Tuesday, February 17, 2015

CSHM, LLC (Small Smiles Dental Centers) Files for Chapter 7 Bankruptcy

February 17, 2015
Just 4 months after CSHM, LLC (Small Smiles Dental Centers) were Excluded from the Medicaid program, Michael F. Gries, the installed Chief Restructuring Officer, filed Chapter 7 Bankruptcy in Delaware Bankruptcy Court on February 5, 2015. (Case No. 15-bk-10206)
CSHM, LLC is the restructured company that emerged in June 2012 when Church Street Health Management (f/k/a FORBA) filed for Chapter 11 Bankruptcy February 20, 2012. (Case No. 12-bk-01573)
Church Street Health Management signed a 5 years Quality of Care Corporate Integrity Agreement in January 2010 (CIA) after a 3 year investigation by the feds that found billing fraud and gross mistreatment, overtreatment and failure to come close to meeting an acceptable standard of care treating the dental needs of children on Medicaid. They also agreed to pay $24 Million for their misdeeds; the Department of Justice was to received $14.2 Million and 21 states were to share $9.7 million and explained here on page 6.

In addition Church Street Health Management (f/k/a FORBA) signed a Corporate Integrity Agreement with the New York Office of Medicaid Inspector General. Agreeing to paying New York and additional $2.3 million.

After continued blatant disregard for the Quality of Care Corporate Integrity, consistent failures of inspections, a 1500 page bi-partisan 2012 Congressional Report  and various warnings by HHS-OIG, CSHM, LLC received notice they were Excluded from the Medicaid program in March 2014. However the government saw fit to allow CSHM, LLC to pilfer and plunder the Medicaid slush fund for an additional 6 months under an Exclusion Agreement.
This exclusion marks the culmination of a series of alleged failures by CSHM and its corporate predecessors to comply with its CIA. Under the CIA, an independent quality monitor conducted more than 90 site visits and reviews to monitor CSHM's compliance. Since the 2010 settlement, OIG repeatedly cited CSHM and took actions to address those violations, promote improved compliance, and maintain access to care for an underserved population. These actions included imposing financial penalties and forcing the divestiture of one of the company's clinics.

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

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

Despite the “Quality of Care” issues as indicated by the classification of the type of Corporate Integrity Agreement they were under, and results of the Monitor’s monitoring, when CSHM received their Exclusion letter they claimed none of the clinics they own were effected it was just the management division of the company and issued a press release stating the centers different entities therefore not effected. HUH?

Here we are in 2015, 8 years since Small Smiles dental centers and their so called management company, CSHM were first investigated—it started in mid 2007— and it just past the anniversary of the 5 year CIA. Heck it expired two weeks ago—January 15, 2015.
According to the 31 page, 3 columns, list of Creditors filed February 5, 2015 they still owe various states their portion of the $24 million dollars. (a breakdown is below)  

They owe several “owner dentists”, support staff, and other dentists, as well as whistleblowers, dental boards, ad agencies, law firms, TV stations, court reporters, (for the numerous lawsuits in which they are involved), storage facilities,(wonder what’s hidden there), utility bills for their clinics, dental labs and insurance companies (hope they kept the Malpractice premiums up for all those dentists!), and every dental supply company in the country, and various management companies. (yep, the management company hires management companies)

Other notables were, Garrison Loan Agency who ponied up the dough to keep this scumbag company alive and kicking from 2012-2015 and the IRS.

Those missing for the list are David R. Wilson, CEO and other top executives, and Waller Landsden Law Group.  Hmmm… Pleadings indicate Wilson was paid $1,194,432.85 the year preceding the filing of the bankruptcy.

Other points of Interest in the initial documents:
Doc 2 Schedules of Assets and Liabilities,
Page 2, Item 3
—In accordance with the Exclusion Agreement, the Company divested itself of substantially all of the CSHM Assets through a series of sales between April and September 2014.  Included among the sale of the CSHM Assets, the Company sold certain assets to First Quality Management, Inc. (FQMI), pursuant that certain Asset Purchase Agreement, dated as of September 30, 2014.  Separately, the Company also entered into that certain Assignment and Assumption Agreement with FQMI, dated September 30, 2014, in connection with the assumption of six (six) MSA’s.  A breakdown of the other clinics can be found here, beginning on page 9.  Missing from that list is all the Colorado clinics except the Colorado Springs clinic.  Interesting, indeed.
So I was right when I posted about FQMI and the continued operations of Small Smiles Dental Centers. Current pleadings say they paid Dr. Paul Elkin $401,574.00 in the year proceeding this bankruptcy filing.  He’s the new head at FQMI according to his LinkedIn page.
Paul Elkin Linked In
Page 2, Item 4
—Additional assets were sold to employees of the Debtor in September 2014…
Wait, I thought the “owner dentists” were already “owners”, not employees!” (sarcasm)
Page 11 & 12
—1st. Lien Holder: Garrison Loan Agency Services, LLC – $37,500,000.00 initial loan, still owed $28,764,918.60;
—2nd Lien Holder: Garrison Loan Agency Services, LLC – $17,500,000.00 initial loan, still owed $17,786,714.00.
——Grand Total for Secured Creditor Garrison Loan Agency $46,551,633.00
Under Creditors Holding Unsecured Nonpiority Claims (Schedule F, page 15, of Doc 2) are all Medicaid Fraud Control Units Creditors and the amount:
State
Known 2010 Settlement Amounts
Due as of January 2015
1 MFCU of Alabama $463,028.00 $79,595.63
2 MFCU of Arizona $127,853.41
3 MFCU of Colorado $1,200,00.00 $616,099.66
4 MFCU of  Georgia             $288,910.84
5 MFCU of Idaho                   $46,687.18
6 MFCU of Indiana              $348,534.90
7 MFCU of Kansas               $517,959.60 $260,969.66
8 MFCU of Kentucky              $123,693.14 $22,484.43
9 MFCU of Maryland            $275,814.83
10 MFCU of Massachusetts  $726,035.97
11 MFCU of Nebraska             $270,000.00 $61,717.55
12 MFCU of Nevada         $83,402.83
13 MFCU of New Hampshire    $48,090.36
14 MFCU of New Mexico         $182,376.06
15 MFCU of New York $1.15M+ $2.3M     $3,450,000.00 $315,849.66
16 MFCU of DC                       $78,057.19
17 MFCU of Ohio                   $2,392,926.50 $502,185.04
18 MFCU of Oklahoma         $700,00.00 $355,411.82
19 MFCU of South Carolina  $471,779.92
20 MFCU of Texas                $546,000.00 $117,851.57
21 MFCU of Virginia              $228,616.76
22 Department of Justice                                $14,200,000.00 $12,966,496.00
23 Department of Justice                               $7,844,455.34
Grand Total $26,300,000.00 $26,049,276.61
According to the pleadings (Doc 8-1) Amended Schedule B Personal Property they have:
Assets:            $136,369.67
Liabilities:  $73,314,905.16

The 2010 Corporate Integrity Agreement
The DOJ said in 2010 “"We have zero tolerance for those who break the law to exploit needy children," said Tony West, Assistant Attorney General for the Civil Division of the Department of Justice. "Illegal conduct like this endangers a child’s well-being, distorts the judgments of health care professionals, and puts corporate profits ahead of patient safety."
(cough, choke and puke, they have complete tolerance, encourage it, and are accomplices to it!)

Saturday, February 07, 2015

Drs. Michael and Rebecca Tarver: A Serious Threat to Children? I think so!

The latest report out of Ocala, Florida reveals some of the dangerous practices taking place inside Churchill Dentistry, formerly known as Polliwog Dentistry.  I can’t believe there haven’t been a host of dead children due to these two quacks.

Here are a few items pulled from the latest article:

  • "…Churchill Dental billed Medicaid and the Medicaid recipient for the same service and also delegated their duties to dental assistants who sedated patients,"
  • “…Tarver would tell parents that he had to apply the sealant to the patient's teeth and Medicaid doesn't reimburse him for the procedure.”
  • “…Tarver would use a dental tool called a gold flame bur on the top of the child's teeth where natural grooves and cracks were present and would remove "pieces of healthy tooth…Tarver would then fill the space with a resin composite and bill Medicaid as if he had "filled a one- to two-surface cavity. Parents would later complain because they had received a bill from Medicaid, which charges recipients $25 per tooth for each resin filling, though Tarver had told them their children had no cavities.”
  • “…both dentists would sedate every patient with hydroxyzine, which is used as a sedative to treat anxiety and tension, and with other medications for anesthesia..dental assistants would weigh patients and report the weight to one of the two dentists, and then one of them would say how many milligrams to administer…sometimes 12 to 15 children were being sedated. The average number, she said, was 10. For most kids, blood pressure and oxygen levels were not checked during sedation, the former office manager said, yet all their charts reflect blood pressure and oxygen readings that were "almost the same."
  • “…Those who didn't respond to hydroxyzine were given Versed, a brand version of midazolam, used to "produce sleepiness or drowsiness and to relieve anxiety before surgery or certain procedures," the report states. Dr. Michael Tarver would inject it into the child's mouth.”
  • “…the dental assistant — estimated that the office would treat 60 patients a day. It was open 9 a.m. to 5 p.m. Monday through Thursday with only the two dentists.”

Read the entire shocking story here.

Wednesday, January 28, 2015

Polliwog Dental f/k/a Churchill Dentistry Raided By Medicaid Fraud Control Unit.

Wednesday, January 28, 2015

OCALA - Investigators were executing a search warrant at a pediatric dental office in Ocala Wednesday morning.

As part of a Medicaid fraud investigation, officials with the Florida Attorney General's Office and other investigators were at Churchill Dentistry, at 255 SE 17th St., the former Polliwog Dental.

Capt. John W. Nicks Jr., of the Florida attorney general's Medicaid Fraud Control Unit, declined to give other details about the investigation. He said agents would take whatever has evidentiary value in connection with their case, including anything from computers to papers….

…Ocala Police Department officers were telling patients that the office was closed. Dr. Rebecca J. Tarver, who works there, was not at the office Wednesday morning. Nor was her husband, fellow dentist Dr. Michael Tarver….

Read the entire story at Ocala.com

Monday, January 26, 2015

Scams on the public by nonprofit dental clinics

 

clip_image002

By: Michael W. Davis, DDS

Dr. Michael W. Davis practices in Santa Fe, NM. He currently chairs the district dental society peer-review committee, and is active as an expert witness on dental legal cases. He has authored numbers of articles relating to clinical dentistry, dental ethics, and protections for the public.

The recent legal settlement between Sea Mar Community Health Centers, which provides dental services to low-income residents in 10 Washington state counties, and the Washington state attorney general’s office, for $3.65 million highlighted this growing problem. These scams don’t generally benefit the professional staff, patients, contributors, and certainly not taxpayers. These swindles are designed to elevate overall clinic revenues, to enhance salaries and benefit packages of clinic directors. These nonprofit clinic directors often have compensation packages comparable with those working for Fortune 500 companies. Most other employees are not tapping in on the dishonest largesse. Here’s how this particular hustle is played.

These clinics have favorable tax status not enjoyed by private sector companies. They are exempt from most taxes. Clinic “profits” are not taxable. However, these profits are rolled-over in the dishonest clinics, into increased personal revenue for the clinic directors. Dishonest clinic directors may also generate a kickback fee from vendors providing dental equipment and/or supplies, especially if unaudited.

Unlike private sector dental clinics serving the disadvantaged Medicaid population, nonprofit clinics may access federal, state, county, & charitable grant moneys. This can be a huge income generator, especially important since Medicaid fees are often set at a level below the cost to provide that service, to standard of care. Grant moneys provide the nonprofit clinic with a per patient served, “encounter fee”. Patient encounter fees are paid to Federally Qualified Health Centers (FQHC) as a set amount, per patient visit. The patient must lawfully visit with a duly licensed healthcare professional of that nonprofit healthcare clinic, for the FQHC encounter fee to be paid. This nonprofit encounter fee often ranges in the $200 per patient visit range.

Friday, January 09, 2015

Dental billing fraud is more common than you think

imageEverybody knows going to the dentist is important, yet half of American adults skip out on regular dental care.

Some avoid dentistry out of fear of pain or sheer busyness, but a large portion of Americans can’t afford it without financial assistance.

Unfortunately, it’s Americans on government assistance programs for dental care who are being taken advantage of. Worse, their children are suffering for it.

It started as a solution

Many low-income children don’t receive dental care until they’re brought to the emergency room with a toothache, simply because their parents can’t afford it. Nearly half of American children are on some form of government-funded health insurance, either Medicaid or the Children’s Health Insurance Program (CHIP).

…As a result, corporate dental chains started accepting Medicaid and CHIP, and even opening new offices specializing in Medicaid…

…most of the charges were coming from one dental chain, Kool Smiles, and that the x-rays didn’t justify their treatments. Kool Smiles was investigated, and state officials found that the crowns were not only unnecessary but that the dental work was shoddy….

…Kool Smiles isn’t the only dental chain implicated by government officials in fraudulent billing practices. Dental chain Small Smiles settled with the United States in 2010 for $24 million to resolve allegations of fraudulent charges. In April 2014, the company that owns Small Smiles, CSHM, Inc., was excluded from participating in federal health care programs like Medicaid for five years…

Read the entire story at Fox.com

What the story fails to mention:

Small Smiles/CSHM is still operating Small Smiles clinics.  They are simply using a different corporate name—First Quality Management, Inc.  Many of the original corporate level employees still in place. Some clinics are under the control of Hero Management who operates Adventure Dental and Vision and others have been taken over by Sarrell Dental based in Alabama.

Saturday, January 03, 2015

A Wide Range Discussion with Dr. Fred Quarnstrom: Dental Ethics, Regulations and Professional Turf Wars

 

A Wide Range Discussion with Dr. Fred Quarnstrom: Dental Ethics, Regulations and Professional Turf Wars

 

clip_image002By: Michael W. Davis, DDS

Dr. Michael W. Davis practices in Santa Fe, NM. He currently chairs the district dental society peer-review committee, and is active as an expert witness on dental legal cases. He has authored numbers of articles relating to clinical dentistry, dental ethics, and protections for the public.

 

INTRODUCTION

clip_image004With an extensive education and history in the dental profession, Dr. Fred Quarnstrom has been an outspoken advocate for the public when it comes to their dental healthcare. For decades, Dr. Quarnstrom has often taken a heroic stand in protecting the public which often times lands him on the opposite side of fellow professionals and dental organizations.

Recognized as an expert, Dr. Quarnstrom’s many accomplishments include: his current private practice, a faculty member at 3 dental schools, quality assurance consulting, independent expert testimony, and speaker. He has also held positions on what is the equivalent to the dental board in Washington state and Western Regional Examining Board. Dr. Quarnstrom graduated from the University of Washington in 1964 and completed a residency program in General Anesthesia at Washington Hospital Center, Washington D.C. in 1967.

INTERVIEW

Dr. Davis: Dr. Quarnstrom, a number of years ago, you completed a residency program in anesthesiology. You went on to utilize sedation services for your patients, and taught sedation courses, to fellow dental professionals. We both see how dental sedation can be a very helpful adjunct in the practice of dentistry.

What concerns do you have relating to weekend seminar sedation courses, often offered hotel conference rooms? What are the dangers to the public, as well as professionals offering sedation, for marginally trained and minimally emergency equipped dental clinics? Do you have specific concerns relating to the public health and safety; is the public being protected or it is buyer beware? What are the regulating agencies who are setting the standards and rules, and do you feel there is “agency capture” at work?

Are you concerned that it seems violators of sedation rules and regulations of state dental boards, far too often receive little or no disciplinary actions, and what advice do you have for state dental boards?

What advice can you offer to the public, whereby they can more actively protect themselves and their families? What advice do you have for the professional who chooses to offer sedation to patients?

Dr. Quarnstrom: First, I along with a Doctor of Pharmacy and a Professor Emmeritis teach weekend courses in the use of nitrous oxide and oral CONSCIOUS sedation. There is heavy emphasis on CONSCIOUS. We do not teach multiple drugs. When you add a little of drug A plus a little of Drug B plus maybe a little of drug C, D, and/or E. There is simply no research to suggest what the results will be. Personally, I have taught 245 nitrous oxide courses and 110 oral conscious sedation courses. image

Nitrous Oxide is very safe. You really only need to know a few things. Never give more than 50% nitrous for more than a minute. Always check your system to be sure the gases have not been switched.

I know of one near death from switched gas in a surgery office doing IV sedation/general anesthesia and another 70 cases, where gases were switched but there was no damage to the patient.

In the oral surgery office the one patient was under general anesthesia. The surgeon expected him to be unconscious. He discounted the fact that the pulse oximeter reading dropped as low as 35%. His staff had asked him several times if they should call the paramedics. The third time he agreed. But the oxygen levels had been very low for too long. 95% to 98% is the normal saturation at sea level. You should get concerned if it drops to 90%. The patient who was an a student and star athlete ended up with severe neurologic and vision problems. 

In the other 70 cases patients either got too relaxed or went to sleep.The dentists have been taught when this  happens you should take the mask off and get them breathing room air and they quickly returned to normal with no residual problems. I published research 15 years ago to show it was safe to do this. If a dentist insisted on giving the patient 100% Oxygen and the gas lines are switched they would be giving 100% nitrous oxide. You need a minimum of 30% oxygen when being sedated preferably it would be 70 to 80% oxygen. I have taught for 40 years— “if something is wrong take the mask off”. 

The final thing you need to know. IF THE PATIENT BECOMES UNCONSCIOUS OR STOPS REACTING TO VERBAL COMMAND, TAKE OFF THE MASK. If in doubt it is never wrong to call 911. My patients who are paramedics plead with me to tell the dentists at our courses that they will not get into trouble for calling 911. As they state, “Our save record goes way up if we get there while the patient is still alive”.The ADA guidelines and most states require a 14 hour course to administer nitrous oxide sedation.

Friday, December 19, 2014

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
Ohmaha charges of 3 dentists 3

Lincoln Evening Journal Tue, December 9, 1969 pg.51
Ohmaha charges of 3 dentists

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
Ohmaha charges of 3 dentists 2

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

Wednesday, December 17, 2014

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

 

Michael Davis DDSby 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.

pull quote 1Hapless 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 Cosmeticpull quote 2 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.

Tuesday, December 02, 2014

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)

Adam Ditto

 

 

 

 

 

 

 

What secrets does Adam Ditto hold?

Monday, November 24, 2014

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.

Wednesday, November 19, 2014

Mechanisms of Dental X-ray Scams

clip_image002By: 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

Capture

 

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

 

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.

 

Torture Chambers and a sweatshirt-excerpt from Uncle John's Bathroom Reader-The World's Gone Crazy-May 2010

 

 

 

 

 

 

 

 


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.

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”.

Small Smiles Ad Scam

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.

Tuesday, September 16, 2014

Mechanisms of Dental Sealant Scams

By Michael W. Davis, DDS"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)

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!

General Public Dental Care for children v care for underserved

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
1404 Cejka-delta dental-aurora 1404 delta dental-jodi kuhn-aurora
1404 Cejka-delta dental-smile high 1404 delta dental-jodi kuhn-smile high
1404 Cejka-delta dental-springs 1404 delta dental-jodi kuhn-colorado springs
1404 Cejka-delta dental-thornton 1404 delta dental-jodi kuhn-thornton
   

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]
B.
Corporate Owned Dental Clinic For Children[1]
C.
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.”