Wednesday, February 20, 2013

Systemic breakdown attributes to massive fraud

I’m not sure where the breakdown is, but there is no doubt a breakdown; a big one!  Either agencies are failing to report, or the OIG is failing to add criminals to their list. Which ever the case, the free flow of tax dollars from your pocket to fraudsters bank accounts goes unchecked.

In checking to see if Dr. Robin Lockwood is at least excluded from defrauding taxpayers from any more money for her employer, Ocean Dental, I find she still has access to our tax dollars; she’s not on the governments List of Excluded Individuals and Entities (LEIE). 

According to the OIG, if a criminal conviction is related to – Fraud, Obstruction of an investigation or misdemeanor conviction relating to controlled substances and should be reported as soon as the defendant is sentenced - even if appealed - there is supposed to be a “Mandatory Exclusion”. Maybe mandatory means something difference in government-speak.

Mandatory exclusions: OIG is required by law to exclude from participation in all Federal health care programs individuals and entities convicted of the following types of criminal offenses: Medicare or Medicaid fraud, as well as any other offenses related to the delivery of items or services under Medicare, Medicaid, SCHIP, or other State health care programs; patient abuse or neglect; felony convictions for other health care-related fraud, theft, or other financial misconduct; and felony convictions relating to unlawful manufacture, distribution, prescription, or dispensing of controlled substances.

The sources who are supposed to report to the OIG are the USAO’s, MFCU’s (Medicaid Fraud Control Units), Local Prosecutors, State Medicaid Agencies and Licensing boards and should include the judgment, plea agreement, final actions, indictment information, investigative report or narrative, aggravating factors, mitigating factors, and a cover letter with a brief summary.

There are numerous acts under which the government should stop the massive fraud, one being under the Social Security Act 1128(b)(4), where Michael DeRose, DDS and William Mueller, DDS the founders of Small Smiles Dental Centers are listed.

A 1128(b)(4) is one where an individual or entity has had their license revoked, suspended or otherwise lost or voluntarily surrendered, lack of professional competence, professional performance or financial integrity.  The length of the exclusion is indefinite but they are eligible for reinstatement once license is reinstated.

Lockwood, doesn’t have to worry about falling under the 1128(b)(a) act, her Oklahoma dental license is squeaky clean, even though her butt is in the “big house”. 

I wonder if it matter if the individual just owns a clinic, are the excluded?  For instance Michael DeRose owns two medical facilities – Cardiology Now – and they take Medicare and Medicaid. He has ownership in two of the three clinics, the one in Denver and the one in Ohio. What’s up with that? Oh, and we sure can’t leave out Michael DeRose’s backdoor ownership of the Smile Starter’s dental centers in North Carolina. (however, they may be low on patients as this new video suggests – Smile Starter’s fashion show a-go-go)

According to advice from operated by the Leichter Law Firm, there are loopholes and they should be utilized. Let me say here, the Leichter Law Firm should not be concerned because they are being over-utilized!


OIG Presentation

Search Exclusions

Texas Administrative Code to Exclusions

PS – Dental Boards, you are screwing the taxpayers from stem to stern, here.  REPORT, REPORT, REPORT!