WHISTLEBLOWERS IN ACTION: Dr. Steven Pesis Discusses How Unethical Use of HIPAA Contribed to Patient Abuse at University of Pennsylvania

Dr. Michael W. Davis maintains a general dental practice in Santa Fe, NM. He serves as chairperson for Santa Fe District Dental Society Peer-Review. Dr. Davis also provides a fair amount of dental expert legal work for attorneys. He may be contacted via email: MWDavisDDS@comcast.net
By: Michael W. Davis, DDS





Dr. Steven S Pesis DDS
Email: Shimstock1@gmail.com
Dr. Steven S. Pesis studied psychology at Queens College before receiving his DDS at The University of Michigan School of Dentistry. He then received advanced training in general dentistry by attending the AEGD residency program at the Kornberg School of Dentistry at Temple University. During his residency he was educated in a variety of complex dental cases, including full mouth rehabilitations, implant dentistry, esthetic dentistry, Invisalign and dental anxiety. Following his residency, he worked in public health dentistry until he joined the Penn Dental Family Practice at the University of Pennsylvania. He also taught as Clinical Associate in the Department of Preventive and Restorative Sciences for the University of Pennsylvania School of Dental Medicine.
 
Born and raised outside of Detroit, Michigan, Dr. Pesis is a member of a family of dentists. His father and uncle share a practice in Michigan, while his brother practices in the public health sector for Philadelphia. He hopes to use his knowledge of dentistry and psychology to provide patients with the best possible care, educate future dentists and to further the advancements in the dental field.
 

INTRODUCTION

Dr. Steven Pesis is a public safety whistleblower, who acted in accord with his ethical and legal obligations to expose patient abuses under the American Dental Association Principles and Code, Pennsylvania Commonwealth administrative statutes under the dental practice act, as well as internal policy of the University of Pennsylvania (U/Penn). As a result, Dr. Pesis alleges he was wrongfully terminated from employment by U/Penn. Dr. Pesis filed a legal action against the Trustees of U/Penn and Peter K. Kauderwood, assistant dean at U/Penn School of Dental Medicine.

See: Suit Claims Penn Dentist Was Fired For Reporting Unneeded Treatment
 
INTERVIEW
Dr. Davis: Dr. Pesis, I sincerely thank you for taking the time and effort to address matters of this case. Our readers will fully appreciate you are unable to address certain specifics and details of this issue, because of ongoing litigation. However, could you give our readers an overview and outline of your case? 
 


Dr. Pesis:Thank you for taking the time to discuss these issues, Dr. Davis. You are a true dental professional, constantly advocating for patients and bringing these issues to the public. The importance of quality care for dental patients, honesty and integrity are the cornerstones of dentistry and should not be overlooked.
 
My situation began close to a year ago. The Penn Dental Faculty Practice also known as the Penn Dental Family Practice (PDFP) renovated a large portion of a new building at the University of Pennsylvania in order to relocate one of its three offices. The cost quickly began to increase and once completed, the project was rumored to be severely over budget. This office at 3737 Market, known as the University City location, was to be the crown jewel of the PDFP and many of the top producing dentists were transplanted from the other offices to this new location. After all of the commotion, I remained as the only full-time dentist at the PDFP Locust Walk location and I was designated by Dean Denis Kinane of the dental school as the Clinical Advisor for this location.
 
Shortly after the opening of the new office, the Locust Walk location hired a new dentist in order to fill the void left by the relocation of multiple dentists. During the new doctor’s first few days working at Locust Walk, I received reports from doctors and hygienists that he was extremely aggressive in his treatment plans, over-treating patients as well as billing incorrectly. The clinical advisor from another office also discussed similar concerns with me regarding the new dentist. We both investigated the information and determined that there were real concerns regarding the new dentist’s billing practices and treatments of patients. These findings were finally reported to the clinical director, Dr. Alisa Kauffman. Shortly after the reports were made, I was terminated from employment from the University of Pennsylvania. I was pulled into an office and told that I had violated HIPAA and that I was being terminated from my clinical and teaching positions. I spent nearly an hour explaining that these allegations were false and that everything I did followed HIPAA protocol and did not violate the university privacy policy. One of the last things I said was that regardless of what my fate is, PDFP owes it to the patients to investigate the new doctor’s practices. To my knowledge, no investigation was conducted into the claims that were made and to this day, individuals at the PDFP remain scared to report any wrongdoing by the new dentist for fear of retaliation.

When Dental Surgery Lands A Patient in a World of Everlasting Regret

Don’t miss this entire in-depth article by Dianna Wray at the Houston Press by clicking here.

“…Before Hoover went to work on Noah’s mouth, the receptionist told Deel it would cost $300.”

“…A few minutes later, Hoover asks Deel to come take a look inside Noah’s mouth. As Deel stands by, Hoover opens Noah’s mouth and begins poking around with her fingers and silver instruments. The cavity is too deep, she tells Deel. They might have to put a crown on it. Hoover gestures to the teeth on either side. These teeth are weak too, she says, so they need crowns as well.”

“…Deel agrees the teeth need to be fixed and goes back to the front, where McGonagle, who also happens to be Hoover’s husband, offers Deel another margarita. A dental hygienist appears in the waiting room and informs Deel his son now needs five crowns. It will cost $6,000 out-of-pocket, she says.”

“…McGonagle doesn’t miss a beat. He can see Deel is a nice guy and he wants Noah to get what the boy needs, McGonagle says. Deel might qualify for a “special loan” from a lender that pays the office “right then and there,” says McGonagle. “I’ve had good luck with these guys,” McGonagle tells Deel. Hoover’s office also bills the Deels’ insurance for $6,000. Before Deel has even thought about it, he has applied for a “care card,” a health-care credit card with an extremely low initial interest rate that soars if the card isn’t paid off within the first six months.”

“…According to state district court records filed in Galveston County, Columbo stated that “every one of the crowns done just months ago have short margins or recurrent decay under them.” The documents also allege that “Columbo [told] Lisa and Noah that the crowns need to be replaced in the next few months and furthermore that there [wasn’t] any indication that Noah needed five to six crowns. Columbo also [gave] Lisa contact information for the Texas State Board of Dental Examiners and [encouraged] her to file a complaint.”

“…The Deels contacted Jim Moriarty, a Houston lawyer with years of experience in dental cases, and decided to sue. The case was filed on August 2 in Galveston County District Court.”

“…Moriarty has been representing people and their claims against dentists and dental corporations for about a half-dozen years. “It’s mainly about trust. We’re taught to trust these people in white coats and to believe what they tell us, so it gets very hard for people to ask if they’re trustworthy,” Moriarty says. “

“…Insurance companies have also helped shape dentistry because insurance adjusters have kept the annual coverage rate cap between $1,000 and $1,500 since the 1970s, without adjusting for inflation, according to the American Dental Association. “There are so many financial pressures on dentists today. It’s getting much harder to make a profit than it used to be,” James Quiggle, spokesman for the Coalition Against Insurance Fraud, says.”

“…Another Houston-area case — one that has become infamous — involved four-year-old Nevaeh Hall’s trip to the dentist. When Nevaeh went to Dr. Bethaniel Jefferson’s dental office in January 2016, she was giddy with excitement, her mother says. On a previous visit, she’d taken home a backpack full of dental care supplies, and she loved brushing her teeth with her SpongeBob SquarePants toothbrush. On this second visit, as her dental records show, the plan was to extract her damaged baby front teeth — she’d fallen down face first shortly after the teeth came in — and put crowns on the teeth on the right side of her mouth. “

“…according to a report from the Texas State Board of Dental Examiners. She was given “large doses of anesthetic and sedatives,” and there were “warning sounds and visual indications which showed that for a period of five hours Nevaeh’s brain suffered from a severe lack of oxygen.”

“…When Amanda Lightfoot got the bill for her dental work, she burst into tears right there in Hoover’s waiting room. It was fall 2014 and Lightfoot had come in just to get two crowns replaced….She went home with a hole in her mouth where the tooth had been, and says Hoover told her it would cost about $20,000 to finish the work. Lightfoot cried all night. “

“…This is how most of these cases go, Moriarty says. Dentists are regulated primarily by the state dental boards, the entities that have the power to investigate and discipline a dentist who has done wrong. Unless a board decides to reprimand a dentist publicly, the odds are good the public will never know there has even potentially been an issue, he says.”

“…“People assume dental boards are out there to protect the public and to make sure the dentist that comes out of school can treat you. People assume these boards will be there to protect you from any unscrupulous behavior in the industry, but that’s just not the case,” says Debbie Hagan, a Kentucky homemaker and grandmother turned dental patient rights activist who writes a blog detailing various issues with dentistry across the country. “

“… In March 2016, 14-month-old Daisy Lynn Torres was at Austin Children’s Dentistry to have two cavities filled. Shortly after Daisy was put under anesthesia, Dr. Michael Melanson told Daisy’s mother, Betty Squier, the child needed six cavities filled. Soon afterward, Squier was told there were problems during the procedure. Daisy was declared dead at a nearby hospital about two hours later…In July, Robert Williams, a forensic dental examiner, stated in a report commissioned by the Travis County Medical Examiner’s Office and first obtained by KXAN TV that Daisy may not have needed any of the dental work in the first place.”

“…For people like Moriarty and Hagan, the fight against bad dentistry is in many ways a personal battle, one that evokes longstanding memories.

“…As a child, Moriarty had cavities eating away his two front teeth and his family never had the money to fix them. “I often wonder how my life would have been different if I’d been able to get to a dentist,” he says. “I remember going to high school and being so embarrassed. I feel like it might have been a very different life for me.”

“…“I wouldn’t smile in the class pictures, because of all the metal. Standing up in front of the class was torture because I knew they saw me flashing a mouth full of silver every word I spoke,” Hagan says. “I don’t think most people realize how important it is, that you have to have your teeth in working order in order to thrive. You don’t want to be different, especially when you’re young and going to school. It changes kids. It changed me.”

 

http://www.houstonpress.com/news/when-dental-surgery-lands-a-patient-in-a-world-of-everlasting-regret-8647456

Related Documents:

• Deel v Dr. Amanda Hoover Complaint
• Dr. Amanda Hoover Texas State Board of Dental Examiners Complaint
• Dr. Bethaniel Jefferson Order of Tempoary Suspension

Economic Turf Wars over Dental Sedation and Public Safety

Dr. Michael W. Davis maintains a general dental practice in Santa Fe, NM. He serves as chairperson for Santa Fe District Dental Society Peer-Review. Dr. Davis also provides a fair amount of dental expert legal work for attorneys. He may be contacted via email: MWDavisDDS@comcast.net
Economic Turf Wars over Dental Sedation and Public Safety
By: Michael W. Davis, DDS


Introduction
One can’t evaluate the different parties fighting over dental sedation privileges and the vast sums of money involved, without examination in the context of our toxic dental Medicaid program. Medicaid is a social safety net program jointly funded by the federal government and each individual state. However, administration of dental Medicaid is left to the particular state. Each state handles dental Medicaid very different with a complex variety of outcomes.

Florida
For example, the state of Florida refuses to authorize hospital-based sedation for dental Medicaid cases. Therefore, many of the most severe dental cases go untreated. Institutionalized patients for severe developmental disorders often go untreated. The potentials for ensuing major medical problems may go unaddressed, until the crisis stage for morbidity and mortality (illness and death).
As a result, numbers of Florida dental Medicaid providers deliver in-office sedation upon patients, who truly should only be seen in a hospital setting. Children, who have a much greater compromised airway than adults, are treated en masse with cocktails of different sedation medications, and in risky dose levels. In order to maximize dollar production under a flawed Medicaid fee schedule, these doctors are notorious for a dangerous lack of patient monitoring.

 https://appsmqa.doh.state.fl.us/DocServiceMngr/displayDocument.aspx
 
Authorities rarely deliver more than wrist-slap regulation upon these violators, as their removal from the Medicaid system could hasten the collapse of this broken government program. The poor and disadvantaged are left between a rock and a hard place. They can elect to eat a $hit sandwich or go hungry.

Other providers of Florida dental Medicaid pursue a different scheme. They simply place any “uncooperative” child in restraints (euphemistically called “protective stabilization”). Again because the dental Medicaid fee schedule is so abysmal, these doctors feel justified in maximization of dollar production regardless of a child’s stamina, understandings, and limited abilities. All treatment possible is completed in a single visit. In order not to overdose a child for local anesthesia (generically termed “Novocain”) for their diminutive body weight, these doctors frequently deliver inadequate anesthetic, which generates excruciating patient pain. However, with the child adequately restrained, dental services of extractions, steel crowns and pulpotomies (baby root canals) continue, regardless of a child’s discomfort. Obviously, many of these patients will be in need of extensive psychological counseling for posttraumatic stress. Unfortunately under our programs for the disadvantaged, it’s doubtful this brutal problem of which government bares great responsibility, will ever be addressed. Medicaid dentists too often choose between “juice ‘em (sedate) or papoose ’em (physical restraints)”.

https://appsmqa.doh.state.fl.us/DocServiceMngr/displayDocument.aspx
http://floridajustice.com/wp-content/uploads/2015/11/Schneider-arrest-warrant-affidavit.pdf
https://appsmqa.doh.state.fl.us/DocServiceMngr/displayDocument.aspx
 
Whistleblowers who step forward in Florida to expose these abuses to authorities are met with institutional roadblocks. These professionals with integrity are forced out of government service by superiors. The rationale is that if the crooks and abusers are severely disciplined and removed as Medicaid dental providers, there will be too few providers to keep the toxic program viable. Government enables the abuse of our most vulnerable citizens and assists in cheating taxpayers. http://media.news4jax.com/document_dev/2016/02/03/Dr.%20Mason_2048400_ver1.0.pdf
 
New Mexico
New Mexico (NM) allows for dental Medicaid hospitalization and sedation coverage, unlike Florida. On paper and in theory, Medicaid patients will be permitted access to hospital operating rooms and nurse anesthetists for necessary dental care. The reality is quite different. Further, the in-fighting between providers and hospitals is in anything but in the interests of patients.

Washington State Issues Notice on Comfort Dental

Washington state plans to enforce it’s laws against corporations practicing dentistry. Can we stand up and give Washington a round of applause, please.

Washington State Notice of Intent against Comfort Dental for illegal practice of dentistry

Dental Insurance Rip-Offs… Consumers Beware!

 
Dr. Michael W. Davis maintains a general dental practice in Santa Fe, NM. He serves as chairperson for Santa Fe District Dental Society Peer-Review. Dr. Davis also provides a fair amount of dental expert legal work for attorneys. He may be contacted via email: MWDavisDDS@comcast.net


 
  Dental Insurance Rip-Offs… Consumers Beware!

One of the biggest scams facing dental consumers are products sold to them, which are misrepresented or falsely presented as dental insurance. The reality is usually quite different. Other times the product sold to the public is truly dental insurance, but it has virtually no value or entirely no value to the consumer. The bait presented to the potential dental patient is low- cost monthly payments for insurance. Unfortunately in too many cases, the dental consumer is hustled out of their money with little or nothing to show in cost savings or benefits.

Bogus Dental Insurance Plans
 
There are swindlers who sell consumers all sorts of insurance plans for low-cost monthly payments. Sadly, the plan administrators failed to secure the services of any healthcare providers, assuming these bogus insurance plans even have an administrator. All legitimate dental insurance programs must be registered within the states they do business within. They must comply with each state’s rules and regulations for dental insurance. A check with your state insurance commission will provide you with a listing of all duly and lawfully registered insurance providers. If the dental insurance company providing the plan isn’t listed, that’s a red flag warning. Stay far clear of that company.

Discount Programs
 
Discount programs for dental services are too often presented in a deceptive format, which gives the impression of dental insurance. For that reason, numbers of states have outlawed these discount plans. In no case are these dental discount plans regulated by the state insurance commission. However, numbers of state attorney generals have attempted to close down these dental discount card programs, in service of the public interest.

Some discount dental programs are sold by independent companies, with little or no background history available. They may or may not even have enrolled dentists, who participate and honor their discount cards. Too often, the few dental clinics which do accept these discount programs artificially inflate their fees, to offset any consumer savings. Other dental clinics find these discount plans work to get customers in the door, for more profitable bait-and-switch scams or hard-sell upselling of additional services. Unfortunately, consumers attracted to purchase these discount cards are frequently financially disadvantaged, and not particularly sophisticated in dishonest business dealings. They are primed for the plucking.
Large corporate dental clinics also sell dental consumers a variety of discount dental plans, which are administered under their company. Again, numbers of states have outlawed these plans, because they too closely resemble lawful insurance programs, which they are definitely not. Some corporate dental outfits manipulate and misrepresent their fees in a variety of ways, such that patients purchasing a discount plan actually may have no cost savings, or actually pay more, than patients utilizing standard dental insurance.

Sales of dental discount plans have become so lucrative, that bonafide dental insurance companies have entered into this racket. It’s highly profitable for them, as they don’t need to register these plans as insurance vehicles with any state regulatory commission, and they aren’t as subject to state or federal auditing. Moreover, these discount plans cost the insurance company no outlay of expenditures for patient dental benefits. Since there is no remuneration paid to dental providers by the insurance company (only a promise by dental clinics to discount fees), the insurance company has little incentive to monitor or audit billings from dental providers. Unfortunately, too often the same bait-and-switch and hard-sell upselling we see with corporate dental clinics, also happens with dental clinics accepting dental discount cards sold by an insurance company. Once again, consumers get screwed.

Dishonest Dental Insurance
Dishonest dental insurance has become a highly popular swindle, especially since the inception of the Affordable Care Act (ACA) and the various state insurance exchanges. Yes, these are genuine dental insurance programs, many of which are specifically designed to cheat consumers. With all the new changes in the insurance industry, many state regulators are ill-equipped to provide appropriate oversight. In this deceitful quagmire of the insurance industry, consumers are at risk. Let’s examine some of the more popular methods of gaming dental patients.

Numbers of health insurance companies today sell dental insurance at an additional upgrade fee. What often isn’t disclosed to the plan purchaser is that the dental coverage is fully embedded in the medical insurance plan. The consumer is sold on dental insurance, which covers preventive dental services, along with many restorative services. What isn’t disclosed is that the consumer often must reach the medical deductible limit of $5-6,000, before they become eligible for dental benefits.

Association of Dental Support Organizations Tax Return Comparison 2007 thru 2013

Association of Dental Support Organizations Tax Return Comparison 2007 thru 2013