Friday, February 26, 2010

Roanoke Virginia Small Smiles Report

WDBJ 7 Roanoke, Virginia
February 25, 2010
News7 has discovered a local dental clinic that caters to low-income children was at the center of a national fraud investigation.

The parent company of Small Smiles recently agreed to a $24 million settlement regarding those allegations.

A former Roanoke Small Smiles employee triggered the national investigation. This employee was one of three whistleblowers that lead to a two-year investigation.

Jan Broetsky believes her son, Stephen, may have been one of the victims.

She was surprised what a Small Smiles dentist recommended for her five-year-old son during a visit in September.

"They told me Stephen had three severe cavities. All three were so severe that they needed root canals and they would also need silver crowns," said Jan.

When Stephen was three-years-old, the same Small Smiles office performed two fillings on him.

"Of course I felt like a bad mom," said Jan.

So, Jan Broetsky decided to get a second opinion just days later from dentist David Bittel, who is not affiliated with Small Smiles. She also brought him Stephen's x-ray from Small Smiles.

"The medicaid was the reason I went to small smiles. For me to get that second opinion cost me 100 plus dollars. But I was just so convinced my son had been intentionally misdiagnosed and it turned out to be true," said Jan

In his report, Dr. Bittel stated, "I see no decay anywhere that can be detected with explore or visually or with dental floss,".

He told News7, he's now been contacted by the Department of Health Professions as part of an investigation into the mother's complaint against Small Smiles.

As far as Stephen's case with the small smiles office in Roanoke, the chief dental officer reviewed his records. He released his findings to News7, which basically agreed with the original diagnosis from Small Smiles.

"There is no doubt in my mind I'm not the only person they are doing this to," said Jan.

The U.S. Attorney for the Western District agrees she is probably not the only parent.

" A lot of cases we documented those procedures were not necessary. Yet they performed them anyway and billed medicaid, "said U.S. Attorney Timothy Heaphy.

Heaphy was involved in the government's investigation of the Small Smiles office in Roanoke and helped negotiate a settlement with the parent company FORBA.

"Children are obviously especially vulnerable. The prospect that children were administered anesthesia that they didn't need or had that invasive dental surgery that was unnecessary, it's shocking and disappointing," said Heaphy.

But Small Smiles Parent company, FORBA has admitted no fault. A statement following the national settlement said, "Despite implications to the contrary in the government's press release, we entered into the recently announced settlement to avoid the delay, uncertainty, inconvenience, and expense of litigation, and did not admit any liability."

FORBA's practices were still concerning to U.S. Attorney Heaphy.

"There were strong incentives in place that the company acknowledged that forced unscrupulous people in facilities like in Roanoke to cheat. To get more of that public money," he said.

As part of the national settlement, Small Smiles' parent company FORBA has to follow some new guidelines. Which includes having a third party monitor its practices.

The government's investigation against individual Small Smile dentists is still ongoing.

We are not sure if that includes any of the dentists from the Roanoke location.

Parents should contact the OIG Hotline to report concerns. For more information click here.

Here are the finding of the Great Dr. Adair after he reviewed the patient's chart, x-ray and consulted with the Roanoke Small Smiles Dentist:

"The cavities on the two upper baby first molars (teeth #B and I) are large and clearly evident on the x-rays. One of them (#B) had been restored previously, and the filling had failed because of the patient's decay rate. Given that failure and the size of the cavities in these small teeth, a stainless steel crown would by an appropriate way to restore these teeth.
"The cavity on the mesial surface (side of tooth facing the front of the mouth) of the lower second baby molar (#K) is smaller, but it is evident on the x-ray as a vertical line in the enamel of that surface, which is adjacent to the baby first molar next to it. This cavity could not be detected without an x-ray. Even though it is small on the x-ray, clinical science tells us that it is larger in the mouth than on the film.
"Given this child's history of decay, and given that other surfaces of #K were also diagnosed with decay, a stainless steel crown would be an appropriate way to restore this tooth. A filling could also be done, but it would have a higher likelihood of failure."

Dr. Steven Adair, Chief Medical Officer

What I always find telling are the comments after the story has run.

Lisa Says: Well GOODIE!! I took my granddaughter there2 times & the last time I was there, I felt VERY uncomfortable about their practice. They do the check up & then tell you to initial here, here & sign there but they DON'T tell you what you are initialing or signing. So, being a nosey old woman, I asked them about it & they told me that she needed 2 fillings & to have a front tooth capped. I didn't see the need since she was almost at the age where she will loose her baby teeth, so I took her to another dentist for a second opinion, he found NO CAVITIES, agreed with me that her baby teeth will come out soon, no capping was necessary!
We had already been through he 77 with two other "cavities" she had to have filled. They restrained her, drugged her & it traumatized her against any other dental visits. I am so glad I took her to another dentist!! This place is fleecing the government & making money off of unnecessary procedures!!!
Most parents are just wanting to do the best they can for their kids & have little knowledge about dental process so they just allow the "professional" to advise!! ASK QUESTIONS!!! ASK FOR PROOF!! Yes, it does make a difference!!

Here is a link so you can read all about FORBA's New Practices, but I thought they were great before paying the government $24 million dollars and being forced to sign a Corporate Integrity Agreement, among other things. Guess they really did SUCK!

Thursday, February 25, 2010

Comment From A Parent About Kool Smiles in Vancouver, WA

Eryn said...

Thanks for blogging about this. In December, my son was diagnosed with 4 cavities, one in each of his left 4 molars, at a Kool Smiles in our hometown, Vancouver, WA.

I had a gut feeling that it was just wrong, the Dr. treated me horribly, and that basically I had ruined my son's beautiful teeth. They told me he needed 4 stainless steel crowns.

I went to a new private pediatric dental specialist today, who told me there was no cavity in 2 of those teeth, and the other two were absolutely not in need of crowns. There are cavities, but only need one reasonable filling.

I am shocked and appalled. We plan to contact our local news station in Portland Or. Your blog has been helpful to us in confirming our suspicions about this chain.

Wednesday, February 24, 2010

FORBA's New Branding

There is a new definition for the word FORBA now. Used to be FOR Better Access, now it's all sugar coated as well;

FORBA "For Better Access, For A Better America"

What the heck ever! Nice try guys.

Since you've come up with a new slogan, wanna take the time to comment on EEHC, Inc, or should I?

Moriarty-Leyendecker Stepping Up To Fight For The Children Harmed

Warriors have arrived to take on FORBA and its Small Smiles chain of dental clinics in the form of the law firm Moriarty-Leyendecker . (Jim and Kevin respectively)

I couldn’t be more thankful!! It’s about time there is justice for the children who had to endure the paid from these dental mills.

As we know the states got their reimbursement for the fraudulent billing of FORBA’s Small Smiles dental clinics as did the Fed’s in the $24 million dollar settlement. (I’m thinking it probably cost more than $24 mil to do the 2+ year investigation)

So far, not one child has been compensated for the horrific mental and emotional damage, imagine the humiliation these children have suffered. Nor have they been compensated for the physical damage that may take years to repair, if it can be repaired at all. Much of the damage done will last a lifetime for these children, and there could be up to 300,000 or more of these injured children.

What about the damage done to the trust these children have in their parents to protect them from harm. Will these children ever trust their parents again? What about teachers, policeman and others of authority? At minimum these abused children will find it harder to form long lasting and loving bonds as a matter of course.

It’s likely the child’s brain development has been impaired and certainly interrupted and redirected. The way these children were abused and treated has changed who they were supposed to be, forever! This is undeniable.


Jim Moriarty and his partners are no strangers to medicine gone wild. That’s why I’m so elated to see they are standing up and stepping in.

In 1994 Jim Moriarty took on National Medical Enterprises (NME), later known as Tenet Healthcare. This sleaze ball company was, and I quote from the book Coronary: A True Story Of Medicine Gone Awry:

deceiving parents into allowing their children to be imprisoned in mental institutions where at best they were warehoused and at worst they were subjected to alleged therapies that resembled torture more than treatment

Sound familiar?

I encourage you to read the excerpt from Coronary: A True Story Of Medicine Gone Awry, by by Stephen Klaidman here.

As with FORBA, NME signed a Corporate Integrity Agreement with the Feds. When the federal fraud case was over NME thought the coast was clear. They were wrong!

Enter Jim Moriarty and “a pack of ex-patients and personal-injury lawyers” Jim is described as, and I again I quote:

a motormouthed forty-eight-year-old former Marine door gunner in Vietnam. (he’s a bit older now, I’m sure)

Moriarty is not necessarily someone you would like to have on your tail. When he focuses on something — it could be anything from a big, consolidated lawsuit to racing his hopped-up go-cart at 120 miles an hour — it is with the tenacity of a junkyard dog.

Jim ran into Tenet Healthcare again when one of it’s hospitals in Redding, California had an usually high rate of heart bypass surgeries. Jim was a bit disappointed the case didn’t go to trial so the story would be told. By settling with the 750 patients for $395 million dollars, Tenent kept the nasty truth off the front page. You can read about this outrageous health care scam online by clicking here: Money Driven Medicine, by Maggie Mahar.

Jim Moriarty and Moriarty-Leyendecker want to hear from you.

Please, contact Jim, Kevin and the crew, tell them your story.

Contact Moriarty-Leyendecker here.

***(BTW, no top management in the NME case went to jail, but others certainly did, something you dentists, hygienists and assistants who work for FORBA and Small Smiles should give a whole lot of thought to-like who is going feed your family when you’re in the clinker? FORBA bobble heads will through you under the bus in a New York minute!)***

Monday, February 22, 2010

Dr. Mark Janosky, Lead Dentist of Small Smiles Myrtle Beacn

And it begins:

MB dentist to offer free children's dental clinics

Posted: Feb 08, 2010 12:51 PM CST Updated: Mar 22, 2010 9:47 AM CDT

MYRTLE BEACH, SC (WMBF) - A Myrtle Beach dental center will be offering free dental screenings in honor of "Healthy Smile, Happy Child Day" on Feb. 10.
The free screenings will be held from 10 a.m. to 11:30 a.m. at the Small Smiles Dental Centers of Myrtle Beach, located at 1317 N. Kings Hwy. Event coordinators say the clinic is in part to raise awareness about the importance of a healthy smile during Children's Dental Health Month in February.
"Tooth decay remains the most common childhood disease," said Dr. Mark Janosky, lead dentist at Small Smiles. "Dental problems in young children can lead to a variety of health and developmental challenges including chronic pain, poor nutrition, distractions from learning and self-esteem issues."
Parents who are interested in scheduling an appointment are asked to call (843) 626-5437.

Saturday, February 20, 2010

The Rahm Effect

Once again, FORBA and it's Small Smiles clinics are involved in benefit to aid those less fortunate. Why am I surprised, it's their entire business plan. I see it as preying on those in need or as they like to say, 'underserved'.

To me it's the Rahm effect. No, not this quote "I wake up some mornings hating me too"- however that might fit- but this one:
You never let a serious crisis go to waste. And what I mean by that it's an opportunity to do things you think you could not do before.

I guess if I knew they really did have children's best interest at heart I would applaud them.....maybe and that's a huge maybe.

Here they are set up at a benefit to raise money for fire victims. I guess there is no place they won't go to 'patient shop', at least that's the way I see it.

Fire victims aided by Holyoke event

Sunday, February 21, 2010

HOLYOKE - A benefit for Lyman and Beech streets fire victims was held Saturday at the War Memorial, featuring services available for the displaced tenants and information for the public.

A box for monetary donations for the fire victims also was at the event, which was sponsored by Centro de Restauracion Emanuel Church.

A fire relief fund has been set up at New Alliance Bank for the 15 families affected by the Dec. 23 fire at 103-105 Lyman St., and the donations will be split evenly among them, said Felicita "Nina" Lopez, outreach coordinator for the complete story here.

Excerpts From "The American Way of Dentistry" by June Thomas

June Thomas from has been writing a multi-part article titled "The American Way of Dentistry".

Here is an excerpt:

Part II: The Disappearing Dentist (9/28/09)

  • As the US population is increasing, less people are becoming dentist.
    • Dental schools are closing because of the extremely high cost of training dentist.
    • More and more dentists are becoming specialist
    • More dentist are working less (which helps control overhead)
  • Because of supply and demand, the cost of dentistry is going up.
I'm not so sure about this and would like to know where she got her facts.

Here is another excerpt:

Part IV: How Dentists Think (9/30/09)

  • 80%-85% of American dentists practice as owner-operators, as compared with only about 20 percent of physicians.
  • Unlike medicine, dentist must bear the full cost of the patient care such as:
    • Equipment, supplies, utilities, x-ray machines, several kinds of insurance, rent, equipment loans, and the biggest expense…salaries of a large staff (appointment maker, billing person, dental assistants, hygienist, office manager,…).
  • Most dental offices are only open 4 days a week.
    • This helps control staffing costs.
  • Many people are afraid of the dentist.
    • Approximately 45 million people in the US are nervous or terrified of the dentist.
    • 23 million people avoid dental care because of fear.
    • Improvements in dental technology has taken a lot of the pain out of dentistry.
  • Dentists are a trusted profession.
    • 2003 poll showed that 61% of people rated honesty and ethical standards of dentists as “high” or “very high”.
      • Only nurses, physicians, vets, and pharmacist ranked higher.
  • Dental health in America has improved, but Americans’ satisfaction with their teeth has declined.
    • This has helped bring on the increase in cosmetic procedures such as teeth whitening and veneers.
Look at item 5 above, don't suspect all those numbers are quickly on the rise?

Note item 6 above. They need to take that poll again!! With all the children who have grown up in the age of dental mills I bet that rate has dropped. If it hasn't dropped it certainly will in the near future.

Friday, February 19, 2010

FORBA ads on Craig's list

FORBA has ads for Dentists flooding Craig's list and looking for recruits in just about every state and are will to pay your 'relocation' fees. Most of the ads want canidates to contact Jacob (Jake) Kochenberg. I believe daddy DeRose's (Eddie) daughter is married to Jake's brother. Keeping it "All In The Family" ya know.. I really need to put a little time into the 'family tree'.

Here is an ad for Dentists:

I see the phone number to call in interested is at the Pueblo Office.

Funny how New FORBA, who is suing Old FORBA, is allowing the Colorado office (Old FORBA) continue run the show, do the hiring etc. Maybe New FORBA is just the venue for capital after all.

You would think if there was this horrible breach of contract between New FORBA and Old FORBA as is alleged in the complaint, New FORBA would still allowing Old FORBA to control things. New FORBA says they own all the clinics, and Old FORBA just provided the management of the practice. In fact the idea that New FORBA is still allowing Old FORBA to run things tells me that New FORBA must like the way Old FORBA is doing things. Oh, wait! Maybe, just maybe it's not Old FORBA still running things. Maybe it's EEHC, LLC, who amazingly has the exact same employees as Old FORBA.

Here is another ad and I see their starting pay has dropped $20k.

Thursday, February 18, 2010

A New New York Reader

I get visitors to this blog from all over the world. Some are regulars and some are one time visitors. But I've seen a visitor from Ithaca, New York here a whole heck of a lot lately, and they are spending quite a bit of time. Anyone know who is in Ithaca, New York

Corporate Dentistry Pitfall number 101–Floating dentist filling in where needed.


I was working with a chain practice for a year right after I graduated.  In this type of practice, the management asks of their employee to cover another office in another location, if the dentist at this location has a day off. I was asked to cover one such office. That means, I would be seeing new patients to determined treatment.

I saw this patient in May07. I inserted a PFM on #3 ( the tooth was endodontically treated. The crown prep was not done by me. I inserted the crown after I took  a BW x-ray and checking for occlusion and contacts. (Unfortunately, I forgot to document in her chart)

Now I no longer work  for the company. I received a letter from the board stating that this patient has a complaint against me. In march 08, this patient complained that #3 has been hurting. The treating dentist examined her and determined that nothing was wrong and adjusted the occlusion.

She still complained of pain.

She was told that it was her wisdom teeth that were the reason of her pain, so she got her wisdom teeth extracted. #3 was asymptomatic each time it was been examined, patient stating that pain was a "5 out of 10".  

In the meantime, she saw another dentist who said that the crown was big. Again the dentist got #3 out of occlusion totally,. Patient still complained of pain..............

Now the case is with the board.

I have no clue what would happen. How  should I proceed. I am very very scared as they could take any action.

There were different providers involved here.

The one who did the prep quit (management told me he was on vacation....but had actually quit).

Also the patient saw a different provider next time she came in to the center (after 10 months) who checked her crown and found nothing wrong). Then after she had her wisdom teeth out with an OS, she saw a different provider the next visit (this provider saw her at all her subsequent visits)

This provider recommended other options (re treat endo etc) but he told her nothing wrong with the crown.

She went to another local dentist, who told her that crown was not good. This is when she complained to board.

I got a letter last year and they asked me what had happened. I wrote the letter myself ...did not contact malpractice. I told them hat had happened during that brief half an hour appt. I did not hear from them until nearly after a year and now they tell me that case is with the board. I do not know what to expect.

Any advice would be helpful

Please help,

Scared out of mind new grad dentist



How it ended -

After being advised to contact his malpractice insurance carrier and gathering all the information and documentation he could, which was NOT easy!  His attorney fees in this were astronomical just trying to obtain the patients treatment documentation.

He ended up getting nailed by the dental board.  A black mark on his record remains.

Tuesday, February 16, 2010

Missouri Hit With Disgraced Dental Chain; Small Smiles?

Is it possible Small Smiles has moved to Missouri?  No, not  according to Jeslyn Schillinger, who says the West Edgewood Small Smiles dental center in Jefferson City is not affiliated with FORBA/Small Smiles in any way.  That's good to hear.  She says it's a great place and Dr. Marchack is great with children.  I'll let her tell you:

Here is her email:
I was absolutely shocked and mortified to read the Feb. 16th article on your site. I have been taking my children to this clinic since about that time and have always had great experiences. The staff is friendly and comforting with all of the children I've seen on each of our five visits to date.
I was appalled to see our dentist's name and practice dragged through the mud with no apparent investigation. After my own investigation, I have found that Small Smiles at West Edgewood Dental has absolutely NO affiliation with the Small Smiles/FORBA in other states. Small Smiles in Jefferson City, MO, is a private practice where Dr. Marchack treats each child and parent with the utmost respect. On each visit, we have been welcomed to accompany our children in the exam rooms and have been with them through the entire visit.
During a routine sealant visit, one of my children began telling the Doctor about his toothache, Dr. Marchack looked at it and scheduled him to come back at the end of the day to have the tooth filled and another capped. (We had already been through the antibiotic regiment as a precaution prior to the visit.) I was moved to tears that there our children's dentist would volunteer to stay late on a Friday afternoon just so my child wouldn't have a toothache for another three weeks, until his next scheduled appointment.
I have recommended this clinic to every parent I know, as I am sure you would if you ever went there with your children.   I appreciate the magnitude of the allegations regarding the other Small Smiles/FORBA clinics, but some true investigation should be made before you publicly slander another clinic and doctors for merely having a similar name.
 I would suggest whoever owns this clinic change its name ASAP.  The name Small Smiles and Dental is only going to get worse.

One thing for sure, FORBA is registered to do business in Missouri.  The actual name of the clinic is West Edgewood Dental Small Smiles.  It used to be named West Edgewood Dental Group.  

Over at the Missouri Department for Health and Senior Services showing Cole County it clearly refers to this clinic as 'Small Smiles".  Checking the SOS site, it appears the dentist may have been there for a while, so its highly likely this Small Smiles is NOT affiliated with FORBA.

Here is an ad:

West Edgewood Dental Small Smiles
3306 Emerald Lane
Jefferson City, MO 65109-6877
(573) 638-3897
Get directions
I searched for all dentists in Cole County and 5 popped up. I looked at their names and immediately they appear just like so many of FORBA Small Smiles dentists. 

Here they are:

Over at it give another address for West Edgewood Dental Small Smiles, but the phone numbers are the same.

West Edgewood Dental Small Smiles
Jefferson City, MO 65109

Here is even another phone number (660) 638-3897 I found here. Both area codes are Missouri codes.

Monday, February 15, 2010

Park West Dental; Padula ring any bells?!

Will this never end. Is this horrible family and their offspring going to spread their deceit, fraud and mistreatment of children for ever more. We are now into the 3rd generation with no end in sight. Dr. Ed DeRose and his wife, Neta's neice, Juliann and her husband are now dipping her hand in the medicaid pan.

There's a new DeRose related dental office opening in Pueblo, and yes, they take Medicaid. Awe, hell you follow the links and check it out, I've got a headache! Don't forget the Secretary of State site to search for the corporation papers, and check out the property and who owns it. And note in all your looking around, you'll see N. Grand Street, Pueblo, Colorado! Let me save you a bit of trouble. Click here, and as we are so accustom to finding, Dan DeRose's name it's associated with 409 N. Grand Pueblo, Colorado!! No big surprise there! Oh, there is another company on the horizon...I'll talk about it later. I have come to loath these people, every last one of them.

Park West Dental

John Millea D.D.S, Juliann Padula Millea D.D.S.
3470 parker Blvd
Pueblo, CO 81003
(719) 543-4022

Here, they will introduce themselves.

Just how damn many generations of DeRose and Padula's are citizens going to have to suffer through. Will one of you PLEASE get fixed and stop procreating!!!

Have any of you thought about a new line of work, honestly you're wearing this dentist thing out! Have you ever thought about Park Ranger or something???

Ear, Nose and Throat; But Not Your Eyes or Teeth

I'm looking for an answer as to why a person's mouth, specifically their teeth and a person's eyes are treated more like your car than part of your body. So much so, that separate insurance is needed to cover the needed treatment.

I understand the need for specialist in those areas of the body, but I consider the care and treatment delivered to the teeth and the eyes to be no more or less important than to a person's finger, knee or ear.

Speaking of ear, many times it is difficult to determine an earache from a toothache. I'm sure this has happened to many here. At what point in medical history did this separation take place, and why?

Find Dentists Who Accept Medicaid In Your State At Insure Kids Now Website

Finally there is a .gov website that I personally find useful. I'm sure many parents can as well.

It's called Insure Kids Now ( Wonderfully designed to find SCHIP health or dental providers for children. You can find providers, again, be it health or dental, in all states. It's searchable by your address, by your plan, provider and more.

It's super easy to navigate and extremely user friendly.

If you happen to be searching for a dental provider for instance NOT associated with FORBA's Small Smiles Clinics, then search for a provider and check the name of the dentist against the address of any of these places in your area; Small Smiles, Children's Medicaid Dental, Oklahoma Smiles, Indian Springs Dental, or Wild Smiles

You can also check the address of Kool Smiles, Ocean Dental or Adventure Dental and Vision.

I think parents will find there are several dental providers in their area who will accept Medicaid without resorting to taking your child to a so called 'dental mill'.

Heartland Dental Invades Nevada and Kansas

Heartland Dental invades Kansas and Nevada. Kansas isn't paying attention to who it lets practice dentistry I see. Corporate dentistry is spread like the swine flu these days. The places do NOT deliver the care and treatment you are used to receiving from you local family dentist. Please stay away from them and do your homework before making that appointment. A simple google search for complaints will do the trick.

Here is the latest breaking news Heartland has put out. Take it as a warning.

Heartland Dental Care, Inc. Continued Its Growth in 2009 Adding 32 Dental Practices
Jan 14, 2010 - 5:59:38 PM

( - EFFINGHAM, Ill., -- Heartland Dental Care, Inc. brought its total number of practices to 253 in 2009 with the acquisition of 27 established practices and the creation of five de novos.

Several of these practices expanded Heartland's presence into two new states -- Nevada and Kansas - increasing the Company's footprint to 14 states.

"We are glad to welcome these practices and team members into the Heartland Dental Care family," said Rick Workman, DMD, Founder and Chief Executive Officer of Heartland Dental Care, Inc. "These acquisitions and new practices strengthen our commitment to provide quality dental care in hometowns all across the United States."

"At the beginning of 2009 we set out to add 25 practices, and that's just what we've done," Workman said. "Plus these practices have brought substantial value to our company especially through the innovative ideas of their team members."

Besides a healthy and managed growth in 2009, the Company also experienced several other major accomplishments:

-- Increase in Same Store Sales over 2008
-- Addition of 96 dentists and an overall reduction in team turnover
-- Expansion of education and clinical training programs into regional
-- Integration of digital x-ray technology and other cutting edge tools
and techniques
-- Substantial cost savings on supplies and laboratory fees
-- Implementation of Patient Satisfaction Surveys

"Everything we do works toward our goal to be a world class company and the leader in dentistry," said Patrick C. Bauer, President and Chief Operations Officer of Heartland Dental Care, Inc. "We will continue to work toward this goal in 2010. We will further this vision by helping our doctors and practices be the best they can be. Whether it's through advanced clinical education or simple communication skills - it's all about giving our patients personal attention and professional excellence."

About Heartland Dental Care

Heartland Dental Care, Inc. is one of the leading dental practice management groups in the United States with more than 250 dental practices located within 14 states. Based in Effingham, Ill., Heartland provides its dentists and team members with continuing professional education and leadership training along with a variety of management services which include staffing, human relations, purchasing, administration, financial, marketing and information technology support. For more information, visit

Sunday, February 14, 2010

From Hartford, CT to Sante Fe, NM-FORBA looking for dentists to work in their Small Smiles clinics

Appears Jenna Kochenberger is on the prowl for dentists as well. Here is an ad from
Jenna and Jacob Kochenberger from Pueblo, CO are hubby and wife. Wonder if they get paid by the 'head'? Wonder what kind of Dentist's their looking for, 'lead' dentists, 'associate' dentists, or dentists who will lend them their licenses and so FORBA can call them 'owner' dentists. Like Dr. Jodi Kuhn. I think her name is on the individual clinic LLC state filings in Ohio and Kentucky. Problem is Kentucky statues say a dentist can only 'own' three clinics and I do believe they have to actually practice in those clinics. Wonder how Jodi does that?

Here's the current ad:

SEEKING DENTISTS in our rewarding work environment nationwide.

Positions currently available in:

Hartford, CT
Syracuse, NY
Worcester, MA
Manchester, NH
Cincinnati, OH
Youngstown, OH
Florence, SC
Dothan, AL
Montgomery, AL
Beaumont, TX
Oklahoma City, OK
Omaha, NE
Greeley, CO
Santa Fe, NM

Offering an excellent guaranteed base salary, promotion opportunities and benefits (including monthly bonus potential, 401(k) retirement with company match, paid vacation & holidays and 100% coverage for health insurance, malpractice insurance, disability insurance, continuing education, dues and fees). Relocation reimbursement offered and licensing assistance provided.

Join our team of professionals providing quality dental care. General Dentists, Pediatric Dentists and new grads are encouraged to apply.

Please call Jenna direct at 719-562-4462 or fax 719-584-7696
or email
or visit



Saturday, February 13, 2010

FORBA Looking for Dentists in the Dothan and Montgomery Alabama Clinics

FORBA looking for dentists for it's Alabama clinics. YIKES! Wonder what has happened to:

Dr. Michelle Nicole Dandridge
Dr. Sabrina Lynn Hinton
Dr. Khaleda Imroz
Dr. Kevin Frank Kingry
Dr. Amber Tennile Bishop
Dr. Katherine Wood Merrill
Dr. Nzingha Harris Stovall
Dr. Keri P Turk
Dr. Adra Gibson Washington

Maybe they have moved on. I'm sure if they aren't with FORBA's Small Smiles clinics any longer, I'll hear from them.

All the above have current licenses in Alabama except Dr. Khaleda Imroz. I guess that's because Dr. Imroz is in Colorado, at 415 N. Grand Street. See Links below. I've checked dental licenses for Dr. Khaleda Imroz in Alabama and Colorado and they are none existent. I always worry when I see the same dentist name in several states. For example, Dr. Randall Ellis, DDS, he has current licenses in more states than I've got fingers.

Link showing Dr. Khaleda Imroz in Alabama

Link showing Dr. Khaleda Imroz in Colorado

They're offering you a sign up bonus and relocation reimbursement. Another big YIKES!! Besides signing your right to breath away when signing their normal contract, my guess is they may want your first and second born child. I know they take your gonads.

They are advertising as far away as Tallahassee City, Florida as you can seen by clicking here.

This ad says it was posted on February 13, 2010. Contact info is our buddy, Jacob Kochenberger. I see the number is the Colorado office number: 719-562-4460

Here is the ad:

Offering a $10,000 Signing Bonus & Licensing and Relocation Reimbursement

SEEKING ASSOCIATE DENTISTS in our rewarding work environment! We are
currently searching for skilled and compassionate Dentists for our
state-of-the-art dental centers in:

Montgomery, AL
Dothan, AL

As the nation’s largest and most experienced provider to underserved children
and young adults we offer an excellent guaranteed base salary, promotion
opportunities and benefits (including monthly bonus potential, 401(k) retirement
with company match, paid vacation & holidays and 100% coverage for health
insurance, malpractice insurance, disability insurance, continuing education,
dues and fees). Relocation reimbursement offered and licensing assistance

Join our team of professionals providing quality dental care. General Dentists,
Pediatric Dentists and new graduates are encouraged to apply.



Please contact Jacob at:
Direct Phone: 719-562-4460
Fax: 719-584-7697

ATTN: Angie's List Article

Michael Schroeder is writing an article for Angie's List Health
Contact Michael if you have a story to share.
He's on a tight deadline, this week and next so not
must time.

Michael Schroeder | STAFF WRITER

Angie’s List Health magazine
1030 E. Washington St.
Indianapolis, IN 46202


Thursday, February 11, 2010

Another Old Keystone Employee at FORBA Holding

If you are going to work for FORBA (Old FORBA) or FORBA Holding (New FORBA) you might as well get used to having your name associated with the company and appearing here. If you don't mind it being on social networks and you are proud of your employer, it shouldn't be a problem, right?

Today our star is
Suzy Seigenthaler

  • Office Manager at FORBA Holdings, LLC
  • Executive Assistant at FORBA Holdings, LLC
  • Billing Manager at Regency Health Services
  • Database Manager/Central Business Office Coordinator at Universal Health Services
  • Senior Billing Coordinator at Keystone Education and Youth Services
  • Nashville Technical Community College

Suzy Seigenthaler’s Experience

  • Office Manager

    FORBA Holdings, LLC

    (Hospital & Health Care industry)

    November 2009Present (4 months)

  • Executive Assistant

    FORBA Holdings, LLC

    (Hospital & Health Care industry)

    November 2006Present (3 years 4 months)

  • Billing Manager

    Regency Health Services

    (Hospital & Health Care industry)

    May 2006November 2006 (7 months)

  • Database Manager/Central Business Office Coordinator

    Universal Health Services

    (Public Company; UHS; Hospital & Health Care industry)

    October 2005May 2006 (8 months)

    Previously owned by Keystone Education and Youth Services, UHS purchased Keystone in October 2005.

  • Senior Billing Coordinator

    Keystone Education and Youth Services

    (Hospital & Health Care industry)

    January 2000October 2005 (5 years 10 months)

Saturday, February 06, 2010

Dan DeRose Suing Darek Spring

Here's the deal:
Darek says he worked for some company that had borrowed money from Dan to buy a bank...  The deal fell through as did the company.  Darek worked for this company and ended up like so many during this hard economic times and had to file bankruptcy too.  Dan then went after Darek.  Why  Darek,  I'm not sure, but in the end Dan dropped the suit and ate the $500k. Darek says has never seen nor met Dan DeRose.

Original post:
This is a funny little tidbit of info for my readers. Daniel (Dan) DeRose part of the FORBA DeRose fiasco and owner of DD Marketing is in the middle of an odd lawsuit.

He's suing Darek S. Spring in Colorado, case number 09-25344-HRT. Darek is in the middle of his own Chapert 7 bankruptcy case. Darek is trying to 'discharge' in his bankruptcy, a loan he owed to Dan DeRose. Dan is having a kicking and screaming fit, trying to stop that from happening.

The thing I thought was funny was the loan amount and the reason for the loan. Darek borrowed $500,000.00! Yep, Dan loaned Darek a half a million dollars.

Wonder why Darek needed a half a million dollars.... ?? ... it was to 'buy a bank'! I kid you not!

400 and Still Counting-Bad Reviews for Stephanie Harper, DDS and Alizia Strebe, DDS

I've spent the weekend trying to gather up the names of all the dentists who work of Small Smiles or one of their clinics. It's been extremely time consuming but worth it. I'm at over 400 and not searched New York, New Hampshire, or Massachusetts. Of course I'm sure some are no longer there and some new hires probably haven't been added to the various systems just yet. But I thought 400 at this point was quite impressive!

God, I love the Internet!

So far Ohio is winning at 52 Dentists, with Massachusetts a close second at 42...

Dr. Stephanie Harper, Savannah, GA

Dr. Alizia Strebe, Boise, ID

Small Smiles in Florence South Carolina Lead Dentist Dr. Medrina Gilliam

FORBA Holding, LLC the 'owners' of Small Smiles clinics are definitely in defensive mode after agreeing to pay $24 million dollars to State and Federal governments just to settle claims they committed countless amount of fraud, mistreated and overtreated small children in order to line their pockets with taxpayer cash, via state children medicaid programs. The settlement was announced a couple of weeks ago.

Below is Dr. Medrina Gilliam, hitting a morning show, trying to sell her wares. This particular program on the local NBC station in Myrtle Beach, South Carolin. Dr. Gilliam is 'Lead' dentist of the Small Smiles Clinic in Florence, South Carolina.

Additionally, in the past couple of weeks law suits have been filed, one in Ohio-a Class Action suit and one in Colorado-New FORBA v. Old FORBA. New FORBA says it's owned the clinics since September 2006, but all the bad press and fraud charges are a result of problem with the company when Old FORBA was in control. (actually New FORBA still paid Old FORBA to 'manage the dental operations for them, but that's a whole other story).

Here is a comment posted on a website from an mom who had dealings with the very clinic led by Dr. Gilliam who is in the promo above:

User Rating: 2 out of 5 stars
I took my three year old granddaughter to this clinic and I really regret it. First of all, she was scared, but they didn't think she was scared. I don't know who trained these people, but they expect my baby to just sit still and let them put in five filling while being in a straight jacket and not try to get out.

The child is not use to being tied down. so she didn't handle that well. These days and time, I am glad my child will try to get away for strangers who are making negative comments about her while she is tied down.

I will not recommend this place to any one who has a child that needs work done. Cleaning and just checking, they may be okay, but not to do any work that required a needle. They do not understand when a child is scared and will not call the parent back there if the child is upset. They complained about my child right in front of her.

My baby is very smart and sat through all of her shots at other doctor offices without crying. However, she was terrified with the people at Small Smiles. I think the parent should be allowed to go back there while they are working on the child. If not, the parent should be able to see the child even if the child can't see the parent.

The attitude of some of the staff was negative because the child was upset. I think they acted very stupid in trying to judge a three year old child. By the way, she just turned three. I would not even allow them to recommend her to another dentist if fair of what they would tell the new dentist.

I think Dr. Gilliam needs to keep her ass back at the clinic and do a better job of 'leading', don't you! And... New FORBA sucks as bad as Old FORBA!

Thursday, February 04, 2010

New Improved Taste and Less Filling FORBA, I Think Not

Here is a story of how things went in a Small Smiles office just yesterday, February 3, 2010. The child's name was changed for obvious reasons:

This morning the kids and I headed to the Small Smiles dental clinic for Katie's first ever dental visit. We had read some dentist-type books and almost every mom I talked to (or that commented on FB) reassured me of what would happen on the first visit. According to them, the first visit would be a simple tooth-counting and comfort-building chair sitting experience for Katie. And of course a brand new toothbrush to culminate the event. Sounded pretty non-threatening and even sort of fun!

This morning at breakfast, I was giving Katie the expectation run-down again so she'd know exactly what would happen. Katie is a sweetie but she is a girl that doesn't roll with the unexpected well. She needs time to feel comfortable and letting her know exactly what will happen seems to ease her fears.

Anyways, Katie was excited about the dentist visit and said animatedly, "I sure hope I get a new princess toothbrush at the dentist!" She even dressed up her favorite teddy bear in baby clothes and brought him along for the occasion.

As soon as we walked into the clinic door, I had a foreboding feeling. The lobby was VERY crowded and felt more like a daycare center than the comforting low-key lobby experience I had envisioned. Nonetheless, the kiddos settled in to play while I filled out the paperwork. And then we waited. And waited. And waited some more! It was 45 minutes before Katie's name was called.

After a brief introduction, the dental hygienist took us back and instead of asking us anything curtly stated she would start by taking x-rays of Katie's mouth. Sphincter say what?!? I tried not to let my hyper-mommy-alarm bells go crazy and decided instead to go with the flow and see how Katie did. My girl was all smiles until the hygienist shoved the x-ray slide into her mouth. And then Katie lost it -- with good reason too. The hygienist did NOT prepare Katie for what was happening and I tried my best to comfort her from out in the hallway. Needless to say, the x-ray photography session did not happen. Katie kept crying and was obviously scared.

The WORST part was the hygienist's impatience and obvious frustration with Katie's meltdown. She just kept telling Katie to stop crying and to be a good girl or she wouldn't get a toy. Hello?!? What 4 year old is going to stop crying on a dime for a stranger who is doing foreign things and is telling her she's not being good? I was starting to get seriously ticked off. I asked the hygienist to stop and that we'd have to do the x-rays on our next visit.

Moving on, the hygienist brought us to a huge room with about 8 dental chairs all filled with kiddos having various procedures done. Again, the mommy-alarm-bells started ringing like crazy. Talk about a distracting, loud and scary place! Katie, unnerved and whimpering by this point, was not trusting this hygienist chic. It didn't help that the lady lowered Katie in the dentist chair without warning. Katie's tears started again (and so did my tears - I hated seeing my baby girl fall apart) and I quickly saw that wisest course of action was to split. I told the hygienist we were going home and we'd reschedule.

UGH. What a yucky experience! I truly think the worst part of it was the hygienist's use of bribery and her scolding impatient manner. I spent the entire ride home reassuring Katie that I was not mad at her and she was not "bad" for being scared. I think it was perfectly natural and reasonable for Katie to be frightened given the circumstances.

We will NOT be going back to that crazy clinic again. We're taking my little girl's teeth elsewhere!

What have your kids' dental experiences been like?

FORBA has promised before to get it's act together and has failed each time. FORBA has known they were being looked at by Federal and State agencies since 2007 at the minimum. Here it is, 2010 and there are still complaints. Most of the complaints on this website and all the video reports have been since 2007.

Now we have FORBA Holding, (referred to as New FORBA in the legal proceeding filed last week) suing FORBA (referred to as Old FORBA in the legal proceedings), and all I want is one of two things:

1. Their doors locked shut


2. A much friendlier, improved taste and less filling FORBA!

Toledo Parent Furious with Small Smiles Dentist and FORBA

Tuesday, February 02, 2010

Lawsuits Abundant In The Land of FORBA

I've been wondering how long it was going to be before 'New FORBA' (FORBA Holding, LLC, whose members are listed on the right sidebar of this blog) sued the hell out of 'Old FORBA' or as I call it, DeRose FORBA.

... I've said from the very beginning of my investigation, the DeRose's were still in this up to their eyeballs and now there is proof I don't care how many people they told that has sold it. They sold the assets, and continued to run and profit from the clinics to this very day.

It's all laid out right here, here, and here, in a lawsuit file in Colorado Federal District Court, January 22, 2010.

I do find it odd, by looking at the case number (09-cv-02305)it appears to have been filed in 2009. Oh, I just noticed this particular document is an 'amended complaint' so this probably was originally filed last year. Yes, indeed it was filed on 9-28-2009.

DD Marketing, Inc
DeRose Management, LLC
Danny E. DeRose
Edward J. DeRose
Michael A. DeRose
Michael W. Roump
Richard B. Lane
William A. Mueller
Adolph R. Padula
Padula Famly Partnetship, LLLP

Relief New FORBA is asking the court to assess on DeRose FORBA:
$50,000,000 for breach of contract
$50,000,000 for liable to FORBA Holding (New FORBA)
$50,000,000 for liable to FORBA Holding (New FORBA)
$50,000,000 for monetary damages FORBA Holding (New FORBA) and incurred
...and anything else they can get the judge or jury to hand over to their dirty little hands.

In my opinion, New FORBA (FORBA Holding) is just trying to cover their butts, by saying "it wasn't me"... but in all honesty, they (New FORBA) knew exactly what's been going on and for how long. These people found each other for a reason, ya know. Plus, Smith, Green, Cawood and Gardner are in this Keystone thing too.

Just saying, I don't think "New FORBA" has unclean hands", if ya know what I mean...

Man, this is odd, whose side should I take in this battle. Hmmm... 'New FORBA' is the one who sued me for spilling their dirty beans, yet those DeRoses make me wanna puke just to look at any of them... Gosh, this is hard... Shoot, I really need to send 'New FORBA' a HUGE bill for all the research I did for them...and laying down all the crumbs for them to follow.

Shoot,shoot, shoot...this is gonna be hard. NOT!! I hope they both tear each other to shreds. But my main goal is for the doors to shut on all 69 of the torture chambers, they call dental clinics.

I'm just at page 19 of the Amended Complaint. I knew Dan DeRose looked like a slimball. I was right. In this complaint, I quote from page 12, paragraph 38.

"...instituted a 'contest' to encourage greater production by the dental centers..."

"personnel continued to have regular communications with the Lead Dentist and Office Manager in each of the Small Smiles Centers regarding production."

"...For example, defendant Michael Roump sent emails to Small Smiles Centers emphasizing that 'production per patient' should be an area to focus on with your dentists we have discussed, our focus needs to be on increasing production per patient"

...personnel also ran a series of reports for Old FORBA's (speaking of FORBA, prior to sale) use in managing the Small Smiles Centers, including 'Dentist Efficiency Reports' and 'Dentist Daily Average Reports."

"Dan DeRose recognized the sensitivity of certain of these reports, denying the existence of these reports to Sanus and suggesting that such reports were the 'number one trigger point for fraud'.

Also thinking about that beautiful Ed and Neta DeRose football stadium built with blood money to honor the dishonorable DeRose's. Wow, it's gonna be hard to not pass this thing, and not think about all the children tortured and abused to line the pockets of the entire DeRose-Padula-Mueller-Roump families. Even the death of one of their tiny innocent patients didn't slow these guys down.

Page 25, paragraph 68 lays out what 'old FORBA' or as I call it 'DeRose FORBA', was supposed to do, in which clinics they were supposed to do it and what they failed to actually do.

I guess this is the section where 'New FORBA' points it's finger and cries, 'he did it' or it could be called the Obama defense. Ya know.. 'Bush Did It, It's Bush's fault, or 'I (we) inherited this'.....

Wow, I'm at paragraph 69 and low and behold there is mention of Dr. Robert Andru and Dr. Kenneth Knott and Toledo Ohio center dentist Dr. Swapna Kakarla. Here it mentions the 'falsification of the Credentials. Geez, I thought that 'New FORBA' did that one.

Paragraph 70 talks about all the expenses 'New FORBA' has incurred due to federal and state investigation, wonder if that includes the $60k attorney fees they said they racked up trying to shut me up? Hmm...

Evidently, New FORBA is saying DeRose FORBA didn't comply with accepted standards for charting. There must be an email from Richard Lane dated August 24, 2005 telling DeRose FORBA that 'poor charting will cause problems in the future'. Not only did DeRose FORBA not see to it that the charts were in good order, they didn't correct it, nor did they disclose to the poor innocent unwitting people of 'New FORBA'.

Looks like 'New FORBA' has a lot of 'DeRose FORBA' emails they've uncovered. Wonder why New FORBA is just now getting these emails. They speak of one, in the Complaint dated 12-29-2004 were Dan DeRose said the Atlanta center

"is a mess, a disappointment, a total disaster" and "I've looked the other way and allowed it to happen. Our employees don't care, our Dr's have no leadership and no professional conduct. Our Office Manager is a train wreck, immature little girl with a huge mouth. Our systems are not in place. Medical histories are not being signed, x-rays suck, referrals are being made daily that is not a FORBA clinic and no one to blame but myself... This email is not to be forwarded to anyone printted or duplicated in any way without my permission."
It also appears people in the DeRose FORBA camp warned of investigations in progress or that would be coming. It's stated in the complaint that Dr. William Mueller (who is a defendant in this case) warned of certain

"things we do which have caused concern on the part of parents, dental boards or media."

In this email, Dr. Mueller makes a list explaining the above statement:

1. Parents in the back
2. patients 'Immobilization'
3. use of 'Stainless steel crowns'
4. Amount of work done

I'm just wondering why New FORBA is just now getting their hands on these emails. I just can't buy what they are selling here. So if DeRose FORBA did all of this prior to the purchase of the assets by New FORBA, and DeRose FORBA continued doing business in this fashion and DeRose FORBA clearly knew it was either illegal or immoral, New FORBA wants us to buy, that they didn't know. Well, that is BS. They've been told just about on a daily biases for at least 3 years and they are just now upset about it!! C'mon! They just want the DeRose's to fork over the $24 million dollars New FORBA now owes the government. Todd Cruse worked for the DeRose FORBA and is right in the office everyday at the New FORBA!

Clearly New FORBA (FORBA Holding) who owns the dental clinics Small Smiles are trying to scrub their dirty grimy little hands. Amazing how this comes out just after they get nailed with the $24 million dollar settlement. What about last, year, the year before that, what about in 2007...New FORBA (FORBA Holding) didn't care then, and they damn well knew what was going on!

Any due diligence at all by the New FORBA would have revealed all the troubles of DeRose FORBA, Michael DeRose, Dan DeRose, Ed DeRose, Mark DeRose, William Mueller, Adolph Padula and more. Did they not know about 'google' in 2006?

They could have found out about Michael DeRose's nasty little business in North Carolina as far back as 2003!!!!!!! Stuart Watson at a Charlotte, NC TV station reported on this that far back!!!

By the time you get to paragraph 96 it's clear new FORBA has filed this just to present to the public their hands are clean and Small Smiles clinics are a safe and wonderful place now for children. They have to keep the income coming in, right? New FORBA want's to smell like the 'rose' they've presented themselves to be for year.

New FORBA (FORBA Holding) says they have incurred $1 million dollars in expenses responding to the state and local government inquiries. I would say it's $1,000,060,

New FORBA also wants DeRose FORBA to pay them for the expenses they incurred in 2008 due to a civil RICO suit filed in Tucson, Arizona where a search warrant was executed. This suit was looking into thing that went down as far back and July and August 2004 to May 2005.

During the past 2 plus years I can't count the times I've said, "Oh, what a tangled web we weave, " well I'm saying it again.


It appears this case has been dragging on and on and on and on. Motions galore. We are at doc 41 and the DeRose bunch, aka Old FORBA are just now filing a motion for an extension of time to file their Answer to New FORBA's complaint. A judge has even had to recuse herself due to socially knowing the defendants.

Monday, February 01, 2010

Lobbying For Dental Dollars

FORBA Lobbying Firms:

Strategies: Scare tactics, Gain public trust in order to have an audience

Lobbying in Idaho see here

Georgia Stategies, FORBA Lobbying Group see here

WojDak Lobbying Firm in Pennsylvania see here
Wojdak & Associates helps clients form partnerships with government. Our lobbyists are experienced in cultivating cooperative relationships with public officials and other governmental representatives whose oversight could impact the clients or their industries. Our firm helps clients anticipate legislative and regulatory developments and policy trends as well as expand or refine their ability to incorporate government relations into strategic planning.

Wojdak & Associates has a niche as an effective representative of provider and institutional interests within the complex world of health care. Our firm offers highly specialized technical advice, support and assistance to clients whose business relies on regular, productive interaction with state agencies such as the Department of Public Welfare and the Department of Health. Our health care practice has the extensive experience with health-care structures necessary to develop workable initiatives and solutions to problems, and the skill to guide initiatives through legislative, regulatory and political processes.

Wojdak & Associates, recognizing the influential role the media play in government affairs, often turns to its subsidiary, Bellevue Communications Group, for public relations expertise for clients. Bellevue offers a wide range of services – media relations, strategic planning, community PR, grassroots correspondence, editorial support, crisis communications, media training and news conference/news event management. Bellevue's skilled professionals have worked as reporters and editors with the region's leading print and broadcast news outlets, and as spokespersons for public officials.

Kool Smiles Dental As Bad As Small Smiles Dental According To Report

Medicaid dental clinic defends itself against critics
Dan Stockman
The Journal Gazette
Laura J. Gardner | Journal Gazette

Kool Smiles Dental Clinic on Bluffton Road saw more than 6,000 Medicaid patients last year.

Deanna Vasquez – with 4-year-old twins, Jakob and Kylie, and Brianna, 7 – took her children to Kool Smiles in Fort Wayne, where workers persuaded her to restrain Jakob for a cleaning.
By the numbers
Kool Smiles has 84 dental clinics nationwide, including six in Indiana, and focuses on treating children on Medicaid. Here’s a look at its Medicaid work in Indiana in 2008:
Kool Smiles patients
Indianapolis 2…7,195
Indianapolis 1…6,949
Fort Wayne…6,013
Terre Haute…2,055
Medicaid reimbursements
Indianapolis 2…$2.7 million
Indianapolis 1…$2.5 million
Fort Wayne…$2.4 million
Evansville…$1.7 million
Highland…$1.1 million
Terre Haute…$746,000
Indiana$11.1 million
•Medicaid and CHIP patients treated by Kool Smiles: 7.8 percent
•Medicaid and CHIP claims filed by Kool Smiles: 6.6 percent
•Medicaid and CHIP reimbursements paid to Kool Smiles: 6.8 percent
Deanna Vasquez said she realized something was wrong when she found herself helping a dental assistant hold down her 4-year-old son’s arms and legs as he writhed and screamed.
“You’re basically brushing his teeth,” she said. “I thought, ‘I could do this at home without holding him down.’ ”
But it wasn’t just her son’s screams that left her queasy, she said. It was also the screams of other children – from behind the closed doors of other rooms at Kool Smiles dental clinic, 1852 Bluffton Road.
“Kids were screaming their heads off,” Vasquez said.

She saw one girl emerge. She was 8 or 9 years old, Vasquez said, and had obviously been sobbing. Her parent was in the lobby.

Five sets of parents told The Journal Gazette that Kool Smiles does not allow parents to be with their children during cleanings or procedures. Vasquez’s presence with her son was allowed, she said, only because she insisted she could help calm him down and that they would leave otherwise.

Kool Smiles denies barring parents from its procedure rooms and says its staff acted appropriately.
The national chain of 84 clinics has been accused of overtreating its patients, of prohibiting parents from procedure rooms and of being too quick to restrain the children it treats. Kool Smiles denies any wrongdoing.
Vasquez worries she did the wrong thing in helping Kool Smiles restrain her son – something she now regrets.

Crystal Allen understands.
She had taken her children to the dentist every six months, she said, until financial problems made it impossible. A year after their last appointment, her daughter had a toothache, and Kool Smiles in Fort Wayne was the only practice she could find to see her immediately.
“They made me feel about this tall when they told me how badly I had neglected their teeth,” Allen said. “I left there thinking I didn’t deserve to have kids if I couldn’t take care of them.”
Then came the hard sell, she said.
Kool Smiles said her daughter, 10, needed stainless-steel caps put on four of her baby teeth, and her son, 5, needed six stainless-steel caps. Immediately.

“They were like, ‘This is so important, you need to get it done now. We can make time today; you don’t know when these other teeth are going to go,’ ” Allen said. “I was like, ‘You’re kidding.’ And he was like, ‘No, she’s here, she needs to get it done.’ ”

Then Allen looked around the waiting room.
“There were two kids there, and every tooth in their mouth was stainless-steel caps, including their front teeth,” she said. “Top, bottom, front and back.”
Dropped in home state Kool Smiles specializes in treating children on Medicaid, a federal health insurance program for the poor run by individual states.
That means taxpayers cover the cost of most of the care provided.
Kool Smiles, based in Atlanta, lost its authorization to do Medicaid work in its home state two years ago because of allegations it was overtreating its child patients and questions about its practice of strapping children down.

According to WellCare Health Plans, the company that handles Georgia’s Medicaid program, Kool Smiles dentists were performing 17 percent more procedures per patient than other dentists.
When compared with patients of other dentists, WellCare said, a child treated by Kool Smiles was:
•Five times more likely to receive crowns.
•Four times more likely to receive five or more crowns.
•Forty percent more likely to have their teeth pulled or extracted.
•Three times more likely to be physically restrained during dental procedures.

While Kool Smiles patients were about 5 percent of WellCare’s dental clients in Georgia, those patients accounted for about 20 percent of the Medicaid money spent on dental care in the state, WellCare claimed.

Dr. David Strange, chief dental officer for Kool Smiles and the company’s national spokesman, said the company has been cleared of all allegations. Doral Dental covers dental work for WellCare.
“We have letters from Doral, the third-party provider in Georgia, really, that we’re quite proud of, stating that they did not have any clinical issues with the charts that had been reviewed,” Strange said.

“We received numerous letters, numerous accounts from Doral stating that they don’t have issues and don’t have concerns with the care provided by Kool Smiles associate dentists.”

But the letters Kool Smiles provided as proof it had been cleared do not refer to the allegations made by WellCare. The letters, written in January, refer only to specific Kool Smiles locations and say they are in response to audits requested by WellCare in September and October 2008.

The allegations that led to Kool Smiles’ contract with WellCare being dropped were made more than a year before, and the audit was being conducted by the Georgia Department of Community Health’s Inspector General.

That audit, according to Georgia Department of Community Health officials, found Kool Smiles had performed a “large number” of tooth restorations on children without anesthesia; excessive treatments during the same visit without some type of sedation; large amounts of local anesthesia given to patients below the proper weight; and one treatment in a Kool Smiles clinic that should have been performed in a hospital. Kool Smiles settled the charges with the state in January 2008 for $193,508.

A follow-up statement from Kool Smiles says its contracts were dropped “without cause” and that the allegations made by WellCare were unfounded. Georgia officials said Kool Smiles as a group is still a Medicaid provider, but the 18 locations involved in the investigation are not.

Investment-firm owned Kool Smiles was started in 2002 by Dr. Tu Tran and Dr. Thien Pham. Today, the chain of clinics is run by NCDR, a limited-liability corporation formed in Delaware, headquartered in Atlanta and owned by the San Francisco investment firm Friedman Fleischer & Lowe, state records show.
Most states require dental offices to be owned by dentists. Tran and Pham own Kool Smiles – and incorporate a new Kool Smiles company in each state where clinics are located. The clinics are then run by NCDR or DPMS Inc., also owned by Friedman Fleischer & Lowe.

According to Indiana Secretary of State records, NCDR should not be operating in the Hoosier State: It has not paid its annual business license fee in two years, and in February, the secretary of state revoked the company’s authorization to do business here. State law provides for a $10,000 fine for operating without authorization.

Strange said he was unaware NCDR cannot legally do business in the state and would look into the situation. The company later said it appeared to be a paperwork problem that would be resolved.

The corporate structure means Tran is listed as the lead dentist on each of the dozens of Kool Smiles clinics across the country, though he does not practice at any location. Pham is in the process of retiring from the corporation, Strange said.

Kool Smiles’ 84 clinics span the nation, and so do the allegations against the company, especially from parents who say their children were given – at taxpayer expense – dental work they didn’t need (See related story).
Crowns are ‘routine’ Strange said allegations of over-treatment by Kool Smiles are unwarranted, and he says its patients are often children who are not receiving regular dental care and have severe tooth decay.
“I get asked all the time, does my child really need a crown? And the answer to that is very, very often a resounding yes,” Strange said. “A stainless-steel crown that’s placed on a tooth that’s severely decayed, that has inter-proximal caries (cavities between teeth), on a child that’s at high risk for additional dental (cavities), a stainless-steel crown is oftentimes the most effective, most reliable and most well-suited dental treatment that can be provided.”

Dr. Bradley R. Smith, a Colorado dentist and a spokesman for the American Academy of Pediatric Dentistry, said it is difficult if not impossible to make blanket statements about placing crowns as opposed to fillings on teeth, even on baby teeth that will fall out within a few years.

“If the patient has never been to a dentist and I have very little confidence I’m ever going to see that patient again, I’m much more likely to do a crown because I know it’s more resistant to decay in the future,” Smith said. “That’s a reasonable decision the doctor has to make for each individual patient.”
Smith said it comes down to informed consent: Do the parents understand all the options and the implications of each one?

If not, “then that’s not a good thing,” Smith said.  Strange said the patients Kool Smiles sees might never have been to a dentist and might never return, so it makes sense they would do more crowns.
“We’re seeing children for the first time at age 4, 5 and 6. They have extensive needs without a dental home.

… We’re seeing children where the effects are really quite devastating throughout the entire oral cavity,” Strange said. “Crowns are very much a part of routine children’s pediatric dental care.”
‘He passed out’
Noah Fedele-Woodley, 4, went to the procedure room alone at Kool Smiles’ location in Newport News, Va., because his mother and grandmother were not allowed to accompany him, said his grandmother, Carol Fedele.

“They brought him out screaming. He was soaking wet,” Fedele said. “He was literally saturated from head to toe from crying and sweating. … Once his mother was holding him, he collapsed. He passed out in her arms.”
Burst blood vessels were found on Noah’s face and neck, known as petechial hemorrhaging clusters, which can be caused by trauma to the skin or stresses such as intense vomiting.

“(The dentist) said it happens all the time; they get it from crying,” Fedele said. “He said, ‘They all do that; they just showed up on him because he’s light-skinned.’ ”

Noah’s Kool Smiles records from that visit show the boy was restrained for 25 minutes. Noah’s mother had signed a consent form six months before, in July 2008, but had no idea she was giving permission for Noah to be strapped down, she said. The form is labeled “Pediatric Dental Patient Guidance Techniques.”

Noah also had bruises on his cheeks, Carol Fedele said, as if his mouth had been squeezed open.
Kool Smiles employees reviewed Noah’s records “and continue to believe we provided medically necessary dental treatment,” the organization said in a written response. “Kool Smiles adheres to the treatment policies and guidelines of the American Academy of Pediatric Dentistry and the American Dental Association.”

The American Academy of Pediatric Dentists’ guidelines say restraints should be used only as a last resort and are meant only for medically necessary treatment. “The use of protective stabilization has the potential to produce serious consequences, such as physical or psychological harm, loss of dignity, and violation of a patient’s rights,” the guidelines warn.

Strange did not deny that Kool Smiles patients are three times more likely to be restrained but said it was “an apples-to-oranges comparison” because Kool Smiles sees only children. “We see a patient population that is, generally speaking, younger than the other dentists’ in the community,” Strange said. “It’s kind of like saying a preschool compared to grade school uses more crayons and that using more crayons is somehow inappropriate.”

So younger patients are going to require more restraints?
“Younger patients require different types of treatment. Protective stabilization happens to be that type of treatment,” Strange said.

Strange said that with parental consent, it can be appropriate to restrain a child for any treatment, even an exam. “This needs to get back to the focus, and the focus is really on the children, and if you can’t do an exam, then you’re not focusing on the child,” Strange said. “From my perspective, from a clinician’s perspective, that’s key.”

An assembly line?
For years, advocates for the poor have complained it is difficult to get dental care because so few dentists are willing to accept Medicaid patients, at least in part because of low reimbursement rates.
But Kool Smiles has found a business model specializing in Medicaid patients. The corporate information Web site estimates NCDR has 500 employees at its Atlanta headquarters and did $20.1 million in sales nationally in 2008.

In 2008, the Indiana Family & Social Services Administration, which administers Medicaid, reimbursed $2.4 million to Kool Smiles in Fort Wayne. Statewide, the six Kool Smiles locations were paid $11.1 million in Medicaid reimbursement last year.

Unlike the statistics in Georgia, Indiana FSSA figures show reimbursements to Kool Smiles in line with their number of patients.

Still, the Kool Smiles business model thrives on volume. FSSA said the Fort Wayne clinic had more than 6,000 separate patients in 2008.  Dr. Todd Parco, a dentist in New Mexico, even placed a help-wanted ad for dentists tired of the fast pace at Kool Smiles.

“If you are wanting to get out of the dental mill scene like Kool Smiles … and want to find something infinitely better, give us a call,” the ad said. The Fort Wayne Kool Smiles hygiene bay contains six dental chairs, so six cleanings can be performed at a time.

Kool Smiles rewards its dentists for working fast – they can earn bonuses of more than $10 an hour for production, according to a help-wanted ad the company placed in a trade publication. “In any profession, the more productive you are, the higher your compensation,” Strange said.

“The point that really needs to be made is at Kool Smiles, we are very, very particular and very committed to ensuring that all of the dentistry that’s provided is quality dentistry.”  Strange also disputes claims the company keeps parents out of Kool Smiles treatment rooms.

“The company doesn’t have a policy where parents are excluded from participating in treatment with their children,” Strange told The Journal Gazette. “The company does have a philosophy that most children do well without the presence of the parent. However, we do have an open door when it comes to treating children, and our parents are actively encouraged to participate in the Kool Smiles dental experience.”

But parents from five different families contacted by The Journal Gazette said they were told it was company policy they could not accompany their children and that children whose parents insisted on staying with them would not be treated.

A sign in the waiting room of the Fort Wayne Kool Smiles on July 21 stated: “Parents MUST remain in the waiting room while your child is being treated or they will NOT receive treatment.”

Strange said the sign meant only that if parents choose not to accompany their child during treatment, they cannot leave the premises. That sign has since been removed.

“I was not allowed to go back” to the treatment room, Crystal Allen said of her children’s visits to Fort Wayne Kool Smiles. “I was unable to see anything.”

Christina Bergbower took her children to the Terre Haute Kool Smiles and was told it was company policy that she could not accompany her children. “I said, they’re a minor, and by law I can be there with them, and they told me it was their policy – it was on the wall that it was their policy,” Bergbower said. “They make it very clear to you that parents are not allowed in the back.”

Strange said that is not true at any Kool Smiles location.

“The short answer is absolutely no, we do not have a policy that precludes parents from being in the back or in the operating treatment facilities with their children,” he said.
BBB grade changed A dentist at the Terre Haute Kool Smiles told Bergbower that her 6-year-old son Cody’s tooth was so decayed he had to have a stainless-steel cap put on it.

When she took him to another dentist, however, the cavity was found to be so small they were able to fill it without using Novocaine.  Bergbower’s 16-year-old daughter, Shauna, was told by Kool Smiles she needed fillings for four cavities. Another dentist could not find any.
“I showed them the paper from Kool Smiles,” Bergbower said. “She said if she would have had those teeth filled, it would have caused pain and discomfort and set her bite off.”

Strange said Kool Smiles has a vigorous internal-review process that investigates any complaints made, but it gets few – just one-half of 1 percent of their patients complain, he said.  The Better Business Bureau in Fort Wayne gave the Fort Wayne Kool Smiles a grade of F because a customer had filed a complaint and the BBB never got a response from the company.

“An unanswered complaint is a big deal in the BBB system,” said Michael Coil, president of the BBB of Northern Indiana. “All you have to do is respond. We’re not saying they’re wrong or right. All we’re trying to do is get their side of the story.”

Kool Smiles says it did respond, but the BBB somehow never received it. It refiled its response after being asked about it by The Journal Gazette, and the grade was changed to a B-. It was later changed to a B+ when the company responded to a BBB survey asking for basic company information.

Strange said the situation appeared to be an oversight.

“That’s certainly uncharacteristic that we wouldn’t have responded,” Strange said. “We really, truly are people interested in doing the right thing.”

One thing not noted and probably not known by the reporter is Dr. Todd Parco is related to Dr. Adolph Padula, one of the founders of Small Smiles.  Currently Dr. Parco operates a clinic in Las Curses, NM with another [former?] Small Smiles executive, Dr. Ken Knott.