Blasts from the past much like today penalties for Medicaid Fraud? No today the fraud is worse and penalties even less.

December - Three Omaha Nebraska dentists plead innocent on fraud charges stemming from a 6 month investigation of the Douglas County Medicaid program. 

After their arrest, Dr. Leon E. Fellman (six counts), Dr. Stanley F. Galaska (five counts) and Dr. William V. Harrison (three counts) were released on $500 bond. Reports said the three would likely be tried early next year. Each count carried a prison sentence of 5 years.

That was December 1969!

The Lincoln Star Tue, October 21, 1969 pg. 1

Lincoln Evening Journal Tue, December 9, 1969 pg.51

Fast forward nearly 4 years.

All three were found guilty of the felonies in District Court and placed on probation. After hearings in November 1972, Henry Smith—State Health Director—suspended Dr. Stanley Galaska license for a mere 20 days while suspending Dr. William Harrison’s license a mere 25 days.  Dr. Leon Fellman surrendered his license for 6 months. Only the attorneys for the defendants and Gary Snowden, attorney for the state health department, were present. The State Board of Examiner were then notified of the suspensions.

Dr. B. J. J. Moran, a member of the State Health Board and former president of the Nebraska Dental Association said the disciplinary actions taken “seemed inadequate… based on the information on the case.”

All three had their convictions nullified and civil rights restored based on a 1969 Kansas law.

Lincoln Evening Journal – Thu, April 26, 1973, pg.15

Imagine what Dr. Moran would have to say about today’s actions!

Rick Perry and Greg Abbott Culpable in Debacles of Corporate Dentistry DSO Poster-Boy, R. Kirk Huntsman

 

by Dr. Michael Davis

 

December 17, 2014

Soon to assume the Texas governor position, from his prior office of Texas state attorney general, will be Greg Abbott. Mr. Abbott takes over the governor’s office from another dental industry failure, current Governor Rick Perry. Mr. Perry is most noted in dentistry for his dubious appointments to the Texas State Board of Dental Examiners (TSBDE). The consumer protection group, Texans for Dental Reform, have highlighted a number of these self-serving and corrupt appointments. Members of the TSBDE included a number of notorious Medicaid fraudsters, and at least one convicted sex offender.

Hapless state watchdogs for Texas citizens extended not only to the TSBDE and their incompetent legal counsel, but also to the Texas Office of Inspector General. Despite the fact that Texas is currently the state most recognized for the severity and volume of dental Medicaid fraud, the Texas Office for Inspector General has so far failed to effectively prosecute violator after violator. These habitual failures go directly to the (in)activity of Greg Abbott and Rick Perry.

Federal Fifth Circuit Ruling 07-30430

Let’s examine a case in point. Federal Fifth Circuit Court ruling 07-30430, which is largely based on Texas state statutes, determined that non-dentist ownership of a dental practice in Texas represents the unlicensed and unlawful practice of dentistry. The ruling further stipulates that corporate violators are to receive the same legal penalties, as individual person violators, with no special treatment. The acts of establishing doctor production quotas and bonuses are an action only lawfully permitted by a licensed dentist. State dental regulatory boards are charged under this federal ruling with the responsibility and obligation, of disciplinary actions against both individual person violators and corporate violators. The federal court also determined OCA (f/k/a Orthodontic Centers of America) could not enforce employment contracts with duly licensed Texas doctors, because the corporate entity OCA was not in fact a licensed doctor. The dentist employment contracts were determined unlawful and unenforceable, in their entirety, without being severable.

The federal court clearly saw though the sham presented by OCA (a dental service organization, “DSO”). OCA presented licensed dentists, whom they retained to misrepresent themselves as clinic “owners”. OCA controlled the dental clinics’ bank accounts. OCA held the power to buy and sell assets, such as the doctor employment contracts and individual clinics. In reality, these “owner dentists” were merely nominee owners. OCA, like nearly all DSOs, was the true and unlawful beneficial owner.

In conflict with this federal ruling —and further, avoiding addressing this ruling —the TSBDE has repeatedly stated they have no mandate to enforce the unlicensed practice of dentistry by a corporate entity. This flagrant obfuscation of law by legal counsel for the TSBDE is highly disturbing. Even more troubling is watching Rick Perry and Greg Abbott hide under their desks. Additionally, Mr. Abbott further abandoned his duty as Attorney General by failing to provide a legal advisory opinion based on clear and current legal precedence.

Xenith Practices, LLC & Austin Cosmetic Dentistry

Let’s examine another case, where Mr. Abbott was asleep at the wheel leaving dental consumers in harm’s way. In October 2014, Austin Cosmetic Dentistry simply closed and locked their doors. No notice of the closure was given to patients or staff. The staff was left unexpectedly unemployed and patients were illegally abandoned. Many patients were in the middle of their treatment. Many others, who had pre-paid, were scheduled to begin or finalize their restorations.

Representatives of Xenith Practices purchased the now-failed Austin Cosmetic Dentistry clinic from Dr. John Schiro, a couple of years earlier. The highly disturbing public record of Dr. Schiro with the TSBDE must have been aware to Mr. Huntsman and principles of Xenith Practices. It’s easy to download from the TSBDE website, with the slightest due diligence check. The earlier legal disputes between Dr. Schiro and Dr. Douglas Terry, who openly spoke out about alleged improper clinical care by Dr. Schiro, were also of public record. I have no idea what matters the investors were informed, by way of a lawful full disclosure by Mr. Huntsman. None of this should have escaped the attention of the Texas attorney general’s office, governor’s office, nor the TSBDE.

Xenith Practices, LLC, a DSO, managed the failed Austin dental clinic. Mr. R. Kirk Huntsman, —a business executive with no formal dental education and unlicensed to practice dentistry—formerly served as CEO of Xenith. As we shall see, Mr. Huntsman has quite the storied history in the dental industry. As for the true beneficial ownership of Austin Cosmetic Dentistry, that will be for the courts to sort out. It is alleged that Mr. Huntsman’s son-in-law—a Texas licensed dentist who lives and works in Colorado— signed on as the figurehead, “owner dentist”. Mr. Abbott could not have missed this obvious violation to Fifth Circuit ruling 07-30430, and negative fallout to the public health and safety.

What’s in a name: NCDR and CSHM rebranding

NCDR, LLC (Kool Smiles) can become Benevis, and CSHM (Small Smiles) can become First Quality Management (FQM) but the people are the same, the service is the same and the business model is the same.

  It would be interesting to hear from Adam Ditto, who has been with them all:

FORBA>CSHM>FQM (Small Smiles now “fill in the blank Smiles Youth Dentistry)

Hero Management  (Adventure Dental and Vision, taking over at least some of the old Small Smiles)

NCDR>Benevis (Kool Smiles and Resolution Dental)

 

 

 

 

 

 

 

What secrets does Adam Ditto hold?

Myths, Rumors, and Bald Faced Lies- Truths Revealed about the DSO Industry

Myths, Rumors, and Bald Faced Lies- Truths Revealed about the DSO Industry

By: Michael W. Davis, DDS

There exists a great deal of misinformation, as well as intentional misrepresentations, within the dental service organization (DSO) industry. Much, if not most of this of this, is fostered by the DSO industry itself.

Historically in healthcare, dentists were held to ethical and legal standards within the doctor/patient relationship (legal contract) always placing their patient’s interest, above all other interests. Court rulings have determined that because of a doctor’s expert knowledge, which is not easily accessible to the general public, the patient is at a distinct disadvantage within this contract agreement. Obviously, the delivery of healthcare services is a very different matter, than the buying and selling of widgets.

A corporate third party, the DSO, may enter into this contract agreement (doctor/patient relationship). This is usually without the knowledge or consent of the patient. Such an action may invalidate as unlawful, the doctor/patient relationship. (Please reference Fifth Circuit Ruling: 07-30430.) DSOs, which utilize bonus systems and production quotas for professional providers, are engaging in the unlicensed and unlawful practice of dentistry. Such corporate violators are subject to the same regulatory sanctions and disciplinary actions, as individual violators. Unfortunately, too few government regulators have advanced past their current ineptitude and corruption. This must change.

“At XYZ Dental, we allow you to focus on what you do best; provide excellent dental care for patients. We take care of all the rest.” is a common corporate dentist-recruiting message. Even the provider contracts include a proviso waiver that only licensed dentists provide dental care. Unfortunately, contract verbiage is far from the reality.

Unlicensed corporate managers, not doctors, very often make clinical decisions effecting direct patient care. This may include the quantity and quality of dental supplies for a dental clinic. It may include a very limited selection of utilization of dental laboratories, many of which are undisclosed offshore dental lab sweatshops. Unlicensed corporate clinic managers, who are not under any doctor’s supervision, may be utilizing arm-twisting sales techniques, to get patients to sign on for financing of unnecessary dental care. Similar arm-twisting may be used on doctors and hygienists, to increase clinic profits, by selling unneeded dental treatments to their patients.

Hygienists, who lawfully must be working under the direction and supervision of a duly licensed doctor, are today working for whomever writes their paycheck. Periodontal probing measurements are invented, to generate additional cases of unnecessary scaling and root planing (deep cleaning). Sulcular antibiotic therapy is sold to patients, even before assessment of results, to initial therapy of scaling and root planing. Adult cleaning visits are often restricted to 20-30 minutes, which nearly always leaves excessive disease-causing agents. In fact, often unlicensed dental assistants are providing hygiene services.

Generation of corporate profits trumps the interests of patients. Any dental professional employee who dares question the corporate model will soon be out the door. After all, a corporation’s first fiduciary responsibility is to generate maximal returns for shareholders. The interests of patients never enter the picture.

Upper management in the DSO industry will often argue, that numbers of non-corporate doctors are engaging in the same or similar patient abuses, within their smaller businesses. And, this justifies their grand scale abuses, how? It’s the old lame failed argument, of justifying bad behavior, with other examples of bad behavior. Reality: dental regulatory boards have reported a far greater percentage of statute violations originating from corporate dentistry, than from smaller doctor-controlled practices.

Another DSO fallacy often relates to doctor financial compensation. Verbally, their management and doctor-recruiters advise dentists of compensation, clearly based on a percentage of the doctor’s clinical production and/or hourly wage. Yet, the complex legalese of the employment contract, seemingly tells another story. These contracts are often so complicated, only a law firm concurrently expert in business law, contract law, and finance could hope to decipher the maze of legal verbiage.

Fortunately, any American Dental Association (ADA) member can have these contracts reviewed, as a benefit of membership. Few recent grads take advantage, as they not only lack finances to hire an appropriate attorney for contract review, but also are often not ADA members.

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.

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

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.

 

 

 

 

 

 

 

 

 

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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

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.

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.

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.

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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.

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.