for the ADA to serving as executive director of a state dental association – provides him unparalleled insight into the role DSOs and their supported dentists can and must play in helping to bridge our nation's growing dental divide" – Steve Thorne co-president of the DGPA.
• Beyond his chair-side duties, Dr. Dufurrena served an associate professor at the University of Colorado School of Dental Medicine and worked at the ADA as a Hillenbrand Fellow.
• Dufurrena will officially begin his role as executive director on March 3 and will be based in Denver, Colorado.
• "I've been committed to promoting and providing affordable, high quality oral health care throughout my entire career. These are the same values shared by all members of DGPA and their supported dentists.- Dr. R. Quinn Dufurrena
• "I am honored to have been selected and look forward to working with all stakeholders at the state and federal levels to help them better understand the role and value a DSO plays in supporting quality dental care to millions of Americans every year." Dr. R. Quinn Dufurrena
• He is replacing Dr. Ed Meckler who served as executive director since DGPA's inception.

Doug Brown is president of Affordable Care, Inc. Steve Thorne is president of Pacific Dental Services. Neither are dentists.

Dr. Richard Quinn Dufurrena hasn’t been interested in the actual practice of dentistry in years; if ever. But he has been interested in the business of dentistry. So he is going to fit right in the DGPA and the DSO business modeling they promote.

From the June 2008 article about Dr. Dufurrena’s Hillibrand Fellowship and him taking the position as Executive Director of the Idaho State Dental Association:

• The 12-month program comes with a stipend and focuses on non-clinical organizational experience and education and allows fellows to select a special project and area of study. It provides fellows with an intensive orientation to all ADA agencies and departments, orientation to other organizations serving oral health, a basic orientation to federal and state government agencies playing key roles in oral health, academic courses and project experience

Antoine Dental Centers to remain on payment hold

Judge finds credible evidence of Medicaid fraud by Texas clinic

By Donna Domino, Features Editor

March 5, 2014 -- A Texas judge has upheld payment holds on Medicaid payments for Houston dental clinic Antoine Dental Care (ADC), citing credible evidence of Medicaid fraud. The clinics billed about $8.1 million for orthodontic services in less than three years.

The 36-page ruling was issued February 28 by Judge Rick Gilpin, an administrative law judge for the Texas Health and Human Services Commission (HHSC).

Reimbursements for Medicaid claims by ADC, which has two clinics in Houston, have been on hold since 2012, pending an investigation by the HHSC and the Texas Office of Inspector General (OIG) for Medicaid fraud involving orthodontic care. ADC ranked in the top 25 providers for Medicaid payments; about 70% of ADC's patients were Medicaid recipients, the ruling stated.

Read Complete Article at Dr. Bicuspid

What happened to Richardmalouf.com?

In February 2013, Dr. Richard Malouf of All Smiles and home waterpark fame started his own website, richardmalouf.com. Below is his press release about all the issues he was addressing.

• New Website Released for Dr. Richard Malouf of Dallas

Successful Dallas dentist and entrepreneur sets up own news portal at http://www.richardmalouf.com.

Amazingly, it’s gone poof!

His facebook page is barebones, so is his youtube channel.

• Richard Malouf Facebook - https://www.facebook.com/DrRichardMalouf
• Richard Malouf Youtube Channel - http://www.youtube.com/user/DrRichardMalouf

But no Richardmalouf.com.

Houston dentist, Behzad Nazari, and Antoine Dental to remain on 100% “pay hold” due to fraud investigation

UDATED 03-03-2014

The scammers running the Texas Dentists for Medicaid Fraud Reform (TDMR) website have boasted time and time again, over rulings made against Texas taxpayers and for Antoine Dental. Heck, they have a whole section of their website devoted to their “wins”. They have also had their cronies on this website, commenting about how they are winning their cause; which appears to be “Let us continue to defraud taxpayers.” Frankly, I think their name should be “Friends of Dental Medicaid Fraud”. I’m not sure what they consider a “win”. Apparently, it’s not what you and I call a “win”. Their headlines over there are outright false! So imagine the bullshit contained within! I especially love their comment section, entitled “Speak Your Mind”, amazingly what is on my mind doesn’t seem to make it, maybe yours will. Click here.

Examples:
On November 5, 2013 their headline read, “OIG Loses Another Medicaid Fraud Court Battle” an article they were happy to assist with in the Texas Tribune.

(Battle, yes, WAR, NO!)

Then on November 6, 2013 their headline read – Antoine Dental Center Innocent of All OIG Allegations of Fraud and Misrepresentation.

(This is especially galling, since it is an outright lie! Lie!!! Lie!!)

Again, on January 17, 2014—SOAH Judges Again Reject OIG Arguments in Antoine Dental Case

(Laughable!)

Today, what’s missing from their website is the headline of this blog post;or something close to it.

It appears the Applet Court and Judge Rick Gilpin disagreed 100% with all other rulings in the Antoine defraud Texas taxpayers case. He issued a “Final Order” on Friday (February 28,2014) that walked through this case and all the hearings and ruling step by step and ruled completely opposite of all other rulings—Antoine Dental to remain on 100% pay hold.

You don’t want to miss reading the Final Order. He all but called them all, Antoine owner, Dr. Nazari—including the Administrative Law Judges—criminals and at the best—imbeciles. You read it and decide.

Dr. Daniel Chaparro III, owner of Smile By Design, under investigation by FBI

I found Dr. Chaparro’s concerns over his investigation by the FBI a bit odd.

Apparently, he has enough wrong doings on the radar of authorities to result in a raid by the FBI. Yet, his concerns seems to me a bit misplaced, but I could be wrong.

The icing on my cupcake was his apparent frustration of having to deal with the government’s “spider webs of government red tape”  He seems to think he was forced to see Medicaid patients.I doubt he was grumbling when he was receiving taxpayer monies for those services.

Looking at the 2011 data made available by the 2012 Kool Smiles funded Art Laffer DSO Study, Smiles By Design was way down on the list of outrageous billers in Texas.

However, Chaparro has been in trouble before.

See: http://cqrcengage.com/capg/app/document/1697422;jsessionid=klTJmUc7gY-oFKgGZsWXQeAF.undefined

"Chaparro has faced criminal charges in the past including aggravated and domestic assaults between 1995 and 2000, practicing dentistry without a license in 2003 and injury to a child in 2004. He was convicted of domestic assault in 2002, according to court records."

He was also disciplined by TSBDE in 2000 & 2006.

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Lubbock dentist warns of 'Big Brother' as FBI investigates Medicaid billing

Posted: Feb 20, 2014 12:03 PM CST Updated: Feb 20, 2014 10:45 PM CST

By Shaley Sanders - bio | email

LUBBOCK, TX (KCBD) -

A Lubbock dentist is voicing concerns about patient privacy and complaining about "Big Brother" after the FBI seized his patient records on Thursday morning.

The FBI executed multiple search warrant around 8 a.m. Thursday at the home of local dentist, Dr. Daniel Chaparro III and at his business, Smile by Design.

"They didn't need a warrant, they could come ask for anything they wanted and the record room is always open to them. I don't know why they escalated this to a drama, basically," Chaparro said.

Dr. Donald P. Prohovich pays $400,000 to settle fraud allegations in Massachusetts

 

 

 

By Maria Papadopoulos
The Enterprise
Posted Feb. 25, 2014 @ 12:39 pm
Updated Feb 25, 2014 at 6:17 PM

An Easton dentist has agreed to pay $400,000 to the state’s Medicaid program to resolve allegations of improperly billing for visits to MassHealth members living in nursing homes, Attorney General Martha Coakley announced Tuesday.

An investigation found that Dr. Donald P. Prohovich, a dental provider in the MassHealth program, violated a regulation established in 2010 that limits payments for providers to one “house call” to a facility per day, Coakley said in a statement.

Investigators found that from July 2010 to September 2013, Prohovich allegedly improperly billed for house calls to elderly MassHealth patients in nursing homes in eastern Massachusetts on a per-patient, per-day basis.

UPS Employees targeted by California dentist

Calif. dentist indicted for $1M in fraudulent billings

By DrBicuspid Staff

February 25, 2014 -- A California dentist has been indicted on federal healthcare and mail fraud charges of billing more than $1 million for work never performed, sometimes for teeth patients didn't even have.

According to the U.S. attorney's office, Sacramento dentist David M. Lewis, DDS, 60, began targeting United Parcel Service (UPS) employees in 2008 for dental treatment. The UPS healthcare plan provided 100% coverage with no annual limits. Dr. Lewis offered cash and other incentives to UPS patients for getting dental care from him or for recruiting other UPS employees to receive treatment.

The grand jury's 18-count indictment alleges that Dr. Lewis submitted claims to Delta Health Systems, which administered the UPS healthcare plan, and falsely billed the plan for work that was never performed. In many instances,

READ THE COMPLETE STORY HERE

Dr. David Timothy “Ty” Turbyfill, accused of sexually molesting 3 teens is back in business in Florida.

Dr. David Timore Turbyfill, accused of sexually molesting 3 teens is back in business in Florida. Among claims in the complaints, witnesses alleged that Turbyfill 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.”

I guess it’s possible he was just “twerking”. (sarcasm)

Blessed by the Florida Board of Dentistry, he now has access to patients at Orange City Surgical Solutions
2574 S. Volusia Ave.
Orange City, FL 32763
386-744-2999
info@orangecitysurgicalsolutions.com

It’s also noted he has dropped the “Ty” nickname and using his real name, David Tim (Timore) Turbyfill.

His bio at the website lists numerous titles and awards, but fails to include any mention of the accusations and settlement.

According to his settlement agreement,Turbyfill is required to be “monitored” by a “licensed health professional” when using anesthesia or conscious sedation. I wonder exactly who is doing that “monitoring” and how the “monitoring” is being “monitored”.

Flora Mounessa, DDS and husband—Shahram Sharif—arrested

Flora Mounessa,DDS husband, Shahram Sharif then and now.

According to Great Neck, NY District Attorney, the couple defrauded Medicaid out of $70,000, but this couple did it with a “twist”, not seen much here on DTM.

This couple underreported income and assets to obtain benefits. Dr. Flora must not be well schooled on the proper defrauding of Medicaid by dentists or this is the new “bonus” system.

According to reports, the couple actually had income of $2.74 million during the 5 year period. Just looking at the numbers it might look like they left out some zeros on their reports. I don’t know, and this is just a guess, but I bet there was some other Medicaid defrauding going on over at the dental clinic. Take a look at the “store front”, looks more like a pawn shop to me.

Greed may be good, as pointed out in the movie “Wall Street”, but it sure isn’t good for one’s looks,is it? “Road hard and put away wet” is what comes to my mind when checking out the mug shots.

 

 

 

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A husband and wife face felony fraud charges after underreporting assets and raking in more than $70,000 in Medicaid benefits, according to the Nassau County District Attorney's office.

Flora Mounessa, 39, and Shahram Sharif, 45, both of Great Neck, were each charged with one count of second-degree welfare fraud, one count of second-degree grand larceny, and one count of first-degree offering of a false instrument for filing.

The couple is accused of underreporting their assets enough to be able to claim Medicaid benefits for themselves and their daughter. They allegedly reported an annual income between $23,400 and $31,200. 

Between January 2005 and October 2010, the defendants received $70,193.64 in benefits. During that time, Mounessa worked as a dentist and Sharif was self-employed, buying and selling real estate. Their jobs raked in $2.74 million over the five years they were given benefits.

The couple was arrested and charged Friday after an investigation.

If convicted, the couple faces possible 15 years in prison, plus restitution and fines. The smallest consequence they could face is a conditional discharge, said the DA.

They were released by a judge and put on probation until they return to court March 11.

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Dr. Flora Mounessa’s facebook pages says she works for Nora Family Dental, studied at NYU and prior studied at Yeshiva University (SCW)

Interview with Dr. Mark Malterud — Academy of General Dentistry Region-10 Trustee

 

Interview with Dr. Mark Malterud

By Michael W. Davis, DDS | February 17, 2014

 

 

Dr. Mark Malterud has been practicing Minimally Invasive Restorative Dentistry for over 30 years in St Paul Minnesota. He has had the opportunity to help many patients achieve excellent oral health. His passion for Dentistry has led him into involvement into Organized Dentistry where he has been Minnesota’s President of the Academy of General Dentistry and has chaired at the National level, the AGD’s Council on Dental Education and is the current Region-10 AGD Board of Trustees member. He helped get the Academy of Biomimetic Dentistry up and running and sits on the Board of the World Congress of Minimally Invasive Dentistry. As a consummate student and innovator in Dentistry he has been invited and presented lectures around North America and the World. Mark@drmalterud.com

 

INTRODUCTION

Dr. Davis: Dr. Malterud, I’m honored to bring forth this interview. You’ve done a great deal facilitating education for the dental profession, which eventually serves the public interest. Services dentistry can provide patients today is greatly advanced, from 10-20 years ago. You have personally contributed to this wonderful progress, some of which I hope to expand upon with our discussion.

 

INTERVIEW

Dr. Davis: The dental profession today is exposed to newer concepts, such as “minimally invasive dentistry”. Over time, these principles are becoming accepted into dental university curriculums and the general practice of dentistry. Please explain to the average person, what is meant by minimally invasive dentistry and how it may benefit them. Please give a few specific examples, in our rethinking of traditional treatment protocols.

Dr. Malterud: I appreciate being asked to be interviewed for this column. As far as the meaning of Minimally Invasive Dentistry (MID), I can sum it up fairly easily. It is a philosophy that tooth structure is sacred and once removed it cannot be brought back. So, treat every lesion and problem from the perspective that we remove the problem (pathology) and restore it as definitively as we can with modern technology.

The reality is that whatever we place in the mouth to restore what has been lost will break down, and, in time, given enough use, will fail. However, technology, materials and techniques are constantly being developed, and, when the time comes for restorations to be replaced, we will have better materials to restore the tooth. I heard it once described as tooth banking by Dr. Ray Bertolotti and that is a good description.

Kool Smiles Dentist—Dr. Tuan “Terry” Truong, DDS— sentenced to 18 months in jail

Let me get this straight, private equity firm FFL’s corporation—NCDR, LLC/Kool Smiles—hired Dr. Troung, trained him to be a thief, gave him quota’s to meet, and now want their money back for legal expenses. OMG!

Here is what I want to know:

1. Why was Dr. Tuan Truong not on his hands and knees begging to spill his guts about this crooked company?

2. If he did who stopped him and why?

3. Was he here on a work visa?

PS: Don’t choke and puke when you read out “Kool Smiles” cooperated with the investigation! You bet your ass they did, and directed investigators to only what they wanted them to know apparently.

 

Abilene Dentist Sentenced to 18 Months in Federal Prison and Ordered to Pay Nearly $58,000 in Restitution in Medicaid Fraud Scheme

FOR IMMEDIATE RELEASE

February 5, 2014

Defendant Worked as a Pediatric Dental Provider at Kool Smiles
and Personally Benefitted From Scheme

ABILENE, Texas — Dr. Tuan Truong, aka “Terry Truong,” of Abilene, a dentist who practiced pediatric dentistry at Kool Smiles in Abilene, was sentenced this afternoon, by U.S. District Judge Jorge A. Solis, to 18 months in federal prison.  Truong pleaded guilty in August 2013 to an Information charging one count of making a false statement in connection with a health care matter.  Truong was also ordered to pay $57,969 in restitution to Kool Smiles.  Today’s announcement was made by U.S. Attorney Sarah R. Saldaña of the Northern District of Texas.

According to documents filed in the case, 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.  Dentists were required to use professional judgment in the treatment and management of patient care.

Uh-Oh! Dr. Richard Malouf abandoned his computer servers! YIKES!

Dr. Richard Malouf, founder of All Smiles Dental Centers in Texas, has made the news a lot over the last two years. Much of which has involved charges of Medicaid Fraud, indications of bribery, and his infamous home water park in an affluent neighborhood of Dallas and 2 private jets.

 

 

 

 

Last week, (January 31, 2014) Dr. Malouf was back in court, this time in front of the bankruptcy judge. Under an earlier Agreed Order (Doc 637) Malouf agreed to abandon the property to the state, with the “provision that a neutral third party” would serve as Special Master of the bankruptcy estate.

Apparently Malouf was more concerned about the proper functioning of his waterpark than what incriminating evidence might be on the computer servers he happily “abandon” to the state of Texas. He recently tried to block the State of Texas access, but in an Order issued January 31, 2014 (Doc 762) a judge “clarified” the previous Agreed Order telling Malouf, tough titty.

Ok, so the judge didn’t say exactly that but did say:

“To avoid further doubt, the Court further clarified that the property was abandoned with this Court’s approval to The State Of Texas and simply appointed the Special Master to provide fair access and control, but not as owner of the property.”

“It was the Debtor’s prerogative to decide what to do with the property. The Debtor decided and this Court approved abandonment. The Malouf entities agreed to the abandonment.”

I bet you don’t see this over on the TDMR website!

NCDR, LLC–Kool Smiles-Resolution Dental wants you and your practice.

The private equity firm, FFL, who owns Kool Smiles Dental and Resolution Dental is moving away from opening their own clinics and moving toward the Heartland Dental business model—what I call the F & S business model. (S for suck, so you can figure out what the F stands for). 

F & S Business Model - This is where they come in, offer practice owners an unrealistic amount for their established practice, put the current owner and staff under employment contracts, then set unrealistic income quota’s that forces dentists and staff to make decisions not necessarily good for the patient. See A peek under the sheets of Heartland Dental

Rumors last years indicated Kool Smiles Dental had their highly questionable but lucrative Medicaid income stream reduced significantly due to what was apparently questionable dental treatment and billing practices. In 2013 they began switching many of their practices to Resolution Dental.

Now, they want to purchase already established dental centers. I’m sure this is a much faster way to increase the dwindling revenues.

They advertise:

Are you considering selling your practice? Let's talk.

They want locations “not in the hood” and are offering a “fast and furious” “too good to be true” amount cash for said locations. They want dentists willing to sign restrictive 2 years employment contracts, which will no doubt include a stiff penalties, especially for disparagement of the company. They also offer bribe your staff to stay on, but make no promises.

Any updates on Kool Smiles and Resolution Dental Clinics

I’ve not heard anything about this guys lately. Well, not since they sent warning letters out to current and past employees.

Anyone have any idea what’s happening down in Atlanta?

Pat on the Head or Slap on the Wrist

AG Gansler Secures Settlement from Baltimore County Dentist
Owner of Baltimore city practice must repay $25K to Medicaid program

Baltimore, MD (January 3, 2014) - Attorney General Douglas F. Gansler announced today that the State of Maryland has reached an agreement with Lisa Valentine, D.D.S., of Woodstock, for her to repay the Medicaid program $25,000 in civil damages for services that were billed, but never rendered. The Medicaid Fraud Control Unit (MFCU) of the Office of the Attorney General conducted an investigation into the practice of Dr. Valentine, which included numerous interviews with her former patients and staff.

"The hardworking taxpayers who fund the Medicaid program deserve to know that their money is benefiting those it is intended to help," said Attorney General Gansler. "Our office took swift and decisive action against this dentist who was trying to abuse the system."

The investigation showed that Dr. Valentine's husband, Spencer Brown, in his capacity as an employee of the practice, billed the Medicaid program for services that were not provided.

Brown previously pleaded guilty to one count of Medicaid fraud for submitting the fraudulent claims to the Medicaid program from January 2008 through November 2010. He received a sentence of five years incarceration, with all but one year suspended, and was ordered to pay restitution of $156,918 to the Medicaid program.

Attorney General Gansler thanked Assistant Attorneys General Tom Rafter and Shelly Martin, as well as Investigator Mark Holback, all of the Medicaid Fraud Control Unit, for their work on this case.

http://www.oag.state.md.us/Press/2014/010314.html

Thank you e-mails always appreciated

It all turned out well for this little 3 year old after panicked mom decided to do some research and ask questions.

January 15, 2014

Hi Debbie 

I just wanted to give you an update. I took my daughter for a second opinion. Syosset, NY.

I would have never imagined the dentist  would look like a housewife of Beverly Hills. But she had a brain, so that was great. 

She told me that my daughter DID NOT have three cavities in her mouth as indicated by the first dentist.

As you mentioned in our previous correspondence, it was deep groves and discoloration in her back teeth.

This doctor was able to get perfect images of the teeth. 

My daughter did have one cavity in the front which was a result of her teeth being too close together. 

The doctor advised it was too small to go through the trouble of filling it, gave my daughter a toothpaste that would slow the growth of the cavity and told me to bring her back in six months. 

Had I taken the other dentist word for it,  my daughter would have had work done on teeth that were perfectly fine. 

Sometimes, we doubt ourselves believing that these doctors are smarter than us, because they were able to study longer and go beyond four years of college.  Sometimes these doctors are overly confident in their craft, believing they aren't capable of making a mistake.  

Erasers and malpractice insurance was made for a reason. 

So, THANKS! for your blog. I hope other parents find it, read it and understand that it's okay to challenge the doctors.

Below is this thankful mother’s original email:

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January 5, 2014

Hello

I have 4 four year old that was recently seen by a dentist.  I was told she has three cavities.  My heart dropped.  I wanted to cry for my daughter.  I am 34 years old and I HATE going to the dentist. 

After being told my daughter had cavities, I immediately went home and started to read.  The article of the day was a 3 year old in Hawaii that died from a cocktail of drug while at the dentist.  My heart sank even deeper.  I am dealing with so many things in my life but, the news of my baby having cavities has hands down been the worst.

What would be the proper procedure (in your opinion) for treating children so small with cavities? It seems as if death by the death is very common.

I don't want my child to be in pain and have a fear of the dentist however, i don't want her to be one of the unlucky children that don't make it out the chair.
Please respond. I look at my daughter and start to cry.

Indiana taxpayers pick up the tab for shafted Allcare Dental patients

Customers of Allcare Dental get money back

Updated: Thursday, January 16, 2014, 12:09 PM EST

INDIANAPOLIS (WISH) - Many patients who lost money when a dental business closed its doors without notice got some of their money back, Indiana Attorney General Greg Zoeller announced Thursday.

Allcare Dental closed in 2011, leaving customers in Avon, Evansville, Fort Wayne, Indianapolis, Lafayette, Mishawaka and Muncie without a provider and with a lot of questions.

The dental company declared bankruptcy. Eventually, the nearly 300 customers who filed complaints in Indiana received some or all of their money back. The patients lost anywhere from $69 to $9,125 but the state could only pay back a maximum of $3,000 per person by state statute.

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Wonder if Greg is related to Linda Zoeller of Small Smiles fame?