Tuesday, February 14, 2012

Has your child suffered injury due to the unnecessary orthodontic Medicaid treatment in Texas?

I'm hearing a firm in Texas is interested in Texas Orthodontics cases.  Here is the contract information.


4203 Montrose, Suite 150
Houston, Texas 77006
713-528-0700 or 800-677-7095


Moriarty-Leyendecker on Facebook

Health Care Fraud Prevention and Enforcement yeilds record breaking amounts

HHS released their annual report today on their efforts to control Medicare Fraud and the amount they recovered in Fiscal Year Ending 2011.  They are reporting a record amount recovered a whopping $4.1 billion dollars. Of course every year is a "recording breaking:" amount. 

I'm not so sure this is anything to brag about, I'm leaning toward NOT!

I'm thinking if every year I was returning a record number of cows to the barnyard, I would not qualify for a bonus. I'm just guessing, but I think I would be fired for continually letting a record number escape.

Just saying...
 . 
$2.5 billion was recovered in 2010
$1.63 billion was recovered in 2009
$1 billion was recovered in 2008
I'd like to see that number down to all but $0!  



February 14, 2012

Health Care Fraud Prevention and Enforcement Efforts Result in Record-Breaking Recoveries Totaling Nearly $4.1 Billion

Largest Sum Ever Recovered in Single Year
WASHINGTON –Attorney General Eric Holder and Department of Health and Human Services (HHS) Secretary Kathleen Sebelius today released a new report showing that the government’s health care fraud prevention and enforcement efforts recovered nearly $4.1 billion in taxpayer dollars in Fiscal Year (FY) 2011.  This is the highest annual amount ever recovered from individuals and companies who attempted to defraud seniors and taxpayers or who sought payments to which they were not entitled.
These findings, released today, in the annual Health Care Fraud and Abuse Control Program (HCFAC) report, are a result of President Obama making the elimination of fraud, waste and abuse a top priority in his administration.  The success of this joint Department of Justice and HHS effort would not have been possible without the Health Care Fraud Prevention & Enforcement Action Team (HEAT), created in 2009 to prevent fraud, waste and abuse in the Medicare and Medicaid programs, and to crack down on the fraud perpetrators who are abusing the system and costing American taxpayers billions of dollars.  These efforts to reduce fraud will continue to improve with the new tools and resources provided by the Affordable Care Act.
“This report reflects unprecedented successes by the Departments of Justice and Health and Human Services in aggressively preventing and combating health care fraud, safeguarding precious taxpayer dollars and ensuring the strength of our essential health care programs,” said Attorney General Holder.  “We can all be proud of what's been achieved in the last fiscal year by the Department’s prosecutors, analysts and investigators – and by our partners at HHS.  These efforts reflect a strong, ongoing commitment to fiscal accountability and to helping the American people at a time when budgets are tight.”  more here
Prior Year Reports

Health Care Fraud and Abuse Control (HCFAC) Fact Sheets

Prevention and Public Health Funds for your state

Related:

September 23, 2011

Moving Aggressively on Improper Payments

Today, the Washington Post ran a story about an Inspector General report that showed that from 2006 to 2010, the Office of Personnel Management paid $601 million to retirees who are dead.
Unfortunately, paying people the wrong amount or paying the wrong people – what we call “improper payments” – has been happening in the Federal government for far too long, and it is just plain wrong. It’s why, as faithful readers of OMBlog know, the Obama Administration has moved aggressively against improper payments and wasteful government spending since day one.
President Obama set a goal of preventing $50 billion in improper payments and recapturing $2 billion in erroneous payments. The Administration has taken important steps towards achieving the President’s goals, which have yielded early results.
In 2009, the President ordered agencies to identify programs with the worst records in this area and to select a senior official to be held accountable for coordinating agency program integrity efforts. The Administration set up a public website to track progress on reducing these payment errors and hold leaders accountable and called for action against government contractors for failing to report significant overpayments received on government contracts in a timely way.
In 2010, the President directed that Federal agencies use technology to attack this problem and return billions of erroneous payments to American taxpayers. As the Vice President announced in June 2010, we have expanded the use of cutting-edge fraud mapping tools to gather enormous quantities of information in real time, analyze the data, and connect the dots to identify indicators of possible fraud or error. ...more here


 


 

Monday, February 13, 2012

Dentist admits filing false Medicaid reports | The News Journal | delawareonline.com

 

WILMINGTON — Prominent Wilmington dentist Marieve Rodriguez admitted to 10 misdemeanor counts of filing false Medicaid reports today in exchange for state prosecutors dropping 19 felony counts of health care fraud.

In addition Rodriguez, who operates Gentle Care Family Dentistry on Gilpin Avenue, will pay a $100,000 fine, repay $72,000 to the state’s Medicaid program and $50,000 to cover the costs of prosecution.

She also agreed to have her license to practice medicine suspended for a year and to not participate in the state’s Medicaid program -- should she get her license back -- for at least five years.

Thursday, February 09, 2012

Culture of silence is ending

It is unacceptable when people of authority allow their own interests and greed, influence the treatment of children; be it teacher, doctor, dentist, or therapist.

Nothing less than jail should be acceptable for each person involved. Are we beginning to see a slight advancement in this area? I hope so.

Financial profits of the greedy and executives at private equity firms are over riding professional standards of care in corporate medicine, especially dentistry and troubled teen youth centers.

When a top pediatric dentist in America, Dr. Steven Adair,suggests to dentists working for a corporation where he is an officer, the chief dental officer and head of the advisory board, that using a pillowcase to tie a child down for dental care, as to speed treatment, it is not exactly a high point! ( see Superman Cape) Does Dr. Adair teach this to hid student in Georgia?

Many times it's the same slithering snakes, who move from venue to venue, with the assistance of companies like McBee and Associates, a Medicaid revenue finder for medical professionals.

The culture of silence is ending and presently a handful, and growing, group of brave, strong, and outspoken people are being heard I for one am determined to bring this to an end, at least in the dental profession.

No longer can these abused go unnoticed and unquestioned. The Internet has made information about corruption available for the world to be advised.



Wednesday, February 08, 2012

WR man charged with practicing dentistry without a license - Crime & Courts - Macon.com

 

A dentist who surrendered his license in 1993 was indicted Tuesday on allegations he practiced dentistry without a license in 2011.

Chester Kyle Little, 58, of Warner Robins, is accused of performing dentistry from June 30, 2011, to Aug. 25, 2011, at an office located at 2533 Hillcrest Ave. in Macon, according to an indictment filed Tuesday in Bibb County Superior Court.

Tuesday, February 07, 2012

Babies for braces? News 8's Medicaid investigations continue | wfaa.com Dallas - Fort Worth

 


DALLAS - No one would say being a single mom is easy. Especially being a single, teenage mother.
But the State of Texas appears to be encouraging teenage girls to become pregnant so they can receive free dental care under Medicaid.


Our investigation last year found hundreds of millions of dollars of taxpayer money spent for free braces on kids' teeth under Medicaid. That spurred a federal investigation, because cosmetic braces aren't supposed to be paid for under Medicaid.
If that is an example of good intentions gone bad, Latricia Banks and her mom, Patricia Jones, may exemplify a good idea gone terribly wrong.


For them, home is a tiny, wooden house in the shadow of Dallas' skyscrapers, which they share with Latricia's 82-year-old grandfather. It is a household held together with love, not money. Medical and dental care came mostly through Medicaid.
A little more than two years ago, Latricia's mom got a postcard in the mail, like many people in the neighborhood.  Access Dental was offering to provide free braces for qualified children like Latricia, then 17 years old.

Saturday, February 04, 2012

Pediatric Dentistry’s Revolving Door

We hear a lot about the “revolving” door in Washington, but seldom does anyone talk about the revolving door within agencies and professional organizations.  The same organizations that write the rules, regulations, tests, and guidelines that effect each of us in a more personal way. The same organizations that states and lawmakers trust to protect the public from harm. Chances of corruption are 100% when there are no checks and balances.

Their Publications and Studies

Looking are various websites including the American Academy of Pediatric Dentistry (AAPD), you find publication after publication, study after study, dating as far back as the early 1990’s to the present.  Just about all of them are, rewritten and republished studies that are merely mashups of their own previous written articles and studies.

Here is just one of hundreds of examples :

Journal of Dental Education – Vol. 68, Number 1

General Dentists’ Perceptions of Educational and Treatment Issues Affecting Access to Care for Children with Special Needs. 
Written by:
Paul Casamassimo, DDS, MS;
N. Sue Seale, DDS, MS;
Kelley Ruehs, DDS

Referenced:
Casamassimo PS. The great educational experiment: has
it worked?
Spec Care Dentist 1983;3:103-6.

Seale NS, Casamassimo PS. Access to dental care for
children: profiling the general practitioner who treats
young and low-income children.
J Am Dent Assoc
2003;134:1630-40.

If you get to looking at all the professional opinions, publications, studies, and continuing education courses concerning pediatric dentistry, the same names are there over and over.

Engine trouble eyed in plane crash - The Pueblo Chieftain: Local News

 

Posted: Saturday, February 4, 2012 12:00 am

Engine trouble eyed in plane crash By NICK BONHAM | ​nickb@chieftain.com The Pueblo Chieftain | 0 comments

An engine problem appeared to have caused the Thursday night slide-off of a Learjet at Pueblo Memorial Airport, a preliminary report by the Federal Aviation Administration said.

DeRose Learjet 35 photographed when owned John Denver

The plane "lost power in right engine during take-off and ran off side of runway," the report said.

Due to weather conditions, investigators with the FAA and National Transportation Safety Board won't arrive in Pueblo until early next week, said Mark Lovin, airport director, on Friday.

No one was injured in the Thursday night crash. The private plane was occupied by the prominent DeRose family of Pueblo. The group was taking off in poor weather conditions to Las Vegas to watch the Super Bowl. Lovin, however, has said it doesn't appear the weather was a factor.

The report said the plane sustained "substantial damage" in the crash. The name of the pilot has not been released.

The DeRoses were on Learjet ID number N31WS, which was once owned by singer John Denver, according to flightaware.com

"John Denver took delivery of this Lear in 1975. He named it WindStar 1. He created WindStar Aviation. His father, Dutch, was the chief pilot," the website said.

Records show the Learjet is now owned by Extra Point LLC, in Delaware. The plane's most recent flight was from Centennial to Pueblo on Jan. 27.

The Learjet was removed from the side of the runway late Thursday night and is being stored at the airport for investigators.

The airport was closed following the incident but was reopened Friday morning.

Engine trouble eyed in plane crash - The Pueblo Chieftain: Local News

Friday, February 03, 2012

DeRose Learjet crashes at airport - The Pueblo Chieftain: Local News

This morning I awoke to hear news about the big snow storm in the Rockies.  Next thing that was talked about was the flight cancelations and so forth.  Then it was mentioned a private jet had already slid off the runway in Pueblo due to the fierce snow storm.

Pueblo! The sudden adrenaline rush woke me on up, since I was still in bed half asleep. When I hear Pueblo, I think DeRose.

Being the meanie I am, I thought, “Oh, please let that be a DeRose jet.” 

Then the newscaster said, “luckily no one was injured.” Again, being the meanie I am I thought, “dang”. That little devil on my shoulder shows up every now and again, ya know.  (it does for everyone, I just might admit it more…lol)

That was the end of the report and the newscaster moved on.

The devil side of me disappeared as quickly as it had appeared.  I came to my senses and thought, there has to be dozens of private jets in Pueblo.Then, just moments ago a reader sent me a link to the following story!

Thursday, February 02, 2012

Time is money–ever wonder how much?

So why does your dentist strap your child in a papoose board as soon as they get their hands on them, instead of taking the time to go through the acceptable standards set out by the American Academy of Pediatric Dentistry? (Listed in detail below).

Answer - M.O.N.E.Y.

How much?

Every MINUTE saved is $6-$8.

For a Private Equity firm, or other Wall Street bank or investment firm, wasting $6-$8 a minute is UNACCEPTABLE!  For a greedy dentist who cares nothing about your child, only about his/her 5 million dollar home and private jet it’s also UNACCEPTABLE.  (see below about these numbers)

From the AAPD Guidelines for Behavioral Management

AAPD Guidelines Page 4 - Regardless of the behavior guidance techniques utilized by the individual practitioner, all guidance decisions must be based on a subjective evaluation weighing benefits and risks to the child. The need for treatment, consequences of deferred treatment, and potential physical/emotional trauma must be considered.

Decisions regarding the use of behavior guidance techniques other than communicative management cannot be made solely by the dentist. They must involve a parent and, if appropriate, the child. The dentist serves as the expert on dental care (i.e.,the timing and techniques by which treatment can be delivered). The parent shares with the practitioner the decision whether or not to treat and must be consulted regarding treatment strategies and potential risks. Therefore, the successful completion of diagnostic and therapeutic services.

Acceptable Techniques

1st – Tell-Show-Do Tell-show-do is a technique of behavior shaping used by many pediatric professionals. The technique involves verbal explanations of procedures in phrases appropriate to the developmental level of the patient (tell); demonstrations for the patient of the visual, auditory, olfactory, and tactile aspects
of the procedure in a carefully defined, nonthreatening setting (show); and then, without deviating from the explanation and demonstration, completion of the procedure (do). The tell-show-do technique is used with communication skills (verbal and nonverbal) and positive reinforcement.

New Medicaid Dental Rules in Texas is Potential Windfall for Wall Street–Anyone Surprised? Not me!

I made an entry here a few weeks ago about Kool Smiles telling their patients they have to choose a doctor, not their clinic under the new rules. I wondered how that would work, since the dentist’s don’t stay too long at the dental mills. Chances of seeing the same dentist twice (unless it’s the next day) slim to none. 

Here’s a comment on that from a Texas dentist I thought deserved being front and center.

Wednesday, February 01, 2012

Welcome to HCE LLC–Your Medicaid Profit Scout

www.mcbeeassociates.com 2012-2-1 19-52-59Company is part of McBee and Associates,

 

 

About Us

Learn how HCE can improve your profitability by
obtaining eligibility—especially with the most
difficult cases

Headquartered in Manhattan, with offices in Nassau and Westchester counties

HCE LLC provides Medicaid eligibility services to the New York metropolitan area and lower Hudson Valley. The firm’s clients range from independent health care providers to major medical systems. hcellc.com 2012-2-1 19-54-11HCE maintains a consistent reputation for superior results and client-focused services, and has done so for the past seventy years.

HCE is focused exclusively on Medicaid eligibility services. The firm’s knowledge of and experience with the intricacies of the New York Medicaid system is unmatched. HCE professionals have dedicated their careers to Medicaid eligibility, with most having at least ten years of experience in the field. This depth of knowledge and expertise results in superior return of Medicaid dollars to our clientele.

HCE LLC has expanded into opening a new source of additional revenue for hospitals through the federal grant program, Section 1011 that provides reimbursement for uncompensated ED care for undocumented aliens.

Welcome to HCE LLC

Tuesday, January 31, 2012

Dentist who used paper clips in root canals gets one year in jail - Crimesider - CBS News

 

(CBS/AP) FALL RIVER, Mass. - Dr. Michael Clair, a former dentist who substituted paper clips for stainless steel posts in root canals, was sentenced to one year in jail on Monday.

Clair pleaded guilty earlier this month to charges including assault and battery, illegally prescribing medication, witness intimidation and defrauding Medicare of $130,000.

Prosecutors say that Clair sometimes used pieces of paper clips while performing root canals. This caused infections and other problems in patients.

One woman said her teenage son's tooth turned black and had to be removed after Clair gave him a root canal in 2005.

"He put my kids in pain for months ... I hope he rots there," said Brenda Almeida after Judge Richard Moses sentenced Clair to a year in the Bristol County House of Correction.

Dentist Charged with Medicaid Fraud - Holmdel, NJ Patch

An announcement from the Office of the New Jersey Attorney General

Attorney General Jeffrey S. Chiesa announced that a Monmouth County dentist has been indicted for allegedly submitting false claims to the Medicaid program.

Ping Cai, 49, of Holmdel, a licensed dentist whose practice is located in Hazlet, was charged with second-degree health care claims fraud and two counts of third-degree Medicaid fraud.

The Monmouth County grand jury indictment alleges that between Jan.1, 2007 and Jan.1, 2010, Cai fraudulently billed the Medicaid Program for dental service purportedly rendered to Medicaid recipients. 

It is alleged that Cai submitted fraudulent claims for payment from Medicaid for relining and rebasing of dentures and filling of cavities when those dental services were not rendered. 

Monday, January 30, 2012

The Medicaid Dental Patient

Somethings just burns my ass-there are a lot of things-but the one that belongs here is what people seem to think is the face of the Medicaid poster child.

Perpetrated by the greedy elite, to flaunt their sick and distorted view of philanthropy, the face of Medicaid Dental Patient is NOT a poor black daddy baby, (yes, daddy baby), left alone with a sippy cup full of Mt. Dew, and whose mom has been strung out in some crack house down the street for a week. Somehow by painting this picture we all are guilty of turning our heads. Shame on us.

The true picture of the Medicaid Dental Patient is our handicapped, it's our foster children, it's many of the children at St. Jude's, ( keep that in your mind),it's our children whose fathers are allowed shirk their financial responsibility, it the children of your neighbor who lost his job, it's your grandmother in the nursing home you don't go visit enough! Yes, they too are preyed upon. ReachOut Healthcare America is one of many who do this.










Saturday, January 28, 2012

American Academy of Pediatric Dentistry - Media Information

N.SueSeale

American Academy of Pediatric Dentistry - Media Information

I can’t believe I missed this in 2010! She’s walking in Steven Adiar’s shoes while she’s suppose to be monitoring his child abusing, Medicaid defrauding company, Church Street Health Management. Adair used to be the Editor.  I’ve heard about how her “monitor” visits go at the Small Smiles Centers. She’s either not looking or turning her head! But that’s what you get with self-policing. It really amounts to more layers of cover-up protection. Disgusting!

AAPD Appoints New Editor-in-Chief
The American Academy of Pediatric Dentistry (AAPD), the recognized leader in children’s dental health, appointed Dr. N. Sue Seale as Editor-in-Chief of Pediatric Dentistry and Journal of Dentistry for Children effective January 1, 2010.

Seale is a Regents Professor of Pediatric Dentistry at the Baylor College of Dentistry, Texas A&M Health Science Center in Dallas, Texas. She received her dental degree in 1970, her certificate in pediatric dentistry in 1972 and her Master of Science in Dentistry in 1979 from the Baylor College of Dentistry. Since 1974, she has been a full-time faculty member in the Department of Pediatric Dentistry at the Baylor College of Dentistry and was Chairman of the Department from 1986-2009.

Seale has served in a variety of leadership roles, including serving as a past president of the Texas Academy of Pediatric Dentistry and on the Board of Trustees of the American Academy of Pediatric Dentistry. She received a Distinguished Alumni Award from the Baylor College of Dentistry Alumni Association and was elected to the Baylor College of Dentistry Hall of Fame in 2010. In 2001, the AAPD named her Pediatric Dentist of the Year. Seale was also a recipient of the AAPD’s Merle C. Hunter Leadership Award in 2003. Seale is a diplomate of the American Board of Pediatric Dentistry.

“I am excited to take on this new role and look forward to participating in the changes that will take place in our journals over the coming years as we strive to meet the changing needs of our readers,” said Seale.

Seale’s areas of interest include pulp therapy for the primary and young permanent dentition, dental education and access to care.

Justice Department and Arizona AG Break Up Dental Conspiracy 1994

FOR IMMEDIATE RELEASE AT
TUESDAY, AUGUST 30, 1994 (202) 616-2771
TDD (202) 514-1888

Press Release

DEPARTMENT OF JUSTICE AND ARIZONA STATE ATTORNEY GENERAL
BREAK UP DENTAL GROUP'S CONSPIRACY TO ELIMINATE DISCOUNTING
WASHINGTON, D.C. -- The Department of Justice and the Arizona Attorney General's office acted jointly today to stop a statewide agreement that made it almost impossible for many dentists in Arizona to cut their prices or offer discounts on dental services.

Similar agreements are common in the health care industry, and those that stifle price competition are likely to be challenged elsewhere, the Justice Department warned today. In a civil antitrust suit and proposed settlement filed in Phoenix, the dentist-controlled Delta Dental Plan of Arizona Inc. was accused of eliminating discounts and reducing price competition under an agreement that had the effect of preventing dentists from cutting fees below those offered in the Delta Plan.

This is the first action challenging such contract provisions, which are known in the industry as "most favored nation" clauses. Approximately 85% of the dentists in Arizona have affiliated with Delta, the dominant dental plan in the state, the Department said.

 

Who are on these committees and subcommittees making these guidelines? Who are they cozy with?

 

2011 Behavioral Management Guidelines

The link above contains the latest version, according to the American Academy of Pediatric Dentistry (AAPD). It’s written and revised by the AAPD Clinical Affairs Committee – Behavior Management Subcommittee. I want to know who is on this committees, don’t you?

In fact, I think it is extremely important to know who is on each of these committees and subcommittees. They are setting guidelines and standards that our federal and state government rely heavily on. Most of the time these guidelines are 100% relied upon.

We certainly demand to know who is making our laws and just who these lawmakers are all cozied up with, well, what’s the difference?! NONE!

I’ve found a helpful little website where you can check guidelines for various healthcare professions. It’s at the Agency for Healthcare Research and Quality (AHRQ). It’s the National Guideline Clearing House.

I’ve not tried it, but it appears you can compare guidelines, now isn’t that cool.  Well, if it works anyway.

You can check past guidelines going back to 1997, that seems handy: browse by Organization,Topic,Guidelines in progress, get expert commentaries and much more.

Of course in checking this place out I got fired up over reading all the guidelines for Behavioral Management (D9920). Various terms for it are used; Behavior Guidance, Behavior Management, Behavior Control. The latest term, “Guidance” sounds so much nicer doesn’t it.

I don’t care what they call it, it’s worse than a straight jacket. In a straight jacket you can at least have use of your legs, but not in the papoose board, rainbow wrap, blankets or whatever cuddly term is thrown at the damn thing.

Friday, January 27, 2012

Shreveport dentist convicted of Medicaid fraud | Shreveporttimes | shreveporttimes.com

It’s not been a good month for dentist committing Medicaid Fraud has it?

Shreveport dentist convicted of Medicaid fraud | Shreveporttimes | shreveporttimes.com

Shreveport dentist David Earl Reed faces prison and fines after a conviction on two counts of Medicaid fraud.

Reed, 56, was barred from participating in the Medicaid program after a fraud conviction in 1992.

He continued applying to participate in the program from 2006 to 2008 and was denied. In 2009, state health officials told him he would be barred from the program for at least five more years.

However, from 2005 to 2007, Reed treated Medicaid patients while working for another Shreveport dentist. Reed submitted false billing claims to the program under the other dentist's provider number and received payment from Medicaid.

Health providers excluded from the program can't provide any services that will be billed directly or indirectly to Medicaid. It's a crime to be employed by, have a contract with or have an ownership interest in a healthcare provider that bills Medicaid, said Louisiana Attorney General Buddy Caldwell.

Reed will be sentenced April 27. He faces up to five years in prison and fines up to $20,000 on each fraud count.

Dentist arrested for Medicaid fraud - Breaking News - www.observer-reporter.com

January 27, 2012

A Washington County dentist, who allegedly prescribed more than 6,600 narcotic pain killers to seven patients, was arrested today by state narcotics and Medicaid fraud agents.

Dr. Charles Kokoska, 48, 2 Mill St., Millsboro, was charged by the state attorney general's office. Koskoska has offices at his Mill Street home and at 161 Waterdam Road, McMurray.

According to the criminal complaint, between January 2009 and October 2010 Dr. Kokoska wrote more than 300 prescriptions for more than 6,600 narcotic pain killers to at least seven different patients.

The prescriptions were written for the powerful prescription pain killers Oxycodone, Hydrocodone, and Propoxyphene and filled at various pharmacies in Allegheny, Fayette, Greene and Washington counties. Kokoska also wrote prescriptions for Diazepam, a generic form of Xanax, commonly used to treat anxiety.

Dr. Kokoska is charged with seven counts of prohibited acts by medical professional and two counts of provider prohibited acts.

He was arraigned before Brownsville Magisterial District Judge Joshua Kanalis and released on $25,000 unsecured bail.

Dentist arrested for Medicaid fraud - Breaking News - www.observer-reporter.com

Centre County Dentist Facing Insurance Fraud Charge | GantDaily.com

 

January 27, 2012 at 6:46 AM

HARRISBURG, PA – Attorney General Linda Kelly announced criminal charges have been filed against a Centre County dentist accused of submitting more than $52,000 in false insurance claims following a joint investigation with the Federal Bureau of Investigations (FBI) State College office. 

Kelly identified the defendant as Dr. Jamshid Assadinia, 53, of 1764 Cambridge Drive, State College, Centre County. Dr. Assadinia owns and operates Jamshid Assadinia DDS,300 South Allen St., State College.

Kelly said Assadinia allegedly submitted insurance claims for dental procedures that he never performed and then billed the insurance companies more than $52,000 under the names of several different patients.

Wednesday, January 25, 2012

I don’t know, but I’ve been told, ReachOut America is as low as they go.

I’m hearing ReachOut Healthcare America mobile dentistry, and their Big Smiles program has a “service center” type place with hoards of telemarketers in cubicles, burning up the phone lines with a list of potential victims to contact that is as long as your arm. 

Telemarketers? Yes,telemarketers. This is where the “ReachOut” part comes into play. Each telemarketer has a list of the names of children, parents, your child’s school, and parent or guardian contact information.

For example, let’s say you are home, the phone rings, you answer and it’s a nice lady telling you the mobile dental clinic your school has approved, which is staffed with a highly qualified dentist and two assistants will be at your school on such and such date. Sounds just like picture-day doesn’t it?

ReachoutAmericaThe telemarketers have their expertly crafted scripts ready, which makes this phone call really a “high pressure” sales call. You’re probably going to be quoted statistics and such about the poor status of children’s dental health here in America, your state or even your town.

The telemarketer tell you they just your verbal permission - probably recorded- or so they might tell you. ReachOut can have their highly qualified and well trained dentist do just a little look-see, a screening so to speak, or maybe its been a while since your child’s last cleaning, they could do that for you too. They may tell you they will send home a report detailing Susie’s dental health.

They might ask, if their highly trained staff does find a problem, with Susie, do you what them to fix it, right then and there, since it is a full service mobile clinic. It will save you all kinds of time and we know as parents, time is a valuable commodity, right? Plus, how can you neglect your child by withholding dental care? Free dental care?! Free, you may ask?

The telemarketer, I mean company representative, tells you there will be no cost to you, since your child is eligible for free dental services because of your states Child Health Insurance Program (CHIP). Sounds like if you are on the “free lunch” list you get free dental care at school too, doesn’t it? 

In fact you may feel at the end of the phone call your this is all arranged by your school system as a service to all the children, included as a normal as the school nurse. Remember the fluoride rinses back in the 1980’s?

You could be lead to believe it’s nothing more than dental hygiene instruction – remember those Bell Telephone movie reels that used to make the rounds at schools?  No, well you’re not as old as me then.

If you decide you would like to be there for the event, you’re likely to be told that since they aren’t sure exactly what time Susie will be called, you could possibly be sitting there in the school all day, and you don’t want to be doing that, right? That’s just another classic separate the child and the parent ploy.

Speaking of that “free lunch” list, is that where ReachOut Healthcare got your contact information?

Tuesday, January 24, 2012

BUSINESS BRIEFS: Padula chosen citizen of year - The Pueblo Chieftain–more like snake of the century! GAG!

 

The Greater Pueblo Chamber of Commerce will honor Center for American Values founder Adolph "Rudy" Padula with its annual Citizen of the Year award, the group announced Monday.

   The award presentation will take place at the chamber's annual dinner Thursday night at the Pueblo Convention Center. Tickets remain available for the event. For reservations, call 542-1704.

   Padula, a Pueblo dentist for nearly 40 years, launched the Center for American Values several years ago. He purchased and renovated The Waterford, a large, aged building on the Historic Arkansas Riverwalk of Pueblo, into a new retail-office building that also is home to the center's meeting room and Medal of Honor portrait display.

BUSINESS BRIEFS: Padula chosen citizen of year - The Pueblo Chieftain: Local Business

UPDATED: TX Medicaid combats overuse of kids' braces -- 22 visits a year! | Trail Blazers Blog | dallasnews.com

 

UPDATE, 3:30 p.m.: The attorney general's office has 31 orthodontists under investigation for possible Medicaid fraud, David Maxwell, the office's deputy director of law enforcement, testified to the House panel. According to Rep. Lois Kolkhorst, R-Brenham, the panel's chairwoman, 24 percent of the nearly 80,000 children who last year received orthodontic services from Medicaid were under the age of 12. State social services czar Tom Suehs testified that, starting in March, the minimum age for treatment of severe misalignment of upper and lower teeth will be 13. "Some of our providers out there gamed and manipulated the system," Suehs testified. "I won't use the word fraud. ... Clearly, we didn't have some of the controls we should've had."

ORIGINAL POST: Poor youngsters in Texas who were put into braces courtesy of taxpayers saw their orthodontist an average of 22 times in fiscal 2010, state Medicaid chiefs said in testimony they were to give to a legislative panel Tuesday.

"Typically, 12 visits per year is expected," said the written testimony by Medicaid chiefs Tom Suehs (right) and Billy Millwee to the House Public Health Committee.

Read the rest – click below

UPDATED: TX Medicaid combats overuse of kids' braces -- 22 visits a year! | Trail Blazers Blog | dallasnews.com

You may have paper clips in your root canal too! -Michael Clair Guilty Plea

A Massachusetts dentist plead guilty yesterday of Medicaid fraud and assault and jury tampering. Michael Clair had been banned from providing services to Medicaid patients, yet, but in so many cases these days, that means little. He still managed to collect $130,000 in fraudulent reimbursement. He would have other dentists in the dental practice provide billing services for work he did, in order to service Medicaid patients. He also managed to get his staff to fill prescriptions and give him the pills.  Tsk Tsk  His dental license had been revoked in Maryland, West Virginia and Florida, but Mass let him in!  Yes, those dental boards are fantastic!!  NOT!

A couple of sad things, one, it took 4 years to get here!  There were anonymous reports to the dental board (yes, I'm 100000% positive on that and they weren't so anonymous!), many other letters of concern and pleas for someone to stop this man. His dental license was suspended in 2006 and he's supposedly barred form practicing dentistry, which means, he's probably already open another office.

The second, sad, and oh so scary thing is, you may have paper clips in your mouth too! Today I received the following email:

Hi there,

I saw your post regarding the dentist in Mass that "did a root canal with a paperclip. I am not defending him at all. I just wanted to let you know that the use of a paperclip as part of a provisional crown is a legitimate technique. Now, I have no knowledge of the legitimacy of billing this to Medicaid. Attached is a photograph I just took from Herb Schillenberg's "Fundamentals of Fixed Prosthodontics" 3rd edition. This is the most cited text book on the market on the subject of fixed prosthodontics.

Thank you for your time,

DrJ





Thanks Dr. J

Monday, January 23, 2012

Victim Talks About Paper Clip Root Canal - Boston News Story - WCVB Boston

Michael Clair's trial was to start today:

Michael Clair, the former owner of Harbour Dental in the New Harbour Mall, pleaded guilty to Medicaid fraud and to charges that he substituted paper clips for stainless steel dental posts in dental procedures.

Clair will be sentenced on Jan. 30 in Superior Court.

Clair, 53, now of Maryland, was scheduled to begin trial today in Superior Court on a total of 15 charges including fraud, assault, illegally prescribing drugs and coercing office staff to remain quiet about the conduct.

Instead, he offered to plead guilty to two counts of assault, three counts of larceny, five counts of Medicaid fraud, three counts of writing illegal prescriptions, one count of tampering with evidence and one count of intimidating a witness, according to a release from Attorney General Martha Coakley.

Clair remains free on bail pending his sentencing.



Victim Talks About Paper Clip Root Canal - Boston News Story - WCVB Boston

Dr. Michael Clair's license was revoked in Maryland for 5 years, but that didn't save patients in Massachusetts

Sunday, January 22, 2012

Four Winds Health, Midwest Dental, Kool Smiles Dental and Friedman Fleischer & Lowe (FFL)

logo_nwh
From FFL website:
Four Winds Health, LLC was formed to build and manage a chain of high-end urgent care centers that offer walk-in, extended-hour access for non-life-threatening acute injuries and illnesses. Through its centers, Four Winds is focused on creating a superior patient experience through the delivery of convenient, comfortable, high-quality medical care.
Four Winds is headquartered in Atlanta, GA. The company was formed by the same management team which previously founded Kool Smiles, another FFL investment. FFL provided founding capital to Four Winds in 2011

logo_midwest_dental
Midwest Dental is a leading dental practice management company with over 75 clinics in six states. Midwest Dental clinics are typically located in suburban and rural areas, and the company has demonstrated an impressive track record of growth through acquisitions of independent dental clinics. The company provides the clinics with a full range of management, administrative and financial services, allowing clinical staff to allocate more of their time to patient care.
Midwest Dental is located in Mondovi, WI. FFL acquired the company in 2011 and plans to provide additional capital to support future acquisitions.
 
ncdr
NCDR, LLC provides various non-clinical services to dental group practices, including providing dental facilities, support staff, and other business services. NCDR's principal [ONLY] client is Kool Smiles, a nationally-branded provider of dental care focused primarily on children enrolled in Medicaid and State Children's Health Insurance Programs. The limited access to care for children on Medicaid/SCHIP plans provides an attractive growth opportunity for Kool Smiles as it continues to expand offices with a mission to provide quality care to this underserved population.

The company is headquartered in Atlanta, GA. FFL invested in NCDR in 2004 to provide growth capital and liquidity to founders.

Saturday, January 21, 2012

R. Kirk Huntsman’s- The Beginning: Reachout Healthcare America-Dental One, Nexus Dental Alliance and more

Last September(2011) R. Kirk Huntsman’s was featured at a seminar entitled “Beat The Dental Practice Management Companies”  Warning attendees of the “Walmart Effect” taking over dentistry.

Yet, among many other ventures in Dental Practice Management, R. Kirk Huntsman has been Managing Partner of Montage Venture Group LLC since March 2010, according to Business Week. 

R. Kirk Huntsman Bio from Nexus Dental Alliance, his virtual Dental Management company.  Virtual, meaning you just “pretend”, “not real”? 

Mr. Huntsman has been active in the dental industry for over 23 years.

Yet, never took time to become a dentist, wonder why?  If he was so into it, you’d have thought he would want to actually be one, right?

In 1988, he became the Dallas/Ft. Worth licensee for Associated Financial Transition Consultants, Inc.(AFTCO Associates,) a dental practice brokerage company with over 65 offices nationwide.  Within two years, his was the top performing office in the nation.   In 1991, he acquired the Houston license and continued to rapidly expand. 

By 1995, he was ready to begin owning and operating practices, so he launched Dental One as a dental management services organization, or DMSO.

In 1995, as well as today, it was illegal for a non-dentist to own dental practices!  I guess Mr. Huntsman failed to read the following page of info over at the AFTCO website, but it’s easy to see how he could become confused, since it’s written in a lot of double speak BS. Plus, it used the word “Goodwill” which I’m sure is not in his vocabulary.  Had the word, “Greed” been used, it would have had his complete attention.  Here is what is on the AFTCO’s website:

Orthodontics for sale- Texas

I was over on a dental practice brokerage firm site and wondered how many orthodontic clinics might be up for sale in Texas.  Surprisingly there were only two currently listed, however I’m guessing right now you can’t give them away down there…  Anyway, I saw this one and thought it amusing.
Specialty: Orthodontics
Number of Operatories:
Active Patient Count:
One Year Gross:
Opportunity Type:
Practice for Sale
DALLAS – 5 locations - Multi-Million Dollar Investment Opportunity! One owner wishes to sell all locations to the next “Dentist – Entrepreneur”. All staff and associates are to stay. Ideal for more than one Doc willing to “partner up” with a colleague or two. If you are an Oral Surgeon, Pedodontist, Endodontist or Orthodontist you can even have all of these offices refer to your specialty practice. Each facility computerized for easy practice management. Don’t go to work today! Let others “bring home the bacon” for you! Be a contributing clinician in this large operation or just the investor owner. Too much information to list in this ad regarding each location.


Friday, January 20, 2012

Fortune CNN Money article on a New Jersey Medicaid dental clinic

I was a bit offended by the attitude of these piece, but isn’t that the case when the press speaks of the less fortunate, poor or temporarily down on their luck.

It was titled Building a business with unwanted customers”, so I guess I had an attitude before I read it. 

My first thought was; of all the dental centers out there geared to treat child whose parents have fallen on hard times, why this one? 

All the right buzz words and phrases the dental mills use today - “Underserved” and ”Target Patients on Medicaid” for example – were used perfectly.  Even the added “nobility” factor was included – “believes that treating the underserved can make for good business.”

By the end of the article it sounded more like a story about a business in the ‘hometown” section of the local newspaper, not CNN Money.

This may be a fantastic dental center, I don’t know.  All I know is what I read and it had the sound of a local, one shop, assembly line style dental center.  That was until I saw the logo. Continue on and you’ll see what I mean.