Sunday, July 13, 2008

After the first Small Smiles Report

Over the course of a few months, after Roberta's first report, there were a lot of follow-ups and communications between a lot of organization and state agencies and FORBA, now known as Church Street Health Care Management.
November 2007:
At that time, Maryland had 3 companies that managed their dental program.
  1. Amerigroup who contracted out to Doral who contracted with FORBA (this drives me insane!)
  2. United Healthcare - Mid-Atlantic Medicaid Plan (United Medicaid/UHCMA) who contracted with Dental Benefit Providers, Inc.
  3. JAI Medical Systems
All these companies started investigating Small Smiles clinics Nov. 9 and Nov. 12, 2007.

November 9, 2007 Mike Lindley tells employees there would be audits that they estimate may take 30-45 days and during which time they could not seek reimbursement, but they had made the decision to continue to treat patients.  (because they felt so strongly about taking care of the underprivileged, all services would be "at no charge". 

[Am I the only one who doesn't think they knew how things would end and they could float these clinics for a couple of months, no problem]

Amerigroup/Doral: (like every company who gets a bad name, they too have changed their name, Doral is now Dentaquest)

November 9, 2007 Amerigroup wrote Maryland Dept of Health telling them that Doral had suspended all four SS clinics in MD and DC pending outcome of investigation.

February 15, 2008 Doral writes Maryland Department of Health and said they had completed their investigation and had required Small Smiles to make some changes.  Now Doral "clients" which include Amerigroup, had given "written" permission to allow SS back into the network and receive payment, as of 1-21-08 . Doral also said Maryland Physicians Care, Coventry Diamond Plan and Priority Partners had also given permission to allow SS back into the network of providers.

Doral said it mandated SS to immediately discontinue use of Papoose Board until clinic staff receives "Significant advanced training on the use of the papoose board."  "Training documentation must be maintained on site" and the Informed Consent form must be updated explaining the risk.

They also said that would be "modifying our requirements for use of Papoose Board nationally, and will be requiring that all general dentists who use them have training in their use that is consistent with AAPD guidelines."  Signed by Kevin Klein, VP Marketing and Development at Doral Dental USA.

[We know this never happened!!!  Nor did Doral Plan on it.  If Doral had implemented this, why isn't there some papoose board training programs somewhere?  Surely some company would have started up a training program, right?]

United Healthcare/Mid-Atlantic (UHCMA)/ Dental Benefit Providers, Inc

November 9, 2007 United Healthcare wrote Maryland Dept of Health telling them they suspended all SS clinics pending outcome of their investigation and were removing any reference to SS from their website and reaching out to their particular members to make other arrangements for their treatment.

January 30, 2008 United contacts Maryland Department of Health saying they had concluded their investigation, they found they "overpaid"  Small Smiles $253K but could not identify a pattern of obvious billing errors or pattern of fraud.  They too implemented a Corrective Action Plan for more detailed review, check for up-coding etc.  They talked as though they were looking deeper into it and expects a full report by mid May 2008.  They never said if they were letting SS back into the network or not.

November the week of Nov. 9, 2008  JAI and Todd Cruse had a chat and some correspondence. 

November 14, 2007 JAI writes FORBA and says they are checking into things and depending on the outcome may terminate them from their network. 

State of Maryland:

December 11, 2007
  Shelly Lehner and a Dr. Roosevelt Bush visited three SS sites.  They reported their findings to Susan Tucker, Ex-Director of Maryland Dept of Health.  They said they check out patient charts that had a large number of root canals and crowns but found no fraudulent billing nor able to identify any services that were performed on children that were not medically necessary.
They said they talked to the dentists and found they took many CE courses. 

(honestly this is what is said next) 
"This means that many of their dental procedures are consistent with what is happening in the dental practices across the country."
[WHAT! Because they take CE's everything they do must be ok and what's happening in dental treatment!  Is this person a complete idiot or just a plain old fashion fool?  clearly the govt didn't take these idiots word for it, since they nailed Small Smiles two years later for $24 million to settle the fraud, I hope Maryland didn't call upon these two ever again!]

July 8, 2008, John Folkermer of Maryland Dept of Health said they had implemented some requires for SS and must let parents back with children, training for papoose boards and change the consent form.  And they were working on sweeping changes and hopefully by 2009 there would only be one company managing the dental services.

All these letters were made available at WJLA website, under the heading Audit Reports.