Thursday, December 30, 2010

Nashville Biz Journal Picked Up FORBA's Name Change

I guess my work is done.

Small Smiles parent company changes ways, name following scandal

Date: Wednesday, December 29, 2010, 2:34pm CST
Management at FORBA Holdings LLC say the Nashville-based dentistry company has changed its ways. It is also changing its name.
Beginning Jan. 1, FORBA becomes Church Street Health Management, a reference to the company’s corporate headquarters at 618 Church Street.

Senior Vice President Todd Cruse said the name change better reflects the company’s “overall purpose and mission” of providing dental care to underserved communities. FORBA operates 68 Small Smiles Dental Centers in 22 states, none of them in Tennessee.

In the last 12 to 18 months, FORBA has expanded beyond providing dental services to children and now treats adults, Cruse said. Its also has begun offering other lines of oral health treatments, including oral surgery and orthodontics, and has struck up relationships with outpatient surgery centers for more complicated procedures, he said.

The name change is also a fresh start of sorts for FORBA, which in January 2009 agreed to pay $24 million over five years to settle charges that it billed Medicaid for unnecessary dental procedures on low-income children.

Read Complete Article Here

Monday, December 27, 2010

FORBA Holding, LLC Changes Name Once Again ; Now Church Street Health Management, LLC

Another name change for FORBA!
No Big Surprise, most companies who end up with a horrible reputation do a name change, but the leopard never changes it's spots.  They can change their name weekly if they want, but what they do and how they do it isn't changing.

Look for your "One Call Sees All" card in the mail, advertising they are accepting adult patients.

Wonder what happened to the sales pitch surrounding FORBA - For Better Access?
FORBA Holdings, LLC is now
Church Street Health Management, LLC  or CSHM

The name changed was filed today, in Colorado, December 23, 2010 at 2:24PM 

Look For Letter Head and Business Card To Be Ready To Go By January 1, 2011
Big Smiles and Small Smiles, since they are treating adults now.

Monday, December 20, 2010

LSU Study On Behavioral Management - 2005

What about a MotivAider instead of Papoose Board, however, it might take longer than 10 minutes!

LSU study on Behavioral Management in the dental setting.

Sunday, December 19, 2010

"Operating As" "But not Really"

I've noticed a lot of ads in the past few months have the phrase I've highlighted.  "Operating as"  Sounds to me that is only the first part of the phrase, the omitted ending would be "but not really".  I just love how creative they get with their wording.  They imply they are operating individually knowing they are not.


Ad for Dental Assistant in Muncie, Indiana

Small Smiles Dental Centers, the nation's most experienced dental provider to children who qualify for government insurance and has been named one of Fast Company Magazine's 2007 Fast 50 Companies doing good in the world. We have over 60 dental centers in the United States operating as individual practices where each team member takes our mission seriously. In order to accomplish that assignment we must hire great people! And we have an excellent opportunity for an ambitious DENTAL ASSISTANT to grow our state-of-the-art dental center.

Friday, December 10, 2010

How To Have Perfect Chart Audits

When Corporate sends the list of 10 “random” case files for their audits, here is what to do:

Step 1 -  Pull the charts.

Remember, Corporate already knows exactly which charts to pull as they get a report every day on who was treated, what was done, why treatments were done, or why patients did not wait to be “converted” from Hygiene to Operative, etc.

Every day, they know how many appointments were scheduled and how many canceled.  They know what patients they saw, how many crowns were placed on each patient and who treated the patient.   I am sure they know where the treatment took place (i.e. the OR or clinic).  They know if treatment was not completed and they know why.

Each day, Corporate knows how many patients are on the appointment schedule a month or more in advance.  It is all in the computer.  It is even broken down by the department; the exact number scheduled for Hygiene\Operative\ and the Total, no doubt.  After all, this is a For-Big Profit organization.  Clinics and the employees within are answering to a “higher power” and it is not a divine being.

  • Actual revenues for the week
  • Who was off from work that week or day and why
  • Number of customers that week, in this case patients.
  • How many were new, how many were reschedules, how may kept their assigned appointment, how many did not.
  • Amount of supplies used and the difference from what was budgeted.
  • How many morning “huddles” for the week, who was there and who was not.
  • The number of returns, in this case redos.
  • Likely to include customer comment cards, the good ones, as the bad ones get tossed.
  • Any new hires, any fires.
  • Problems that need to be address, such as Nitrous Oxide levels too high in the clinic.  Those sort of things.

Step 2 - Immediately print out the account information on each chart pulled.

Step 3 - Make photo copies of everything in the chart, include a copy of the x-rays.

Step 4 - Give to the HBIC (Head Bitch In Charge).

Step 5 -  HBIC will review each file to make sure everything documented in the chart matches what the computer said was done to that patient

HBIC makes sure if the computer statement said tooth A (upper right baby tooth) but the chart said it was tooth M (lower left) that entry was corrected.

But which was true?  Without recalling the child for a look-see, who actually knows.

If they do not match, make them match.  Either by rewriting the treatment plan or correcting the record in the computer.

Maybe they will make a note to check the actual child when he or she comes back for the next visit and it will be corrected again, then maybe it will not even be checked and life goes on.

How can the chart be changed, you ask?

It is only my opinion, I would say, adjust the chart would be much easier since the account has already been billed out and you would have to add to the billing or make other  billing corrections.  So chart changing might be the best choice.

With such a high turnover at these places, it seems it would be difficult to correct chart notations to match the original hygienist, dental assistant’s and dentist’s notations. 

Maybe the best would be a whole new document.

Except when one forgets, that the new handwriting belongs to a new employee who was not there when this patient was seen, but who is going to look at that, right?

If the original employee is still there, the HBIC could just approach the hygienist, assistant or associate dentist and threaten them with their job, if they do not fill it out or at least sign the new and improved treatment plan and charting.  Talk about being put on the spot, it is not like the employee would have a couple of days to think about it.  After they sign it, what do they do then?  You do as you are told if you want to keep your job, feed and clothe your family and keep a roof over your children’s head.

Maybe you also forgot to have the parent sign the treatment consent form.  What about the “It’s Ok To Strap My Child Down, Man Handle Them, and Send Them Back To Me Covered in Puke and Urine” form.  Ooops. 

That would be easy to correct, especially if they have the parent’s signature on other forms.  Just trace it, right?  not send it.

Again, who is going to check?

Of course, there are times when things are crazy in the clinic and treatments completed will get left off the chart.   But how did the treatment get on the computer account if it was not charted?  Hmmm…

The dentist is supposed to review the chart of the patients they saw at the end of the day.  Ideally, the dentist should be doing a quick review of the chart immediately, as the patient is being cleaned up and walked out. 

I think it would be good, to do as my doctor does and as soon as he steps out of the room with my chart in hand, out comes his recorder and he immediately records in his very own voice what treatment was done, what diagnosis was made and when he wants me back.

Mistakes happen and agreed, many of the assistants are not trained and most likely worked at the local 7/11 last week.

Step 6 - The copies of the charts are put into a Fed-Ex package and shipped off for analysis.  In about a week or so, a grade is handed out, just like in school, and points given toward your bonus for doing such a marvelous job.

I bet if you can ask, the office staff will know how well they do on chart audits, and whether they are at the head of the class or sucking hind tit.

Of course this is no way to do a chart audit.  The Regional Manager should be doing this, if he had a clue what he was doing and not a former mortician or something.

Better, would be the company Compliance Officer  off his or her ass or Assistant Compliance Officer, if there was one, to fly around from clinic to clinic and do the audits.  What about an outside objective party do the chart audits?

Surprise visits are the ticket to proper chart audits.  An auditor marches in, briefcase in hand, and start pulling charts.

When chart audits are done in this manner it means nothing when told how fantastic Compliance is within the company, in fact, it is laughable.

I have heard FORBA has an in-house specialist on this matter.  They may even give “webinars” on the best possible signature forging technique.  Who knows.  I guess you could just leave that document out and

Wednesday, December 08, 2010

Head Start Dental Home Initiative Ripped From The Grip Of The AAPD

In February 2008, just months after Arcapita, American Capital Strategies, Carlyle Group, CIT, Michael Lindley, Al Smith and others bought all the assets of the Small Smiles Dental Clinics from the DeRose "family", the American American Academy of Pediatric Dentistry (AAPD) was awarded $10 million dollars and a 5 year contract to manage the newly created Head Start Dental Home Initiative. 

Don't tell me this had nothing to do with the sudden surge of dental mills across America.  Of course it did.

In 2009 the AAPD hired a huge PR firm, the MWW Group, to drive home the importance of pediatric dentistry.

In June 2010, the AAPD received the Award of Excellence from the 2010 Associations Advance America Awards program.  This AAAA sounds a bit sinister to me.  Sounds like an award for their success in being hijacked or something.

By November 2010 the Office of Head Start notified the AAPD their services were no longer needed and would be taking control of the Head Start Dental Home Initiative.

Did we get our money back?


FORBA's Small Smiles Clinics Playing Catch Up To Kool Smiles In 2011

NCDR's Kool Smiles Dental Chambers pulled ahead of FORBA's Small Smiles Dental Chambers in 2010 but FORBA  is planning on a big come back by April 2011.
FORBA's Small Smiles Washington DC # 2 is now up and running. 


I wonder how many of the bright smiling faces will be there in 60 days? 

I bet by Christmas these two dentists will be crying in that bed they just crawled into.
Not sure which on is the lead dentist, Dr. Siobhain Sprott and which is Dr. Takeisha Presson.

Think either of these two dentists had their credentialing papers forged by Janelle?  Would they even know if they had?

Muncie, Indiana is not far behind this one.  It may  be open already.  Employment ads have been out for a while on these two clinics. (Indiana is a hot bed for Kool Smiles and Small Smiles, Texas as well)

They are already advertising for employees for the Mission, TX Small Smiles clinic set to open the end of January 2011.

By the first of May 2011, plans are to open a second clinic in Hartford, CT, a third and fourth in Baltimore, Maryland, with another Maryland location and two more in Indianapolis, Indiana.
Imagine the number of children to be herded through another 8 more clinics?

New Clinics To Open In:

Muncie, Indiana
Washington DC #2
Mission, Texas
Baltimore, Maryland  #3
Baltimore, Maryland  #4
Indianapolis, Indiana #3
Indianapolis, Indiana #4
Mystery Maryland Location
Merry Christmas, Y'all!

Tuesday, December 07, 2010

This Is What A Tangled Web Really Looks Like

updated 12/27/2010

Monday, December 06, 2010

Massachusetts New Dental Laws and Regulations Have Dentist Concerned

A wonderful letter from a dentist who is very concerned about the state of dentistry in Massachusetts.   I hope they don't mind that I shared this.


Dear Debbie,
I hope this e-mail finds you and your loved ones in good spirits and good health.

Over here in MA the state dental board passed a host of new dental laws and regulations this past August. While there are a few new laws that at least give a nod towards promoting public safety, when I read many of the laws, I saw many regulations written with dollar signs in mind.

Three of the laws (Public health center, dental director, and public health hygienist laws.) will further entrench the unscrupulous Medicaid mills already present in this state. On top of this horror, a host of sedation laws will allow dentists to be, for all intents and purposes, anesthesiologists.

Deep sedation, whether one is working on the heart or in the mouth, functions the same in both patient populations. In other words, although the specific purposes are different (heart surgery vs dental work), the physiological mechanism is the same, and the risks are the same. Unfortunately, these risks involve death and/or brain damage.

Where things are now different in this state, and where things have gone horrifyingly awry, is that with a brief (and expensive, of course.) period of training, some of my colleagues will be able to place patients under deep sedation. In medicine, MD anesthesiologists and nurse anesthesiologists must go through a rigorous residency program lasting for years. (4 years for MDs and 2 years for nurse anesthesiologist practitioners.)

On a functional level, medicine has recognized that it is better to have a specifically-trained person in a proper setting to perform anesthesia. Medicine recognizes that it's not a good idea for the surgeon to try to sedate the patient, monitor the patient's life signs and breathing, and also perform surgery. The only "positive" side to this hypothetical medical scenario is that the surgeon could make out like a bandit by doing everything him/herself.

Debbie, my deep and abiding fear is the day when the new dental mill-enabling laws in this state converge with the new sedation laws in this state. Imagine what Small Smiles would do with a state-sanctioned sedation carte blanche. Now, it's only a matter of time before the carnage starts. Kids shouldn't die for the profit margins of the ruthless. Goddamn them.
Please be well Debbie.

Saturday, December 04, 2010

30 Year Old Describes Trauma From Being Papoosed At 3

Meridith L.
Posted 05/15/2010

As a person who had a root canal done on a papoose board as a 3 year old, please do not have major dental work done on your child without general anesthesia or conscious sedation.  At 30 years old, I still have nightmares about the experience and have to be sedated for even the most routine work.  At 3 years old, I couldn't tell the dentist that the numbing medications were not working and that I could feel every second of the root canal.  They dismissed my crying as fear and not true pain.

Find a dentist and an anesthesiologist who you love and trust and who will let you be there with your child so that it is calm, peaceful, and a good-as-the-dentist-can-be experience for your child.

Bad, painful, and scary experiences now can lead to a lifetime of fear, trauma, and distress, but good experiences can lead to a healthy smile, good oral hygiene, and improved overall health.


To read for yourself click here

Friday, December 03, 2010

New Fool On The Block In Youngstown, OH Small Smiles Clinic

Looks like we have another change of faux ownership for the Youngstown, Ohio clinic.  Yes, it’s true!  I know, amazing, right?  This is the clinic who had the idiot dentist fall asleep during a procedure.

I know, I know, he says he was dozing while the assistant was doing something, but that assistant says that is a total lie!  I believe the assistant.

The latest foolish dentist to add his name to the Secretary of State’s LLC documents as “owner” of this clinic is….

drum roll please….

Dr. Michael Crites! 

Dr. Michael Crites should know better by now, he’s been there for just over two years.  Maybe being “owner” is his reenlistment bonus.  If so, it is NO bonus!  It’s more like putting your head in the guillotine. 

However, Dr. Crites is no stranger to the Ohio dental board.  There are 16 pages of “actions” against him.  That explains why he fits right in at Small Smiles of Youngstown. 

I find it hard to believe (no I don’t) that he has credentials with any state or and especially any company that manages Ohio’s Medicaid Dental Program.  Geez!

History of this clinic

First registered as an LLC in Ohio February 2007, Joseph Bower the authorized representative, (Agent).  Name- Small Smiles of Youngstown, LLC –Kenneth E. Knott, DDS and Robert F. Andrus, DDS.

Knott and Andrus were “fired” because Kallene West (also let go) was taking their CE’s for them.  However FORBA didn’t have a problem with Kallene taking the CE’s for Dr. Bridgett Merritt-Brooks.  Dr. Bridget is still working her little fingers to the bone in South Bend.  In my opinion Dr. Bridgett is practicing without a licenses in Indiana…but heck, who am I to judge right?  More on this a bit later. 

Back to Youngstown:

Apparently Dr. Michael Crites can’t wait to be added to the next lawsuit.

February 2007
- Small Smiles of Youngstown, LLC- Dr. Robert E. Knott and Dr. Kenneth Andrus.

September 2007- Trade Name - Small Smiles Dental Clinic of Youngstown

September 17 2008- Small Smiles of Youngtown, LLC- Jodi Kuhn, DDS and Patricia Nicklas, DDS.

February 4, 2010 - Small Smiles of Youngtown, LLC – Jodi Kuhn and Olivia Croom, DDS

October 4 2010 - Small Smiles of Youngtown, LLC-Michael Crites, DDS

Where are those documents of the sale of this clinic?
Someone needs to send out the “Prove It” letter to Dr. Michael Crites.

Anyone, Bueller, Ohio Dental Board?