Dr. Jason Hirsch Talks Changing the Approach in the Treatment and Care of Childhood Caries

Interview with Dr. Jason Hirsch

By: Michael W. Davis, DDS

Dr. Michael W. Davis maintains a private general practice in Santa Fe, NM. He also advocates for disadvantaged citizens, and provides expert legal work for numbers of attorney clients. His publications and lectures are on ethical and whistleblower issues within the dental profession, as well as numbers of clinical research papers. He may be contacted at: MWDavisDDS@comcast.net

 

 

Jason Hirsch DMD MPH maintains a private practice of Pediatric Dentistry in West Palm Beach, Florida. Dr Hirsch has degrees in Chemistry, Public Health, Dentistry and Pediatric Dentistry and has been a licensed dentist in his home State of Florida since 2002. Dr Hirsch's philosophy is simple, treat children like they were your own, treat the cause of the problem first and foremost and practice with principles of benevolence, non-maleficence and veracity.
Contact information: DrJ, 685 Royal Palm Beach Blvd, Suite 201, Royal Palm Beach, Florida, 33411. Phone: 561 795 7959 Email:jhirsch1971@gmail.com

Introduction

Dr. Jason Hirsch is at the vanguard of revolutionary changes in dental care for pediatric dental patients. This advancement goes far beyond progress in dental methods and materials. Dr. Hirsch examines dental disease in its totality, and arrests the causation and progression of dental caries (tooth decay). He has rejected the paradigm in restorative dentistry of continual drill-and-fill (or steel crowns), followed by pulpotomies (baby tooth root canals) and extractions. His emphasis is solidly on evidenced-based medicine and dentistry in treatment for the root causes of disease, and not simply the manifestations of disease (seemingly an endless cycle of tooth decay).

 

Question 1

Dr. Davis: Dr. Hirsch, I feel quite honored to provide this interview for our readers. Could you explain how our current mode of dental care for pediatric dental patients is irrational? We see endless cycles of restorative dental services for our nation’s children, especially disadvantaged Medicaid children. Costs to taxpayers are outrageous, with unsustainable deficit government spending. Too many parents are only given two options involving their child’s dental treatment; “juice them (sedation), or papoose them (restraints a/k/a- protective stabilization)”. Each venue has its own set of risks. How is your vision for children’s dental care different, in relation to immediate benefits for the youngster, associated cost of treatment, and the long-term wellbeing of the child into adulthood?

Dr. Hirsch: Pediatric Dentistry (or children’s dentistry) has become too focused on teeth treatments instead of disease treatments. I fully understand that dentists are trained to repair teeth. How can we achieve this lofty goal of incorporating dentistry/oral health into systemic health, if we are hypocrites and continue to myopically focus on teeth? I hear these oral-systemic connection buzzwords, but how are we supposed to connect the dots, if we don’t begin doing this in children?

You cannot take an adult in the middle of his/her life and try to convince them of the oral/systemic connection. It just won’t work. This has to be accomplished in pediatrics with mothers/moms as the gatekeepers to this paradigm change.

The care system is irrational because we have acute treatments for a chronic disease. If you look at diabetes management you will see some parallels that frankly pediatric dentistry needs to focus on. Diabetics’ needs daily insulin and a child with tooth decay in whatever stage, needs daily fluoride. I don’t see dentistry promoting fluoride as medicine and that is disturbing to me. The pharmaceutical industry has created longer lasting insulin, so we have created a longer lasting fluoride, silver diamine fluoride (SDF).

We have an opportunity to stop dental disease faster than ever before because of this SDF product and because of SDF; we can reduce the need to papoose children or sedate/ anesthetize them. What SDF buys is time, and we all know that the most precious and expensive commodity in life is time to ignore this therapy would be a great setback for children and dentistry in general.

We cannot talk out of both sides of our mouth. If we want to integrate oral health into systemic health, I’m telling you it starts and ends with this concept of care, and it starts with children. Period.

Question 2

Dr. Davis: I’d like to get into some of the “nuts and bolts” of your modalities of arresting the dental caries (tooth decay) process. Are you giving little children shots with needles, to numb teeth from pain of dental therapy? Do you generally require sedation of the child to gain patient cooperation? How long is the child sitting in a dental chair for these therapies?

Dr. Hirsch: SDF treatment requires skill, not in the delivery of the treatment, but in assessing whether or not the situation requires SDF treatment. We cannot think that we can just slather this medicine everywhere and we can sit back. On the contrary, we must identify the specific children that will benefit most from this therapy, and then we can slather it judiciously.

 

Frank conversation with Florida dentist Dr. Michael Barr

 

Frank conversation with Florida dentist Dr. Michael Barr
by Dr. Michael W. Davis

Dr. Michael W. Davis maintains a private general practice in Santa Fe, NM. He also advocates for disadvantaged citizens, and provides expert legal work for numbers of attorney clients. His publications and lectures are on ethical and whistleblower issues within the dental profession, as well as numbers of clinical research papers. He may be contacted at: MWDavisDDS@comcast.net

 

Dr. Michael Barr is a private care general dentist at Palm Beach Smiles in Boynton Beach, Florida. He began his dental career spending three years in the U.S. Navy. Two of those years were onboard an aircraft carrier, the USS Independence, which was the first response in the Persian Gulf (Operation Desert Shield).

Dr. Barr’s dental passions include Cosmetic and Reconstructive Dentistry. He served on the board of the local affiliate dental association (South Palm Beach County Dental Association) up to President. He has also served on the board and as a lecturer and clinical instructor (currently) at the Atlantic Coast Dental Research Clinic. He writes an eclectic blog about dentistry, marketing, current dental events, and frequent musings about personal safety, security, and armed self-defense at www.TheDentalWarrior.com. You can also find him stirring the pot on DentalTown.com.

 

Question 1

Dr. Davis: Dr. Barr, you’ve been very outspoken on how government administered healthcare like dental Medicaid has not served the public favorably. We’ve seen disadvantaged patients abused, taxpayer monies wasted, and ethical caring doctors forced out of this dysfunctional government program. Please give our readers an overview of your perspectives.

Dr. Barr: I have not had any personal exposure to Medicaid. But, my first “wake-up call” was when a dentist posted (on DentalTown) about his run-in “with the law” as a Medicaid dentist. He ended up doing time in prison for, if I recall correctly, $5,000 worth of administrative errors over the course of five years. He lost everything.

Another frightening case involved Dr. Morse, in New York. He was suspected of Medicaid fraud. They shut down his practice. The state attorney was intent on “cracking down” on Medicaid fraud (and make examples of the offending doctors). The short version of the story is that not only was this dentist exonerated, but the state attorney’s office was found to have fabricated false evidence against him. In such cases, the defendant can sue the state. And, so he did… and won a $7 million settlement. Of course, it dragged on for 11 years and made it all the way to the Supreme Court. (No kidding!) You can read about his case (and others) in my blog and read Dr. Morse’s own comments at the bottom of my article.

I wouldn’t accept Medicaid if they offered to pay double my fees. If you are suspected of fraud, you can be shut down BEFORE Due Process. You can have your assets frozen or seized BEFORE Due Process. It can take years to clear your name, and even then, you’ve already lost everything. No thanks. No way. Never. Too risky.

 

Question 2

Dr. Davis: Dr. Barr, could you give us your ideas on a few mechanisms, which might help ameliorate our toxic dental Medicaid program? Further, what suggestions might you offer for a financially disadvantaged parent who relies on the dental Medicaid program for their children?

Corporate Dentistry, Dental Insurance, Dental Academia, Professional Associations: Dental Professionals Game of Musical Chairs

Dr. Michael W. Davis maintains a private general practice in Santa Fe, NM. He also advocates for disadvantaged citizens, and provides expert legal work for numbers of attorney clients. His publications and lectures are on ethical and whistleblower issues within the dental profession, as well as numbers of clinical research papers. He may be contacted at: MWDavisDDS@comcast.net

 

 

There are a myriad of individuals who jump in their careers between corporate dentistry, the insurance industry, education and professional organized dentistry. This is not evidence of corruption or collusion, but often represents a disturbing appearance of conflict-of-interest. The apparent conflict-of-interest often undermines the integrity and ethical standing of professional dental organizations and academic institutions. Rank-and-file doctors, as well as the general public, should begin to question whose interests are truly represented. Some names on this list are high profile individuals in leadership roles. Others are less well known, but nevertheless highly influential.

1. James Bramson, DDS

• Executive Director Massachusetts Dental Society (1997-2001). Organized Dentistry
• Executive Director American Dental Association (ADA) (2001-2008). Organized Dentistry
• Chief Dental Officer- United Concordia Companies, Inc. (2011-2017). Insurance Industry

2. Kathleen T. O’Loughlin DMD, MPH

• President & CEO Delta Dental of Massachusetts (2001-2006). Insurance Industry
• Chief Dental Officer United Health Group (a/k/a United Healthcare, Oral Health Foundation a Medicaid managed care organization inclusive of DentaQuest) (2008-2009). Insurance Industry
• Executive Director of ADA (2009-pres.). Organized Dentistry

3. Steve M. Adair, DDS, MS

• Taught specialty of pediatric dentistry and later chaired the department at Eastman Dental Center (1983-1990). Education
• Chair dental pediatric specialty program at Medical College of Georgia (1990-2003). Education
• Board of Trustees American Academy of Pediatric Dentistry (1998-2001). Organized Dentistry
• Editor-in-Chief American Academy of Pediatric Dentistry Journal (2004-2008). Organized dentistry, Education
• Chief Dental Officer & Senior Vice President, for Clinical Quality Initiatives and Education for Small Smiles Dental (a/k/a CSHM- a disgraced and bankrupt corporate dental chain involved with Medicaid fraud and child abuses). Corporate Dentistry
• Senior Clinical Affairs Advisor for DentaQuest (a dental Medicaid managed care organization) (2016-pres.). Insurance Industry

4. Todd R. Cruse

• Senior Vice President for Development & Chief Development Officer for Small Smiles Dental (a/k/a CSHM- a disgraced and bankrupt corporate dental chain involved with Medicaid fraud and child abuses). Corporate Dentistry
• Vice President Government Relations for DentaQuest (a dental Medicaid managed care organization) (2013-2014). Insurance Industry
• Vice President of Public Affairs for DentaQuest (2014-2015). Insurance Industry
• President DentaQuest Care Group (2015-pres.). Insurance Industry

Excerpts from the recently unsealed False Claims Action against Dental Professionals of Texas, (MB2), Dr. Chris Villanueva and his pack of cohorts

Keep in mind they admitted no guilt to the claims but agreed to pay $8.45M to settle the issue. They are currently still in operation and open for business; which is scary once you read the allegations. You can read the entire Complaint by clicking here. Buyer Beware!! Never take your children to any of these clinics!  EVER!

Civil Action Number: 3:12-cv-02126-P
Filed: September 26, 2012
Settlement reached: December 27, 2016 (when the Corporate Integrity Agreement was signed)

The DEFENDANTS: CHRIS STEVEN VILLANUEVA, Individually and as member/managing member of Defendant companies; TRUNG MINH TANG, Individually and as member/managing member of Defendant companies; MAURICIO DARDANO, Individually and as member/managing member of Defendant companies; MB2 DENTAL SOLUTIONS, PLLC; DENTAL PROFESSIONALS OF TEXAS, PLLC; VILLANUEVA UNIVERSAL ENTERPRISES, LLC; PEPPERMINT DENTAL, PLLC; ARCHSTONE DENTAL, PLLC; PICASSO DENTAL, PLLC; DENTAL FAMILY CIRCLE, PLLC; VILLANUEVA PLAZA, LLC; PEPPERMINT DENTAL-MCKINNEY, PLLC; DFW FDC-REDBIRD, PLLC; PICASSO DENTAL-MANSFIELD, PLLC; ARCHSTONE DENTAL-BEACH, PLLC; VIVA ORTHODONTICS, PLLC; PICASSO DENTALCORSICANA, PLLC; CHRISS VILLANUEVA DENTAL, PA; DFW-FDC, PA; CROWN NOW DENTAL, PLLC; MINT REALTY, LLC; LEGEND DENTAL, PLLC; ARCHSTONE DENTALGRANBURY, PLLC; PEPPERMINT DENTALGREENVILLE, PLLC; CRESCENT DENTAL, PLLC; FRESH DENTAL, PLLC; ELEMENT DENTAL, PLLC; BLISS DENTAL, PLLC; SAGE DENTAL, PLLC; BLISS DENTAL-MIDLAND, PLLC; SAGE DENTAL-DEER PARK, PLLC; CRESCENT DENTAL-SAN MARCOS, PLLC; ELEMENT DENTAL-BRYAN, PLLC; ELEMENT DENTAL-CONROE, PLLC;

SAGE DENTALPEARLAND, PLLC; SAGE DENTAL-PASADENA, PLLC; TIDE DENTAL-CORPUS CRISTI, PLLC; SPEARMINT DENTALWITCHITA FALLS, PLLC; SCARLET PEGASUS GROUP, LLC; FRESH DENTAL-LONGVIEW, PLLC; LEGEND DENTAL-GEORGETOWN, PLLC; WOW DENTAL-OAK CLIFF, PLLC; BLISS DENTAL-LUBBOCK, PLLC; GALAXY DENTAL-GARLAND, PLLC; PEACH TREE DENTAL-CARROLLTON, PLLC; ARCHSTONE DENTAL-HULEN, PLLC; IRVING TOWN CENTER DENTAL, PLLC; SOUTHERN GEM DENTAL, PLLC; LUCKY DENTAL, PLLC; CRESCENT DENTAL-INGRAM, PLLC; ELEMENT DENTAL-SPRING, PLLC; VIDA DENTAL, PLLC; GULFSIDE DENTAL BEAUMONT, PLLC; DENTAL CENTERS, PLLC; SLAP-ON, INC.; PEPPERMINT DENTAL MCKINNEY, PLLC; DENTAL CENTRAL, PLLC; ARCHSTONE DENTAL-WEATHERFORD, PLLC; PEPPERMINT DENTAL-SHERMAN, PLLC; PEPPERMINT DENTAL-LEWISVILLE, PLLC; ELEMENT DENTAL-HUMBLE, PLLC; ELEMENT DENTAL-TOMBALL, PLLC; BALENTIMES HOLDINGS, LTD., PEPPERMINT DENTAL-MONTGOMERY, LLC, PEPPERMINT DENTAL-RIO BRAVO, LLC, PEPPERMINT DENTAL-SAN MATEO, LLC, RED ROCK DENTAL-FARMINGTON, LLC, FRESH DENTAL-BOSSIER CITY, PLLC, FRESH DENTAL-SHREVEPORT, PLLC;

Dental Professionals of Texas=DPT now known as MB2
Relator = Whistleblower
Dental Practices = DP

…This action is also brought under the qui tam provisions of the Texas Medicaid Fraud Prevention Law, V.T.C.A., Hum. Res. Code Ann. §36.001 on behalf of the State of Texas, the Louisiana Medical Assistance Programs Integrity Law, La. Rev. Stat. Ann. §§46:439.1 et seq.; 438.3 on behalf of the State of Louisiana and the New Mexico Medicaid False Claims Act N.M. Stat. Ann§§ 27-14-1 et seq.on behalf of the State of New Mexico.

Kevin Howard Byington ("Byington") is and was in the marketing department for DPT. Byington works directly for Frank Villanueva, Defendant Chris Villanueva's brother and head of the marketing Division of DPT. Byington and Frank Villanueva were responsible for recruiting willing marketers and paying them kickbacks for locating likely Medicaid families with children eligible for dental services and referring those patients and their families to the DP defendants.

When DPT's kickback scheme was aired by Dallas news stations, Byington formed KHB Community Outreach Associates, LLC. This was done at the request of Defendants, including DPT (a/k/a MB2), Villanueva and Tang, to cover up and conceal the illegal kickback solicitation scheme.

Frank Villanueva is the brother of Defendant Chris Steven Villanueva and the person primarily responsible for obtaining illegal referrals and direct solicitation of patients for the Defendants. He is and was an employee of DPT (now MB2) and was the person who hired Relator, coercively persuaded her to accept the "promotion" to work for KHB Community Outreach Associates, LLC and coordinated the kickback payments to the referring marketers and the Medicaid parents or family members.

Ann Villanueva, the sister of Defendant Chris Steven Villanueva, is and was the Human Resources Director for DPT (now MB2) and the DP defendants. She assisted in the recruitment of dentists and other staff and paraprofessionals for the dental offices of DP defendants and for DPT.

Mary Pu is Trung Tang's wife and the Vice President of Finance for Dental Professionals of Texas, PLLC (now MB2). In her position, Pu was knowledgeable about the illegal billing practices, the solicitation of patients, and the budgeted "promotion accounts" for every practice which were actually used for kickback payments. She was and is responsible for the entire accounting team.

John Steen is the Chief Financial Officer of DPT. Steen is shown as the "Authorized Agent" for DPT in signing the February 23, 2012 Certificate of Amendment to the Certificate of Formation of Dental Professionals of Texas, PLLC changing the name to MB2 Dental Solutions, PLLC. Steen ostensibly served as "compliance officer" for Medicaid and in

Byron’s Lens: Dental Kickbacks The Story Behind The $8.45 Million Dentists’ Settlement

There’s a McDonald’s on Garland Road in Dallas near the old Lochwood Mall, almost across the street from what used to be Galaxy Dental.  Galaxy’s florescent green and yellow paint scheme made it stick out, even in the clutter of Garland Road.

I spent several mornings at that Mcdonald’s in the spring of 2012, nursing a coffee while everybody else was dining on McMuffins. I was there to try to overhear the conversation a group of women who often met there for business. They were “community outreach workers,” they said. But what they talked about were their plans to scour low income neighborhoods for children eligible for Medicaid.  Their mission: to recruit Medicaid eligible mothers to bring their children into Galaxy Dental. The outreach workers talked loud enough that I could tell they were pumped.  

A federal lawsuit unsealed in Dallas last week alleges why they were so excited.

See the entire story by Byron Harris at WFAA’

https://creatavist-g49brf5.atavist.com/byrons-lens-dental-kickbacks-?units=us

Haunting Headline: “Hands-On Training Helps DSO’s Profit from Pediatric Dentistry”

“Hands-On Training Helps DSO’s Profit from Pediatric Dentistry” Boy, that’s a headline at Group Dentistry Now (GDN) that grabbed my full attention.

I felt no better when I read the following quotes from GDN page and The Institute for Pediatric Dentistry (IPD) website. IPD is the company offering this “training”. (more on IPD below)

“It’s often said, that children are the future, and that’s certainly true in the field of dentistry.”

“Dental benefits have increased dramatically to bring more children into dental practices, with all but 6% of children being insured by either government or private plans.”

“For DSOs and large group practices treating children, it’s hard to find qualified clinicians who can provide quality dental care while also being efficient enough to meet production goals.”

“As a leader in a DSO or large group practice, the demands on your time are constant. Developing and offering ongoing Continuing Education for your dentists and their staff that is relevant and capable of improving their skills and your bottom line is extremely challenging.”

The IPD website also asks “Why should you attend”. Their answer is “Unlock the potential of pediatric dentistry for your practice” WHOA!

TEXAS: Chris Villanueva, DDS and others finally NAILED! Sadly they are not JAILED

FOR IMMEDIATE RELEASE

Monday, January 9, 2017

Texas Dental Management Firm, 21 Affiliated Dental Practices, and Their Owners and Marketing Chief Agree to Pay $8.45 Million to Resolve Allegations of False Medicaid Claims for Pediatric Dental Services

DALLAS – Texas-based MB2 Dental Solutions (MB2) and 21 pediatric dental practices affiliated with MB2, along with their owners and marketing chief, have agreed to pay the United States and the State of Texas Medicaid program $8.45 million to resolve allegations that they violated the False Claims Act by knowingly submitting, or causing the submission of, claims for pediatric dental services that were not rendered, were tainted by kickbacks, or falsely identified the person who performed the service, announced U.S. Attorney John Parker of the Northern District of Texas.

“Today's settlement demonstrates our unwavering commitment to protect the Medicaid program and the patients it serves from unscrupulous providers,” said U.S. Attorney Parker. “Providers who waste taxpayer dollars by billing for services that were not provided, or were otherwise improper, will be held accountable.” U.S. Attorney Parker commended the Texas Medicaid Fraud Control Unit, the Civil Division of the Texas Attorney General’s Office, the FBI and the Health and Human Services Office of the Inspector General for their coordinated efforts to investigate and resolve these allegations.

This settlement resolves allegations that between Jan. 1, 2009, and Dec. 31, 2014, MB2 and affiliated dental practices submitted claims to the Texas Medicaid Fee for Service Program for single-surface fillings in children that were not provided. The settlement also resolves allegations that MB2 paid kickbacks to Medicaid beneficiaries and their families, marketers, and marketing entities, in violation of the Anti-Kickback Statute, and that MB2 and affiliated dental practices used erroneous Medicaid provider numbers misrepresenting the dentists performing the pediatric procedures.

Medicaid is funded jointly by the states and the federal government. The State of Texas paid for part of the Medicaid claims at issue and will receive approximately half of the settlement amount.

MB2 is a dental management firm based in Carrollton, Texas, that provides management services to affiliated dental offices. The dental practices included in the settlement are Dental Professionals of Texas PLLC; Archstone Dental PLLC; Bliss Dental PLLC; Crescent Dental PLLC; Dental Central PLLC; Dental Family Circle PLLC d/b/a Forney Wellness Dental; DFW Family Dental Centers PLLC; Element Dental PLLC; Fresh Dental PLLC; Galaxy Dental PLLC; Legend Dental PLLC; Peppermint Dental PLLC; Picasso Dental PLLC; Sage Dental PLLC; Spearmint Dental PLLC; Tide Dental PLLC; Vida Dental PLLC; Viva Orthodontics PLLC and Wow Dental PLLC.

As part of the settlement agreement today, Drs. Christopher Steven Villanueva, Trung Minh Tang, Mauricio Dardano, Gabriel Shahwan and Akhil Reddy agreed to pay $250,000 each to resolve the governments’ claims against them individually. They are owners or part owners of MB2 and the dental practices included in this settlement, and practice dentistry in Texas. Frank Villanueva, MB2’s head of marketing, also will pay $100,000 to resolve his alleged personal liability.

As part of this settlement, MB2, Drs. Villanueva, Tang, Dardano, Shahwan, and Reddy have entered into a five-year Corporate Integrity Agreement (CIA) with the Department of Health and Human Services Office of Inspector General (HHS-OIG). The CIA requires an independent review organization to annually assess whether claims reimbursed by a federal health care program were correctly coded, medically necessary and appropriately documented.

“HHS-OIG is particularly vigilant about potential abuses in Medicaid pediatric dental offices where patients and their families are especially vulnerable to questionable practices,” said Special Agent in Charge CJ Porter for the HHS-OIG in Dallas. “Today’s settlement should ensure other dental clinics are aware that we are watching how they operate and will pursue appropriate resolutions when profits are put before patient care.”

Part of the allegations resolved by this settlement were originally filed under the qui tam, or whistleblower, provisions of the False Claims Act by Veronica Garcia, a former MB2 employee. The act permits private parties to sue on behalf of the government for false claims for government funds and to receive a share of any recovery. It also permits the government to intervene in such lawsuits, as it did in this case. Ms. Garcia will receive $1.521 million from the United States and the State of Texas.

This settlement illustrates the government’s emphasis on combating health care fraud and marks another achievement for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced in May 2009 by the Attorney General and the Secretary of Health and Human Services. The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation. One of the most powerful tools in this effort is the False Claims Act. Since January 2009, the Justice Department has recovered a total of more than $31.8 billion through False Claims Act cases, with more than $19.3 billion of that amount recovered in cases involving fraud against federal health care programs.

The matter was handled by Assistant U.S. Attorneys Kenneth G. Coffin and Scott Hogan. The claims resolved by the settlement are allegations only and there has been no determination of liability.

MB2 Corporate Integrity Agreement

All current companies under Corporate Integrity Agreement

Aspen Dental Complaints Top $1.7M in “Claimed Losses” by Consumers

One would think Aspen Dental would have cleaned up their act after it was one of the chain clinics featured on FRONTLINE’s Dollars and Dentist in 2012.  However, over at Pissedconsumer.com complaints about the horrible dental care, upcharging and down right fraud from patients continues to grow—now topping 2,000 (the additional “me too” comments to the posted complaints is off the charts). In addition, patient “claimed losses” is nearing the $2M mark. With the average loss: $3, 300 each. (personally I would say it is much more than this). Out of all the complaints only a pitiful 10 (yes, just 10!) are reported as “resolved”. Frankly, I’m shocked 10 are reported.

Doctors Selling Practices to Corporate Dentistry; or Dancing with the Devil

 

Title: “Doctor No Control” By: Vaidya Selvan, DDS

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

 

Doctors Selling Practices to Corporate Dentistry; or Dancing with the Devil

More and more, dentists owning and operating private practices are approaching retirement age. In today’s dental practice sales market, and within numbers of demographics, practice buyers are limited. Younger practitioners are saddled with student loan debts between $250,000 and $330,000 upon graduation. These junior professionals usually lack adequate credit ratings to assume the purchase of a small business. They often must pay down mountains of debt over an extended period of years, to demonstrate credit worthiness.

Most states have statutes which require only duly licensed dentists may own and clinically operate dental practices. These laws were established because a doctor has a primary ethical and legal obligation to place interests of patients to the fore. By contrast, a corporate entity has a primary obligation to place generation of profits and the interests of shareholders (not patients) to the fore. The conflict of interest is obvious.

The dental service organization (DSO) industry (a/k/a corporate dentistry) has stepped into the mix seeing an opportunity to generate profits for Wall Street and the private equity investment industry. Over most of the past decade, the feds have kept interests rates artificially low for the intended purpose of economic stimulation. DSOs have moved into this buying opportunity and purchased many hundreds of dental practices.

DSOs often retain selling doctors for a limited time after the sale of their dental practices. However, with maximal profit generation being the bottom line, not patient welfare, these doctors are usually dispensed in short order. A recent dentist graduate may be retained, regardless of limited skill and clinical experience, for far less salary remuneration.

Also favorable to the DSO, the recent grad employee doctor has little emotional or professional ties to the existing patient base. These doctors are unlikely to question policies of the DSO diminishing quality of patient care. If they do raise ethical questions, they are quickly replaced with others who play along with the DSO’s practice of dentistry, with the ultimate goal of maximizing quarterly profits. Most of these young doctors are primarily focused on paying down educational loans, and moving out of the DSO clinic, as soon as reasonably possible. Most of these doctors truly do care about providing patients with the best care possible, but their hands are tied.

(Author’s note: To circumvent state statutes about only doctors owning dental practices, DSOs establish shell companies for nominee ownership of their dental practices.^1-6 These may be individual dentists who purportedly “own” one or several dental clinics, or a group of dentists who are assigned “ownership” status for an entire chain of clinics. In no case do these doctors exercise any real control or benefits of ownership of these dental practices. The “big lie” of the DSO industry is that they only control the non-clinical aspects of a dental practice and doctors contract with them for this service. In reality, doctors are employees of corporate management and do what they’re told, or forced out or fired.)

Case of Dr. Susan McMahon vs. Refresh Dental Management, LLC, et al

Legal cases arising out of disputes between selling doctors and the DSO industry is highlighting many of these problems. Dr. Susan McMahon alleged in her action against Refresh Dental Management, et. al., that she was financially and professionally damaged after selling her practice, to a shell company subordinate of a DSO.^7,8 Within a couple of years, she was terminated from employment, as is common.

(Author’s note: Dr. McMahon’s resume includes very substantial clinical achievements, as well as professional teaching assignments. Although the legal filing was against Refresh Dental Management, LLC, et al, the parent company is North American Dental Group⁹, which is in the private equity portfolio of ABRY Partners- a Boston-based private equity investment firm.¹⁰)

Dr. McMahon alleged that for numbers of months after leaving employment, her name remained on the DSO’s clinic signage and advertising from insurance companies. Clinic staff was instructed to misrepresent to patients her employment status; claim she now worked in the restaurant industry, and claim she had a license suspension for abuse of controlled substances, or had retired from dentistry, all according to signed affidavits in Dr. McMahon’s legal pleadings. Dr. McMahon further alleged that patient records were denied her, upon patient request. Allegedly, Refresh Dental staff was using the name and positive reputation of Dr. McMahon to get patients in the clinic door, but invent falsehoods as to why she wasn’t there when they got there—the classic bait-&-switch scam.