Dentist The Menace

Wednesday, November 19, 2014

Mechanisms of Dental X-ray Scams

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.

November 19, 2014

Frequently, the media, non-dentist investigators, and the public ask me, the methods and means of swindles played out with dental x-rays. Most incorrectly assume, that patients are simply given excess numbers of unnecessary radiographs, to increase billing statements.

Both the insurance industry and Medicaid generally pay 100%, for the costs associated with dental x-rays. These third party payers have limits on the frequency and types of radiographs, which they will cover for benefits under their contracts with dental providers. Most dental insurance carriers have computer-generated algorithms, which are triggered when excessive x-rays are taken. Moneys are then not paid out, or immediately recuperated, in the next insurance payment cycle.

Medicaid oversight is generally more lax. However, there is a very real risk with dental x-ray over-billing, that this will be caught by Medicaid oversight mechanisms, even as incompetent as they usually are. Generally, large sums of Medicaid over-payments are generated, and regulators chase down very large sums, well after the fact (“Pay-&-Chase”). Often, only pennies on the dollars are returned to taxpayers. However, it represents a scam with some element of downside risk. As dental Medicaid fraud has become an accepted business model with in the dental industry, swindlers desire to minimize or eliminate regulatory risk.

Today, large interstate corporate dental providers retain former state and federal dental investigators. These corporate dental providers, which are usually beneficially owned by the private equity investment industry (Wall Street parties), have a good idea of which forms of fraud will be potentially investigated, and which methods of fraud will fly under the radar. Regardless, the corporate beneficial owners always retain licensed doctors acting as nominee owners (sham-owners), to assume any potential regulatory liabilities.

Most commonly, we observe the following forms of dental scams with dental radiographs.

Unbundling of X-ray Services

The American Dental Association (ADA) has established a clinical coding system called, “Common Dental Terminology” (CDT). Numerical codes are designated for nearly every possible dental service. This system is updated annually. Every insurance carrier and Medicaid will establish fees for each dental service, for which coverage is provided under their program. One such dental service is called a “complete series of radiographs”, which has a set fee, and CDT code number.

The scam involves taking a fair number of x-rays on a patient, and charging out for these multiple individual radiographs with multiple different CDT codes, to a sum greater than the fee, for a complete series of radiographs. This dishonest billing is termed unbundling.

Upcoding of X-Ray Services

Many pediatric dental patients, especially those with short attention spans, and who physically move about frequently, are unable to sit still long enough for a panographic x-ray (very large radiograph, approximately the size of a small loaf of bread). Thus, two occlusal radiographs (these approximate the size of a playing card) are often substituted. Cheats will frequently take a standard sized periapical x-ray (approximately the size of a domino), and turn it 90-degrees, and misrepresent that radiographic service, as an occlusal x-ray, and not a periapical radiograph, which it truly is.

This scam is usually played out, when the CDT code fee for an occlusal radiograph is more than a periapical radiograph. Since the only way to catch this fraud is with a physical auditing of the patient records, it’s easy to get away with.

Non-Diagnostic Quality X-rays

When dental providers bill for x-ray services, they are assumed to bill for diagnostic quality x-rays. Any reasonably qualified doctor should be able to view the radiographs, and use that data to assist in generation of a patient treatment plan with their total examination. A patient treatment plan is generally an essential and required part of any patient record. Further services (fillings, crowns, extractions, root canal therapies, etc.) provided to a patient are based upon the patient treatment plan, and diagnostic quality x-rays.

When a doctor utilizes non-diagnostic quality radiographs (x-rays with processing errors and distortions, incorrectly positioned x-rays, etc.) to generate a patient treatment plan and provide clinical services, the patient and third party payer may be cheated. Not only is it unlawful to bill for the non-diagnostic quality radiographs, but also dental services delivered based upon these x-rays may represent malpractice and/or fraud.

Again, this form of malpractice/fraud is difficult to catch, without an on-site patient record audit, or physical examination of the records. Once patient records are subpoenaed for a civil or criminal legal action, a Medicaid audit, or a state dental board administrative law complaint, we commonly see non-diagnostic quality x-rays to be the unreasonable standard-of-care, for an unfortunate subset of practitioners. Too frequently, we see very extensive patient care (multiple steel crowns, pulpotomies a/k/a baby root canals, extractions, etc.) based on non-diagnostic x-rays and a very sketchy patient treatment plan.

Missing X-Rays

This too often comes down to three possible situations, none of which are good. The doctor claims the x-rays have gone missing. Patient records are assigned a responsible custodian for ownership. In most states, this is a licensed doctor. In other states, a corporate dental service organization may be assigned ownership, and treating doctors have specific and limited rights to access patient records (Again, a dangerous situation for patient rights. Also, potential for a corporate dental provider, to blackmail employee dentists’ testimony, when the corporate model of dental practice is outside the norms of the dental industry, involving fraud as an overall business model. “If you talk doctor, we’ll throw you under the bus, just like we did with the current defendant.”).

Missing records, inclusive of dental x-rays, does not bode well for defendants in civil or criminal malpractice or fraud cases. A judge will most often make a ruling, which casts a negative inference, upon subpoenaed and non-produced discovery material. Records not produced are deemed to negatively impugn defendant(s).

The third possibility is that the dental radiographs never existed, in the first place. Yes, billing statements were generated for dental x-rays, but these services were not provided. Extensive treatment plans and other dental services were provided, all without supportive dental x-rays. A good question for plaintiff’s attorney to ask a defendant/doctor at deposition may be, “Are you related to Superman, because you must have x-ray vision?”.

Conclusion
Scams involving dental x-rays may be somewhat more complex, than many assume. Implications for malpractice and/or fraud go far beyond the radiographs themselves. Auditors, investigators, policy makers, legislators, leaders in organized dentistry, and the public must be alerted, to these common frauds played out in the dental industry. The crooks aren’t simply a handful of small-time dentist bunco operators. These swindles go directly to the heart of unregulated corporate America, which beneficially owns many of these disturbing dental clinics. The public interest must supersede the interests of all others, when it comes to our nation’s healthcare.

Wednesday, November 05, 2014

Nearly 100 Indiana dentists found to have questionable billing in HHS Report

Feds: 95 Indiana dental providers have questionable billing

Marisa Kwiatkowski, marisa.kwiatkowski@indystar.com 7:01 a.m. EST November 5, 2014

A federal report released Wednesday found questionable billing practices by 94 dentists and one oral surgeon who treat Indiana children on Medicaid.

Those providers received about $30.5 million in government funds for pediatric dental services, according to the report by the U.S. Department of Health and Human Services’ Office of Inspector General.

Federal officials did not cite specific dentists or clinics in the report, but said the findings demonstrate the need for improved oversight of pediatric dental services paid by Medicaid in Indiana.

Officials studied claims paid by Medicaid in 2012 for such dental services and focused on those who served more than 50 children.

Two-thirds of the dentists cited in the report for questionable billing worked for four dental chains. Three of those chains have been the target of state and federal investigations, according to the report.

Read the entire story here

HHS Report - Indiana Questionable Pediatric Dental Mediciad Billing November 2014

Here is the March 2014 New York Report

Monday, October 27, 2014

Torture Chambers-with free sweatshirt!

It’s 10 years later.

Excerpt from Uncle John's Bathroom Reader-The World's Gone Crazy (May 2010)
TORTURE CHAMBERS--WITH FREE SWEATSHIRT:

In 2004 twenty dentists in California Central Valley area were accused of defrauding the state Medi-Cal health system of $4.5 million by performing unnecessary—and cruel—dental work. To lure low-income patients, these dentists went to homeless shelters, shopping malls, and schools and offered gift certificates, sweat-shirts and electric toothbrushes. The patients were then given unnecessary dental work, including root canal. Some dentists were accused of holding crying children down in the dental chair and using straps on elderly patients. Then they charged outlandish amounts of money for the work and sent the bills to Medi-Cal. "In every single one of the 300 files we checked, " said an official, "we found fraud.". In 2008 the two lead dentists in the scam were sentenced to one year in jail and forced to repay $3M.

The Dentist’s were:

1. Steve Sangmoon Ahn, 41, of Fullerton
2. Hoon Young Chang, 34, of Anaheim Hills
3. Wen Hsiang Chou, 46, of Alhambra
4. Anthony Halili Galvan, 42, of Dublin
5. Eduardo Sabater Gerodias, 36, of Modesto
6. http://www.dbc.ca.gov/public/dds46799_20060907_dec.pdf 37, of Reseda
7. Keith Yoshikuzu Komaki, 58, of Anaheim
8. Ricky Hung-Tak Lam, 35, of Antioch
9. Rahim Mesbah, 49, of Modesto
10.Duc Sy Nguyen, 33, of Milpitas
11.Sang-Hyuk "Sean" Park, 35, of Merced
12.Luis Alexandrino Pinto, 42, of Irvine
13.Rodolfo Poscablo Ravanera, 57, of Oakland DEAD
14.Behnam Rostami, 48, of Stockton
15.Williams Defreitas Saraiva, 60, of Irvine
16.Seyed Mohamed Tarifard, 58, of Stockton
17.Tri Duy Vu, 32, of Sunnyvale
18.Shiyu Wang,44 of Alameda
19.Faruk Cenap Yetek, 43, of Pleasant Hill
20.Kyon Maung Teo, 42, Hatch Dental clinics in Ceres, Stockton and Modesto

Attorney General Charges Central Valley Dentist and 20 Others in $4.5 Million Medi-Cal Fraud Scheme

October 2008-

Intentional Harm as Dentists profiteer in California

December 5, 2008

California Dental Board Decision regarding Dr. Kyon Maung Teo

Thursday, October 16, 2014

Small Smiles now under direction of former Small Smiles Employee gone rogue: Ron Montano, Hero Dental Management and Adventure Dental and Vision.

If you are seeing more commercials for Adventure Dental and Vision lately it’s not an accident. Check the phone number, it’s actually Small Smiles clinics.

Hero Dental Management is the new FORBA/Church Street Dental Management/CSHM and many Small Smiles clinics are now under the umbrella of Hero taking the name Adventure Dental and Vision.

Ron Montano broke out on his own and created Hero Dental Management and clinics operating as Adventure Dental just like Drs. Pham and Tran broke away and created NCDR and Kool Smiles.

Read Complete Article By Clicking Here >>

Tuesday, September 30, 2014

It’s September 30, 2014

Today is the deadline for CSHM to have divested in all of the Small Smiles clinics. Have they? Have the simply rebranded?

I don’t know.

Monday, September 29, 2014

DD Marketing, Small Smiles Dental Centers: Double dipping?

In 2003 while dental centers owned by the DeRose family were coming under fire for abusive dental treatment of children, by North Carolina investigative reporter, Stuart Watson, South Carolina was gearing up to not only allow the clinics to operate in the state, but also let the taxpayers foot the bill for the clinics advertising while it lured children to the torture chambers. School districts signed contracts with DD Marketing agreeing to pay them $48K per year plus 20% commission, and DD Marketing would work their hardest to recruit advertisers to assist in generating income for the schools. By August 2003 the South Carolina school district was locked in a lengthy and complicated contract with DD Marketing.

First recruited advertiser, was Children’s Medicaid Dental Clinics—Small Smiles Dental Centers as we know it—who contracted to pay the school district $10K so they could hang 2 x 5 foot banners in schools and adorn school vehicles with signage. In return the school district paid DD Marketing $6K for that first advertiser—$4K monthly fee plus $2K commission.

Problem? DD Marketing and Children’s Medicaid Dental Centers, were owned by the same people. Stink? Yes! Multiply that by nearly 200 districts across the county and that’s nearly $1Mil in additional revenue and it stinks way past “high heaven”.

Vending machines were also allowed in the schools of which DD Marketing also reaped a hefty profit; need those to keep the patient flow up at the clinics, right?
Double dipping? More like Quadruple dipping in my opinion.

Schools Welcome Ads, March 5, 2003

“Pueblo, Colorado-based DD Marketing will receive $4,000 a month to recruit business and 20 percent of the proceeds generated for the district.”
CHEROKEE COUNTY SCHOOL DISTRICT NO. 1 Minutes, March 11, 2003

“Mr. Paige Carlton - Tompkins, Kinard & Associates, an advertising and consulting service whose regional office is located in Columbia, South Carolina; Mr. Dan DeRose - President of DD Marketing, Inc.; and Mr. Mike Roumph - Vice President of DD Marketing, Inc. (DDM); made a marketing presentation to trustees. The company is located in Pueblo, Colorado and is a consulting service for marketing and advertising that works to meet the specific needs of government, public and private agencies, political organizations, corporations and individuals by developing a multi-faceted campaign to generate revenue for the client. The firm provides detailed research and analysis to develop partnerships for clients such as education, economic development, transportation, energy and natural resources, and environmental regulations.

Read Complete Article By Clicking Here >>

Tuesday, September 16, 2014

Mechanisms of Dental Sealant Scams

"Dr. Michael W. Davis maintains a private dental practice in Santa Fe, NM. One day per week, he assists at a dental clinic focused on disadvantaged children and adults. Dr. Davis chairs the Santa Fe District Dental Society Peer-Review Committee. He is also an active member, in the New Mexico Dental Association House of Delegates, which drafts legislation relating to public protections in dentistry. Dr. Davis also serves as an expert witness, in dental legal cases. He may be reached at: MWDavisDDS@comcast.net

Mechanisms of Dental Sealant Scams
By: Michael W. Davis, DDS
September 16, 2014

Dental sealant scams have been a mainstay hustle, in unethical dental practices for numbers of years. The insurance industry terms this dishonest and unlawful activity, “upcoding”. It’s a highly lucrative and successful play, especially in Medicaid settings, because it costs nothing from the patient, and there’s no pain or discomfort generated. Here’s how it works.

The crooked doctor etches the tooth’s enamel surface with an acid gel, which has no dental caries (dental cavity). The tooth may or may not have a stain, which certainly doesn’t require clinical restoration (filling). Next, they place a flowable resin-composite into the tooth’s pits & grooves. This is a tooth-colored material, which lacks physical properties of strength and wear resistance. Manufactures never recommend flowable resin-composites to be used in high physical stress areas, like the chewing surfaces of teeth. Basically, the clinician has delivered the service of a dental sealant.

However, unlike a preventive service like a sealant, this “service” is billed out as a resin-composite restoration. Not only does this activity generate more billable fees, but also each surface the flowable resin-composite contacts generates additional billable fees. While a preventive dental sealant may command in the neighborhood of a $35-40 fee, a multiple surface resin-composite restoration will produce a fee ranging from $85-170. The only real limitation is the greed of the dishonest dentist.

Sometimes, the doctor may actually roughen the enamel surface, for better adhesion of the restoration (in reality, a sealant). However, because of the compromised material used, a general lack of adjusting of the patient’s occlusion (the manner in which teeth bite together), and the rush to maximize production under a challenging Medicaid fee schedule, this form of restoration has a compromised longevity. The compromised longevity is yet another moneymaker, in that these “fillings” require frequent replacement.

When I’ve audited Medicaid patient records, it’s rare to actually see any radiographic evidence of tooth decay on teeth restored like this. (On review of x-rays, there’s no indication of any prior tooth decay.) Further, once these teeth are restored, there’s still no evidence of these restorations entering dentin (Dentin is the tooth structure under enamel, which is a qualifier for a definitive dental restoration, under most Medicaid and insurance programs).

One exception is “preventive resin restorations” (PRRs), which are not a covered service under most insurance and Medicaid plans. Under magnification, and using micro-air abrasion or a fissurotomy bur, the doctor selectively removes only the caries-affected enamel. PRRs do not command an equal fee for restorations, which enter into dentin. However, that won’t stop an unethical dentist for charging, for the more lucrative service.

A sealant scam is difficult to pull off, with private pay and dental insurance patients. Here are the reasons why.

Whether the patient (or their parents) pays the full amount, or simply a lesser-required co-payment, they have “skin in the game”. They feel a pinch in their pocketbook. If these “fillings” fail to hold up, which is virtually guaranteed, patients will complain. They may complain to the doctor, the state dental board, professional peer-review, a civil attorney, their insurance company, or their employer who purchases the dental plan. They are also highly likely to discontinue services with an unethical doctor, who provides this disservice.

By contrast, Medicaid patients have no skin-in-the-game. They pay nothing. They absolutely rejoice, when a dentist places a large “filling”, which doesn’t require Novocain (local anesthetic), and never hurts. They have no concern; this “restoration” is replaced or repaired every 2-3 years. This creates an ever-renewing financial annuity, for a crooked doctor.

Further aiding the dishonest doctor is the abysmal to nonexistent oversight provided by Medicaid regulators. While dental insurance auditors are very well aware of this common dental scam, Medicaid auditors are generally clueless. I seriously don’t know if Medicaid auditors are mostly corrupt, lazy, or stupid. Regardless, I don’t have the time or energy, to broker fools.

So far, I’ve focused on the role played by dishonest dentists. Numbers of corporate dental clinics also play this fraudulent game on Medicaid. These dental service organizations (DSOs), which purport to limit their supervision to non-dental activities, misrepresent the reality. They are active in instructing doctors, on how to cheat the system. The private equity investors, clinic managers, and fraudster doctors all dip their collective beaks, in taxpayer largesse. This represents corporate fraud on a massive interstate level. Unfortunately, since the victims are disadvantaged Medicaid beneficiaries and US taxpayers, regulators generally sit on their hands, or hide under their desks.

In conclusion, misrepresentation of dental sealants as resin-composite fillings is not a “billing error”, as some dental crooks would have you believe. These “fillings” are often placed upon specific teeth, and surfaces of teeth, not covered under a Medicaid program for sealants. These are intentional misrepresentations to deceive the Medicaid program, for one’s financial gain at taxpayer expense. This represents violations to the Unfair Trade Acts and False Claims Acts (both state and federal), which is fraud. Fraud is not malpractice, and a doctor’s malpractice insurance generally doesn’t cover for acts of fraud. Acts of fraud often carry both civil and criminal penalties. Financial penalties are generally treble (3X) damages.

We already have state and federal legislatures, which have enacted powerful laws onto the books. The problems primarily lie with worthless regulators. They are unwilling to enforce existing laws, to protect the disadvantaged and taxpayers. Government regulators too often serve as enablers, for white-collar criminal activity.

From my perspective, I hold Medicaid auditors and regulators to equal culpability, as the actual violators. By ignoring their lawful responsibility to enforce the rule of law, regulators give criminals a tacit green light. Sadly, this green light perpetuating dental Medicaid fraud has been frozen on “go”, for many years.

Monday, September 15, 2014

Small Smiles Dental Centers: Countdown to Exclusion is Business as Usual

As the days count down to CSHM Exclusion from Medicaid becomes effective on September 30, 2014 I’m getting more and more reports that “lead” dentists of the individual Small Smiles clinics are “purchasing” their respective clinics. (Colorado clinics, New Mexico clinics and Indiana clinics just to name a few that have been reported.)

Since January 2010 the clinics have been visited by monitors and care continued decline to the point they were Excluded from Medicaid participation as of September 30. Several reports from monitors found care unacceptable as dentists and staff continued to deliver substandard care as reported in the bipartisan Senate Report.

How can leaving same dentists in place improve the situation?

It is more than highly likely dentists who have been delivering the unacceptable care and treatment for years will continue with business as usual and children are still at great risk and taxpayers will continue to be fleeced.

The risk may be greater than ever.

Anyone think care will be better?

The dentists and clinic operations may not have the watchful eye of the government monitors or be bound by any Corporate Integrity Agreement with HHS-OIG. That Agreement was made with CSHM, the management company of the Small Smiles dental centers. (another pitfall of corporate owned dentistry)

Read Complete Article By Clicking Here >>

Monday, September 08, 2014

Pediatric Dental Care for General Public verses Dental Care for the Underserved

Dentists, lawmakers and regulators should be ashamed for condoning, supporting and fostering such disparity in dental care for children in America. They should all be ashamed and disgusted! I certainly am!

Saturday, September 06, 2014

Small Smiles in Colorado Springs, Colorado is now Front Range Smiles, PLLC–Dr. Nathaniel Conrad Cejka

The can move down the street, they can change their name to Front Range Smiles, but as long as the same employees and same lead dentist work there it’s a Small Smiles; “by any other name as they say.”

The CSHM statement in March 2014 after it was announced Small Smiles Dental Centers were Excluded from Medicaid was correct; it has no effect on the clinics whatsoever. Business as usual and now, NO oversight!

I see little difference now than when Jodi Kuhn “purchased” the clinic for $100 from previous fake owner dentist, Randall Ellis in 2013. Only difference I see is they took the time to create a new business entity and slap another dentist’s name on the documents and moved down the road. BTW, this move to the new address was in the works BEFORE the Exclusion letter was announced. Someone should get a look see at the lease.

(Hasn’t Kuhn purchased two or three of the clinics again? Wonder what new and improved name she is using these days and how much she paid for them when she bought them from herself?)

Frankly I smell a bunch of hoodlums from Pueblo involved. Am I alone? It’s no secret I’ve believed for a very long time the Pueblo bunch very much still has their hand in the operations of the dental clinics in Colorado. There is more evidence supporting that hypothesis than disproving it, that’s for certain.

Front Range Smiles, PLLC f/n/a Small Smiles

Don’t believe Dr. Nathaniel Conrad Cejka is a Small Smiles Dentist? He is listed as a provider at each of their Colorado clinics in Delta Dental provider book dated April 2014. (You will find other “owner dentist” Jodi Kuhn listed right along with him).

Small Smiles - Dr. Nathaniel Cejka	Small Smiles – Dr. Jodi Kuhn

Read Complete Article By Clicking Here >>

Friday, September 05, 2014

Why are these children treated so differently?

None of these children had dental insurance. A and B had Medicaid, C paid out of pocket.
Ask yourself why the children in pictures A and B are treated differently than the children treated in picture C?
Years of studying this issue has revealed only one reason: Profits over Patients!
A.

Corporate Owned Dental Clinic For Children[2]

Corporate Owned Dental Clinic For Children[1]

Non-Corporate Owned Dental Clinic for Children

Wednesday, September 03, 2014

I've had it with agencies and investigators who say that are going to take it to crooked dentists!

After 8 years of blogging and more than a few new stress related grey hairs, I have had it. I've had it with dentists who hurt kids. I've had it with politicians and regulators that say they are going to stop children from being hurt. I've had it with agencies and investigators who say that are going to take it to crooked dentists. I've had it with a government that doesn't want to protect children. In the last few months 3!! investigators have told me that after years of hunting, gathering evidence and being sickened at what they found, they have hit brick walls WITHIN their own agency. Two quit, one after telling me about recent DEATHS in their state that were swept under the rug.

So here is my question for all of you readers - when are you going to wake up and say you've had it, too? Do you not realize that the mouth and bank account of you and every person you love, is at risk? This crap started almost a decade ago. Did you really think that a decade of DeRose trained dentists would simply put in their time and then go into humble private practice without retaining any of their bad habits?

Don't be foolish.

Just like a fart stinks up a whole room, the fraudster dental clinic alumni started a stink that goes DEEP into the dental biz. Think I'm wrong? Tell me if this sounds familiar?

Case in point number one:

Your friend has a 14 year old boy who has had braces on for 3 years. The new pediatric dentist who recently bought the practice where this boy is seen announces right before his braces are removed that he has developed 5 new cavities. Because his brushing was probably not so good with those braces. And his orthodontist isn't really looking for decay so didn't mention it. These aren't your run of the mill pit and fissure cavities - these are the multiple surface (expensive) kind. Might as well get them fixed and give that kid a lecture about how his lousy toothbrushing just cost you $1700 ON TOP of the braces, which weren't cheap!

So the dentist "fills" 5 teeth with itty bitty wholly enamel contained occlusal surface only goop and sends the bill to the parents. Oh, I forgot to mention that the parents are both corporate lawyers. With no dental insurance. But nice cars and kids in private school so odds are that bill is going to be paid.

If you think Medicaid has no oversight, guess how much you get when you pay cash? ZERO. That 14 year old boy is a real kid - his parents paid $1700 for Dentally (Medically) Unnecessary care. But how the heck are they going to know that? Right now they think their son is a lousy brusher who will probably need a few more cavities fixed in the near future. They may be corporate lawyers but their son is a sitting duck.

Do you really think that none of the DeRose trained dentists who have since moved on to private practice would not sense an opportunity if presented with such a scenario? Or the ones who did some time at Kool Smiles? Or maybe All Smiles? Perhaps Comfort Dental? Or maybe Aspen dental?

Case in point number two:

Last week the state of Texas startled citizens when it settled a $16 million dollar fraud case for less than the cost of a kitchen remodel!

Last week (August 28, 2014) the Texas Health and Human Services Office of Inspector General (THHS-OIG) setting a $16 million dollar dental fraud case against one of their top stainless steel crown fraudsters for $39,000! That’s right! Just about one quarter of one percent!
Someone please tell me how that is possible!!

In an article by “The Austin American-Statesman” it says:

“The deal represents the latest underwhelming outcome for state regulators who say they have identified hundreds of millions of dollars in dental and orthodontic fraud between 2007-2012, yet have struggled to produce decisive legal victories.”

Rachel Trueblood says the reason for the lowball number is, “There was a complete lack of evidence.”

Read Complete Article By Clicking Here >>

Tuesday, September 02, 2014

CSHM still up and running, business as usual

Linda Zoeller at CSHM in Nashville still has a job and still filing questionable legal documents for Small Smiles, now known as (file in the blank) Youth Dentistry.

This was filed just today in Colorado.

140902 Springs Smiles Youth Dentistry, PC

Thursday, August 28, 2014

Is Dr. Michael Tarver losing it again?

Has Dr. Michael Tarver lost it again? An email this week from a family member of a 4 year old little girl seems to indicate Dr. Tarver’s abusive behavior continues.

“She is very well behaved, obedient and we always receive compliments in public on this. He yelled at her stating things like "If you won't open your mouth I'll do it for you!" My sister (her mom) was forced out of the room and my niece later revealed she was strapped down. Every time she gets still enough to let her mind wander she recants it and cries saying "Mommy I can't believe they hurt me".

Whom do I hold responsible? The regulators! They had him by the private parts and gave his access to innocent children and Medicaid dollars to support his lifestyle.

The regulators and investigators:

Daniel Gesek, DMD – Executive Director of Florida Dental Board
Bill Gladson – Assistant State Attorney, Florida

It was just less than a year ago, on September 4, 2013 when the Florida Department of Health issued an Emergency Suspension of Licenses against Dr. Michael Addair Tarver. Several reports from parent about Dr. Tarver and his wife detailed the outrageous behavior including altering patient records and abusive treatment of young patients. Police have been called to his office on several occasions.

Excerpts from various reports at the time:

“I remember the patient because she was so badly misbehaved. She ran down the hallway kicking and screaming at the dental staff. I didn’t put my hands over her mouth. The child had to be sedated due to her extremely poor behavior.” Tarver was not charged, according to OPD, he had not committed any criminal offences.
“June 26, 2013 OPD received a complaint about a child that received a 1-1/2″ laceration in the middle of his forehead. Tarver “claims” the child tripped over his own feet causing him to fall and hit his head. Tarver did not call EMS. When questioned by OPD Tarver said, “I am Emergency Medicine Certified, therefore I did not feel the need to contact EMS.” OPD notified DCF upon this investigation due to OPD being called out multiple times starting in June of 2012. The injury did require stitches.”
“In one incident a parent said that Tarver placed his hand over the nose and mouth of her child until the child lost consciousness.”

Florida State Attorney, Bill Gladson said his office was asked to investigate and said in an interview:

"Based on the evidence available, it was decided that no single allegation, if proven as alleged, would constitute the crime of child abuse such that any conviction could be sustained on appeal. This office did not review, and was not asked to review, any matter being investigated by the Department of Health or the Board of Dentistry,”

Read Complete Article By Clicking Here >>

Friday, August 22, 2014

Golly Gee..this is just shocking! NOT!

Anyone what to take a guess who the employs these unnamed dentists? Kool Smiles and ReachOut have operations in Louisiana….just saying…

Feds look at Louisiana dentists for kids on Medicaid

By JANET McCONNAUGHEY
Associated Press August 20, 2014
NEW ORLEANS — About 5 percent of the Louisiana dentists treating children under Medicaid may be padding their numbers, overcharging, providing unnecessary treatments or even harming children, according to a federal study released Wednesday.
Auditors for the Department of Health and Human Services checked 512 dentists and 41 oral surgeons. Twenty-six dentists and one oral surgeon — paid a total of $12.4 million for pediatric dental work in 2012 — billed for extremely high numbers of children or amounts of money or showed other possible excesses, according to the report from department inspector general's office.
Some of the bills may be legitimate but they warrant scrutiny, said a copy of the report provided to The Associated Press before its general release.
"Some of these cases are pretty alarming," said Calder Lynch, chief of staff for Louisiana's Department of Health and Hospitals. He cited doctors with high numbers of fillings and "baby root canals," or pulpotomies. According to the report, one dentist billed for 31 procedures, including 13 pulpotomies, four fillings and 10 stainless steel crowns on one 3-year-old — all during the same visit.
Lynch said he believes many of the dentists described in the audit are among more than 20 his department is already investigating. It recently hired a second dental technician to go over records and will check all 27 people as soon as the federal department sends their names, he said.
That list was "still going through internal processes" Tuesday "but will most certainly be provided," Janna Raudenbush, spokeswoman for the Office of Inspector General, said in an email.
State Medicaid Director Ruth Kennedy wrote in a July 24 response included with the report that, as a result of the study, DHH hired Managed Care of North America on July 1. The company will manage dental benefits under Medicaid and the state's Bayou Health program — an insurance-based model that covers 900,000 of Louisiana's 1.4 million Medicaid recipients, mostly pregnant women and children.
The report said the 512 dentists averaged $264 per child, but six billed for more than $663 per child.
"These dentists received more than $2,000 per child for a total of 237 children," and one was paid $8,000 for work done on one child over three visits, the report said.
"Extremely high payments raise concerns about whether these dentists are billing for unnecessary services or services that they did not provide," the auditors wrote.
Overall, the dentists averaged 27 procedures such as cleaning, extraction or X-rays per day, but three billed Medicaid for 146 or more per day. One billed for 376 services in one day, the report said.
"If this dentist spent only 5 minutes performing each service, it would have taken over 31 hours to complete all these services," the auditors noted.
The auditors also checked on specific procedures, such as extractions, fillings, stainless steel crowns and pulpotomies. On the average, the dentists pulled out teeth from 11 percent of the children they saw, but six dentists extracted teeth from at least 40 percent of the children and one did so on 70 percent of the children he treated. Dentists who filled teeth did so for one-third of the children, but one did so for 92 percent.
The audit looked at Louisiana dentists and oral surgeons who billed Medicaid for at least 50 children in 2012.
One-third of the dentists worked for two dental chains, it said. The report did not identify the chains.
The DHHS report is the second in a series of state reports; the first found similar patterns in 23 of 719 dentists in New York State. That's about 3.1 percent.
The state reports are not being done in any particular order, Raudenbush wrote.
---
Online:
http://oig.hhs.gov/oei/reports/oei-02-14-00120.pdf
http://new.dhh.louisiana.gov/
Read more here: http://www.thestate.com/2014/08/20/3629464_feds-look-at-la-dentists-for-kids.html?rh=1#storylink=cpy

Two audit reports in 2 years… Hmmm…. So they should get this done in say… the 48 years!!! Unacceptable!

Here is wherein a major flaw in reports fall… NO NAMES! That’s why the public doesn’t know the dangers of what lurks behind the doors and criminal keep setting up another shop! Aren’t investigators tired of chasing the same damn criminals!

Thursday, August 07, 2014

Dr. Michael Davis’ Series on Dental Scams- Parts I and II

Scams played on dentists: Part 1

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

July 30, 2014 -- In a new three-part series, Michael W. Davis, DDS, details some of the ways dentists and dental offices are vulnerable to scams. This first part will introduce the series and discuss embezzlement and scams that are played on vulnerable employee dentists.

Dentists are played as marks for scams for several reasons. First, we are targeted because our earning potential is much higher than the general population. Traditionally, dentists have often operated in an isolationist bubble and often confer with colleagues on nonclinical matters only in unusual situations. The demanding focuses of the technical aspects of our profession often preclude us from closer examination of what may be obvious to others. We have blind spots. We are vulnerable.

Recently, courageous leaders in the dental profession such as Drs. Gordon and Rella Christensen have openly discussed embezzlement actions against them. These disclosures help dissolve any shame or guilt that other doctors/victims may carry. No one enjoys admitting they were scammed. However, open disclosures by victims help erode the smokescreen, which perpetrators depend on to pull off their scams.

Embezzlement

Embezzlement and employee theft against an owner/doctor can take many forms. The ADA estimates about a third of all dental offices will be or have been victims of embezzlement. Experts in systems management to prevent and investigate dental office embezzlement and fraud say estimates are greater than 50%. Regardless of the exact number, these risks are very real and potentially devastating to a dental practice.

The exact method of the scam can take on enough discussion to fill several volumes of books. In a common method, the office manager, who is generally valued and trusted beyond reason, pockets office receipts. These may be cash payments from patients that the office manager writes off.

Read the Rest of Part 1 on Dr. Bicuspid

Scams played on dentists: Part 2 -- Consultants and practice brokers

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

August 6, 2014 -- In the second of a three-part series, Michael W. Davis, DDS, details some of the ways dentists and dental offices are vulnerable to scams. This part discusses unethical practice management consultants and practice brokers.

Who doesn't receive via email, fax, telephone, or mail a solicitation from a dental practice consultant on a weekly basis? As a young doctor, I saw many that would promise the "Million Dollar Practice." Today, those figures have grown to the $8 million, $10 million, or $12 million practice. The promises are ridiculously laughable. As the man once said, "If it seems too good to be true, it is."

A number of big-name consultants spend a great deal of time with legal actions brought forth from dissatisfied doctor clients. Using a boilerplate formula from a household name consultant has brought many a dental practice to bankruptcy or near bankruptcy. They may also have multiple endorsements from organized dentistry, which today is little more than paid advertising.

Simply because a consultant has exposure, with prolific publication of consulting articles, does not ensure his or her competency to manage the unique specifics of your dental office.

Here are some suggestions.

Do a background check on former doctor clients who the consultant has served. Do they have philosophies and goals similar to yours? What were the specific objectives? Were goals met?

Read the Rest of Part II on Dr. Bicuspid

Sunday, August 03, 2014

Another Squabble with CSHM, Small Smiles Dental Centers and Owner Dentists—Small Smiles Reno—Who is extorting who?

I seldom tire of the spin found in legal pleading between owner dentists the illegal dental management companies such as CSHM but honestly it’s getting old.

Now that Dr. Jodi Kuhn purchased her clinics again and seems to have continued with business as usual in Colorado. Another turd has been thrown in the CSHM punchbowl by “owner dentist” Dr. James Mann in Reno, Nevada. Dr. Mann was hired in October 2, 2006 and I’m positive he can be located as an employee of one of CSHM entities if someone looked.

Dr. Mann filed suit against CSHM in May 2014. The case was filed in Second Judicial District Court of the State of Nevada-Washoe County. In like fashion, CSHM has filed a Complaint against Dr. Mann and Small Smiles Reno and asked for a Temporary Restraining Order. This was filed filed in Davidson County Tennessee Court on July 22, 2014.

In Dr. Mann’s lawsuit he claims he owns the Small Smiles clinic and is suddenly—after just shy of 8 years of employment—”concerned that CSHM’s heavy-handed control of Small Smiles is violating Nevada’s laws and regulations.”

I find It laughable that Dr. Mann is just now “concerned”. The public and government agencies have been concerned since 2004! How does Dr. Mann explain this?

Mann claims despite all the name changes—FORBA, Church Street Health Management, CSHM, etc.— many of the same key employees have remained as has their illegal business practices. (Well, of course, thorn is a thorn by any other name.)

Mann says, “CHSM has continued Church Street’s practices” and “Indeed, many of the personnel associated with Church Street continued to work for CSHM”

He claims:

Dictated the hours that Dr. Mann and Small Smiles should be open for business.
Imposed pressure on Dr. Mann and Small Smiles to schedule more patients.
Decided which equipment Dr. Mann could purchase for Small Smiles
Insisted on certain dental procedures over others
Set. Dr. Mann’s compensation.

Here is a statement that raises HUGE red flags and give me great concern:

Read Complete Article By Clicking Here >>

Tuesday, July 22, 2014

ACS Xerox Answers Complaint filed by State of Texas

Xerox's Original Answer to Texas Complaint

Texas v. ACS Xerox - Xerox's Original Answer to Pleas in Intervention

Link to other Pleading in the case, including the original Complaint

Monday, July 14, 2014

No Action taken against “Creepy” jury stalker, Attorney Scott Greenspan.

Somehow Greenspan thinks “no action” being taken translates to “complete exoneration”. Stop laughing!

Syracuse, NY -- A Manhattan lawyer accused of stalking an Onondaga County jury on behalf of insurance giant AIG won't face discipline by a court system panel, according to the New York Law Journal.
State Supreme Court Justice Deborah Karalunas threw out the verdict in a lawsuit against Small Smiles in November 2013 after ruling that lawyer Scott Greenspan had prejudiced the jury. The jury found no wrongdoing against the now-defunct dentistry accused of malpractice it its office on South Geddes Street.
Karalunas had described Greenspan's actions as 'creepy' and 'seedy' in her Nov. 18 decision.
But Greenspan called the decision by the court's disciplinary committee a "complete exoneration," the law journal reported. Greenspan said the accusations turned his professional career upside down. He's now looking for a new job.
Read entire article here

Related:

'Creepy' jury stalker hired by insurance giant AIG forces retrial in Syracuse dentistry malpractice case

Friday, July 04, 2014

Small Smiles guilty of abusing children, but jury awards nothing to injured children. WHAT!

By Douglass Dowty | ddowty@syracuse.com
on July 03, 2014 at 3:35 PM, updated July 03, 2014 at 3:44 PM
Syracuse, NY -- A Syracuse dentistry is guilty of malpractice and negligence in the care of four young patients, but will not have to pay the families for injuries, a state Supreme Court jury ruled.
That means that while Small Smiles mistreated patients at its South Geddes Street clinic, the injuries did not reach the threshold for compensation, said Richard Frankel, a Texas attorney who represented the patients' families.

The split verdict sets the tone for a huge backlog of lawsuits against Small Smiles. There are 30 other children statewide -- five more in Syracuse.

Complaints against Small Smiles date from 2005 to 2009. The Syracuse office closed in 2012 after the owner filed for bankruptcy.

Before the jury verdict, state Supreme Court Justice Deborah Karalunas ruled that Small Smiles violated state law as a dentistry by being owned by a corporation and not a dentist, Frankel said. …
Read Article Here

Monday, June 09, 2014

Settlement reached between “owner dentist” Jodi Kuhn and CSHM/Small Smiles Dental Centers

What that settlement is remains unknown. Here is the latest entry on the court docket, dated June 3, 2014.

ORDER: The court has been notified that this case has settled. It is hereby ORDERED that a stipulation of dismissal or other settlement document shall be filed within thirty (30) days of the entry of this Order.

The preliminary injunction hearing set for June 5, 2014, and the initial case management conference set for June 6, 2011, are CANCELLED.

Read Complete Article By Clicking Here >>

Sunday, June 08, 2014

Revisiting 2009 MassHealth Independent Audit Report

Revisiting 2009 MassHealth Independent Audit Report; not much has changed.

Audit report for period July 2005 – May 2009
Dental Program claims processing system has resulted in millions of dollars in ineligible claims and potential fraudulent claims being paid.
Only 15.7% of radiograph claims met requirements.
84.3% of radiographs (x-rays) by 10 providers (3 Small Smiles and 3 Kool Smiles) failed to meet requirements
Radiographs (X-rays) claims paid to 3 Small Smiles clinics and 3 Kool Smiles clinics totaling $3,09,172 were unallowable.
DentaQuest (f/k/a Doral Dental) Senior Dental Director stated providers “treat to the benefits allowed and not member’s need)
3 Kool Smiles and 3 Small Smiles clinics routinely gave members bitewing radiographs contrary to FDA recommendations.
Small Smiles said in 2009 they implemented a new dental protocol that included the 2004 FDA recommendations.
DentaQuest contract required them to identify standards of care based on published recommendation of nationally recognized authorities such as the AAPD.
DentaQuest contract required it to monitor providers’ compliance with the AAPD guidelines.
MassHealth failure to adequately control orthodontic services resulting in $321,553 overpayment to just one provider.
DentaQuest failure to adequately monitor claims was widespread.
Many cases of double billing and double payments

MassHealth Dental Audit 2006-2009 by Dentist The Menace

Saturday, June 07, 2014

Remember Allcare Dental?

With corporate dentistry taking over the world, it’s good to remember Allcare who closed it’s doors overnight in January 2011 leaving patients without care or recourse, and dental boards scratching their..uh.…heads.

A class action lawsuit was filed and just like the Allcare’s doors, patients were left lock-jawed.

Allcare Dental Class Action Lawsuit

The Allcare companies filed for bankruptcy in the Western District of New York (Buffalo), Bankruptcy Petition #: 1-11-13848-CLB. Those proceedings terminated in 2013 with a report of no distribution. As such, there are no available assets from these entities for unsecured creditors.
You may have individual claims. Once the class action claims are dismissed, the statute of limitations for your claims will continue to run. You should contact an individual attorney in your state if you desire individual representation. Failure to file within the applicable statute of limitations will forever bar your claims. We are not handling these claims given the no-distribution report.

http://www.allcaredentalclassaction.com/uploads/Allcare-Dental-Class-Action-Complaint-filed-2-7-2011.PDF

Allcare patient speaks about ordeal in 2012.

http://www.abc57.com/home/top-stories/ALLCARE-DENTAL--162156285.html

Saturday, May 31, 2014

Franchise or Ponzi Dental Scheme? — Comfort Dental

In an Affidavit filed this week in the Bahr brothers (CDMO & CDET) v. Rick Kushner and Comfort Dental lawsuit reveals the abuse and threats that reign down from Kushner and other Comfort Dental executives.

Louisville, Colorado Comfort Dental subfranchisees were berated, threatened and assessed $50,000 penalty for failing to use Budget Dental Lab dba Premier Dental Lab owned by Rick Kushner—owner of Comfort Dental, Inc.—and his brother, Barry Kushner, along with Roy Martin, C. Michael Bloss, Bruce Irick and Neil Norton.

“We would order an appliance from the non-Comfort Dental lab because quality was much higher and much more reliable.”

“In some cases costs were higher when using a non-Comfort Dental lab, but we felt it necessary to serve our patients’ best interest.”

“Comfort Dental assessed a $50,000b out-o-system lab referral penalty on us.”

“…after having been summoned by Rick Kushner, at a meeting at the Comfort Dental headquarters in Lakewood, CO… we (the partners of Louisville (CO) office were admonished by Rick Kushner and about the franchise violation, use of an outside lab. Immediately thereafter, Rick Kushner announced that a $50,000 fine was being imposed on our office/partnership. The entire sum due and payable in 2 weeks.”

Read Complete Article By Clicking Here >>

Saturday, May 24, 2014

Florida Dentists, Dr. Miranda W. Smith-Smiles and Giggles Dentistry-Arrested Medicaid Fraud

One of Dr. Miranda Smith’s patient had perfect teeth, yet in Smith’s treatment plan she pulled every tooth and fit the patient with ill-fitting dentures; a pattern said investigators.

Other’s were children, sedated, for dental treatment they didn’t need.

Her husband blames the whole mess on “two disgruntled and racist employees”. And says, “She’s been fighting this for three years, nine employees and their families are out of work because of this”.

Christopher Torres, her attorney, says many of the charges have been disproved on an “administrative level” and believes the criminal charges won’t hold up.

Apparently the Feds think otherwise and have a 21-page affidavit to back it up with $140,000 in Medicaid fraud charges.

It’s not the disgruntled employees that concern me, it’s the ones who are happy at their job working for dentists like these.

Smiles and Giggles Dentistry for Children and Adults is located in Spring Hill, Florida.

Florida AG Press Release:

Attorney General Pam Bondi News Release
May 23, 2014
Media Contact: Jenn Meale
Phone: (850) 245-0150
Attorney General Pam Bondi’s Medicaid Fraud Control Unit and the Pasco County Sheriff’s Office Arrest a Tampa Bay Dentist
TALLAHASSEE, Fla. –Attorney General Pam Bondi’s Medicaid Fraud Control Unit, with the assistance of the Pasco County Sheriff’s Office, arrested Pasco County Dentist Dr. Miranda Smith on charges of Medicaid Provider fraud.
Dr. Smith, owner of Smiles and Giggles Dentistry for Children and Adults in Pasco County, allegedly billed Florida’s Medicaid program more than $140,000 in dental services which were either unauthorized or not provided.
The Attorney General’s Medicaid Fraud Control Unit initiated its investigation of Smith and her dental practice after receiving complaints about suspicious billing from parents and patients. According to the investigation, Smith billed Medicaid for x-rays, anesthesia, and other dental procedures that were not performed. Additionally, former patients alleged that Smith’s employees provided dental care, even though these employees were not licensed dentists.
According to the investigation, at least one minor patient's parent was told her child had eight cavities and would need to be sedated to perform urgent dental work. The parent received a second opinion from a dentist with more than two decades of experience. The dentist performed her own examination and found that the child had no cavities.
Investigators also found that Dr. Smith and staff exhibited a pattern of pulling healthy teeth in an effort to sell patients dentures and make larger Medicaid claims.
Smith is being charged with two counts of Medicaid Fraud. If convicted, she could face up to 10 years in prison and up to $10,000 in fines. The Attorney General’s Office of Statewide Prosecution will prosecute this case.
The Florida Department of Health’s Board of Dentistry voted on May 16, 2014, to suspend the license of Miranda W. Smith, D.D.S., in case number 2011-12390. This suspension will become a Final Order of the board within the next few business days.

I couldn’t help but compare the two pictures above! LOL

Never mind…

Friday, May 23, 2014

Texas State Board of Dental Examiners take swift action!

For those who think the Texas State Board of Dental Examiners can’t take swift action, you are dead wrong.

Bryan, Texas creepy dentist and dental board member, Dr. William Reagan Birdwell was arrested Wednesday, May 21, 2014 after caught filming an employee changing in his office bathroom.

At lightening speed the board took harsh action by removing any mention of him on their board member page.

So there!

Birdwell was appointed by Governor Rick Perry in 2009 for a term ending in 2015. I guess his term ended early.

Wednesday May 21, 2014 TSBDE Board Members

Two days later, poof, he’s gone!

Thursday, May 15, 2014

CSHM-Small Smiles Dental v. Jodi Kuhn: Kuhn Responds to Complaint

The Hearing scheduled for May 14, 2014 to hear arguments on the Temporary Restraining Order and Injunction was rescheduled until after June 5, 2014 apparently to allow time for discovery such as a deposition of Jodi Kuhn. (see Joint Motion to Reschedule)

(Waist high boots will not be nearly high enough; so I’m thinking a full diving getup will be needed.)

May 6, 2014 Kuhn filed her Response to CSHM’s Complaint, which I thought odd. Usually at least 2 extensions are asked for before those are ever filed.

Reading the Response will make your head spin, but don’t be alarmed. It’s suppose to make the judge’s head spin, and frankly after reading the Complaint and the Response my sympathy is with any judge who finds this mess on his docket.

I find the Complaint and Response something conjured up in a witch’s cauldron. Hardly a sentence in either has the actual truth of the matter at hand. I wonder how she squares up everything in her Response with the clinics she has her name slapped all over in Ohio and Kentucky. (you will see what I mean when you read it) .

If Kuhn’s lies hold, then every clinic is up for grabs in more than just Small Smiles!

She goes into great depth about how CSHM was the one Excluded from Medicaid and not her Colorado clinics. She even attaches the Joint Report by Senators Baucus and Grassley, talking about what terrible treatment children receive at Small Smiles clinics.

Since she contends HHS-OIG has serious problems with CSHM, and not Small Smiles clinics, I wonder why the clinics, staff and treatment received at the clinics were under such scrutiny; CSHM wasn’t treating these sweet children.

Anyone think HHS-OIG had problems with the way Kuhn’s paycheck was being printed or something? Further she didn’t mind one bit to hand over every dime “her” clinics made to CSHM until the Exclusion was announced.

Frankly, I would have been pissed long before now they were taking all the money I was making straight out of my bank account. Plus, I’d be pissed they were still taking it out of my Ohio and Kentucky clinics. She doesn’t mention those clinics. Hmmm….

Doc 24 CSHM v Kuhn Response

Related Documents:

CSHM v Jodi Kuhn Complaint, April 21, 2014
CSHM v Jodi Kuhn Response, May 6, 2014
Thornton Small Smiles Purchase Agreement, May 6, 2014
Thornton Small Smiles Stock Pledge Agreement, May 6, 2014
Joint Motion To Reschedule TRO Hearing, May 12, 2014

Tuesday, May 13, 2014

Dental Group Practice Association changing it’s name to Association of Dental Support Organizations

What’s in a name? A brand.

Anyone besides me think the DGPA has gotten such a bad reputation over recent years, it needed a name change? Does it matter? Not really. They are who they are, not matter what they call themselves.

“Association of Dental Support Organizations” Unveiled as New Trade Association Name

(May 13, 2014) – NAME CHANGE REFLECTS EVOLUTION IN THE DENTAL PROFESSION AND ASSOCIATION’S FOCUS
DENVER, May 13, 2014The Dental Group Practice Association (DGPA), a nonprofit industry association representing more than 30 dental support organizations (DSOs), announced today that the organization has changed its name to the Association of Dental Support Organizations (ADSO).
“It’s important that our organization’s name clearly reflects our mission to support DSOs and all they do to ensure the delivery of innovative, high quality and cost effective care,” said Dr. Quinn Dufurrena, Executive Director of ADSO. “Our mission is to provide world-class business and technology support services to dentists, a partnership that lets dentists focus on what they do best, which is serving their patients.”

Read Complete Article By Clicking Here >>

Friday, May 09, 2014

Texas v. Xerox in connection with massive dental fraud in the state

FOR IMMEDIATE RELEASE
May 8, 2014
www.texasattorneygeneral.gov

State of Texas Files Legal Action to Recover Fraudulent Medicaid Payments from Xerox

State of Texas Files Legal Action to Recover Fraudulent Medicaid Payments from Xerox

AUSTIN – The Texas Attorney General’s Office today filed a civil lawsuit in state district court against Xerox Corporation and its wholly owned subsidiary, ACS State Healthcare LLC. The State’s legal action seeks to recover fraudulent Medicaid payments for orthodontic and dental services that were improperly approved by Xerox.

Since 2003, Xerox has served as the vendor responsible for reviewing dental and orthodontic claims submitted to the Medicaid program. Under state law, orthodontic services are not generally eligible for coverage under the Medicaid program. Only the most acute cases where orthodontic disfigurement poses a health risk to a patient are eligible for Medicaid coverage; the Medicaid program does not cover cosmetic orthodontics. The State’s lawsuit seeks to recover Medicaid payments that Xerox approved for orthodontic services that were not medically necessary and therefore not authorized by law.

Texas Attorney General's lawsuit against Xerox Corporation and ACS State Healthcare LLC

Today’s legal action reflects the culmination of a lengthy multi-agency investigation into orthodontic Medicaid fraud. In June of 2012, the Attorney General’s Office, together with the Texas Health & Human Services Commission (HHSC) and the HHSC-Office of Inspector General formed a dental and orthodontic fraud task force to investigate fraudulent overbilling by dental and orthodontic Medicaid providers. One of the results of the task force’s investigation was the discovery that Xerox had not been properly reviewing orthodontic claims as required by its contract with the State. Further, the task force uncovered evidence revealing that Xerox systemically approved orthodontic claims that were not authorized by state law.

The State’s law enforcement action is seeking injunctive relief, civil penalties and restitution of overpayments made by the Medicaid program as a result of Xerox’s unlawful conduct.

CONTACT
Press Office at
(512) 463-2050

Partners Uncomfortable at Comfort Dental; patients caught in the crossfire.

In an article on Dentaltown, dated October 2012 Comfort Dental founder, Rick Kushner said: -

“Corporate dentistry scares the hell out of me for two reasons: first, whether they get their money from the public or from private equity, corporate dentistry will always have only one priority: demonstrate more profit. (By the way, Comfort Dental has only one original money source: me. Oh and a couple of local banks. Of course, every single Comfort partner is equity invested in his/her own Comfort partnership.) And secondly, as a dental “chain” we are unfairly lumped together with corporate dentistry by ignorant dentists including DSIs (dental school instructors) and of course, some patients. Structurally and philosophically we at Comfort are as far from corporate dentistry as traditional private practice. Had the profession listened to me instead of attacked me over the past few decades, the professional landscape would be saturated with Lean & Mean group type practices so prosperous that there would have been neither need nor room for corporate dentistry. So again, how did corporate dentistry happen? It’s dentists’ fault. It’s DSIs (dental school instructors) fault. It’s not my fault; it’s their fault. Dental practices were so bad for so long with their 80 percent overheads and their hygiene-heavy practices that businessmen in business suits looked at them and instinctively knew they could do better and keep the difference in profits. And guess what? They were right. Businessmen in business suits looked at dental practice and knew they could handle our business better than dentists. So they did. Not my fault. I warned dentists but they were smarter than me. Graduates laden with debt and corporate dentistry are a match made in heaven. “

I would agree with 90% of that statement.

However a Complaint filed March 25, 2014 in Colorado US District Court accuses Comfort Dental of “exerting excessive and improper control over medical decisions and judgment of dentists practicing in Missouri, Kentucky and Indiana” appears to indicate Comfort Dental is more “corporate” than Mr. Kushner likes to think.

A Brief filed with the Compliant, seeing an Injunction against Comfort Dental states:

“Comfort Dental’s illegal conduct exposes Plaintiffs to immediate and irreparable harm. Comfort Dental’s demands that the Plaintiffs participate in the MLRP (Mandatory Lab Referral Program) and sell the Gold Plan (unregistered discount medical plan) force Plaintiffs to make an impossible choice: lose their 25 year franchise or violate the laws of multiple jurisdictions.…it impermissibly interferes with, and exerts control over, dentists’ independent medical judgment and forces Comfort Dental dentists to place the financial interests of Comfort Dental’ s owners over the best interest of their dental patients…threatens irreparable harm by threatening to terminate Plaintiff’s franchise, and by demanding that they engage in potently illegal conduct which could expose them to penalties, professional licensure actions and damage to their patients relationships and reputations. “

I read this to say, instead of dentists being fired, their Subfranchisee Agreement can be terminated without notice or opportunity to correct problems that may arise.This sounds a whole lot like more like “corporate dentistry” than independent franchise owners to me. As always I could be wrong.

However, before getting into what meticulously laid out in the Complaint and other pleadings, you need to know the players:

Read Complete Article By Clicking Here >>

Thursday, May 08, 2014

Dr. Li Lou Skelton aka Dr. Li Lou, 7 pending malpractice suits in Texas

Dr. Li Lou Skelton, current dental license status is Active/Probation.

Agreed Settlement Order that began in June 2008; all related to Dr. Skelton’s dental treatment of 8 patients fell below the acceptable standard of care on 2004 and March 2008.

August 2010 Agreed Settlement Order dated August 2010, over substandard care of 17 additional patients. In addition to restitution to patients Skelton agreed to pay the Texas State Board of Dental Examiners $20,000 over the next 4 years in $5,000 installments.

Five Malpractices cases were filed against her in 2013 and between February and April of 2014, 3 additional cases have been filed.

This woman as 7 pending malpractice suits!!

Where is the Texas State Board of Dental Examiners?

	Case No.	Date Filed	Case Status
1	2011CI09803	06-14-2011	DISPOSED
2	2011CI15583	09-23-2011	DISPOSED
3	2013CI00047	01-02-2013	PENDING
4	2013CI05704	04-04-2013	DISPOSED
5	2013CI08156	05-14-2013	PENDING
6	2013CI08796	05-23-2013	PENDING
7	2013CI20502	12-18-2013	PENDING
8	2014CI02109	02-12-2014	PENDING
9	2014CI05424	04-03-2014	PENDING
10	2014CI05500	04-04-2014	PENDING

Saturday, May 03, 2014

Faulted in Medicaid Fraud, Company Keeps Contract

For nearly five years, a state contractor allowed workers with limited expertise to approve dental claims for Texas’ Medicaid program, the joint state-federal insurer. State spending on orthodontic services spiraled out of control; by 2012, federal and state auditors found that the contractor’s actions had opened the door for a “massive Medicaid fraud scheme” that cost taxpayers hundreds of millions of dollars.

More than two years later, Texas health officials have reeled in spending on Medicaid orthodontic services and pursued legal action against health care providers who billed for the services. But a Texas Tribune investigation found that while health officials have repeatedly raised concerns with the contractor, a Xerox subsidiary called the Texas Medicaid and Healthcare Partnership, they have not severed its multiyear contract worth hundreds of millions of dollars.

Critics accuse the state of dragging its feet because of the contractor’s political ties to Gov. Rick Perry, a claim the governor’s office says is not true.

Continue reading at New York Times…

Read Texas Tribune Article Here - Company That OK's Unnecessary Braces Kept Its Contract