Sunday, July 28, 2013

Corporate dentistry criticized for unethical practices, unnecessary procedures

Anniston Starby Eddie Burkhalter

Jul 28, 2013

When Quintoya Seawright’s 3-year-old daughter, Destiny, chipped a baby tooth in November 2010, the young mother took her to the Small Smiles clinic in Montgomery. Quintoya, 25, would end up taking her daughter to the clinic four times that month.

On the last visit on Nov. 9, her daughter was strapped to a board for an hour while the dentist struggled to place two stainless steel caps on baby teeth while her daughter screamed and struggled, saying she could still feel it, the family said.
But without much money, the young mother had to rely on Medicaid to pay for her daughter’s care. Small Smiles specializes in treating children eligible for Medicaid. The company operates another clinic in Dothan.

The large dental chain is owned by a private equity firm and is managed by Nashville-based CSHM LLC. A report released by the U.S. Senate Finance Committee last week claims Small Smiles and clinics like it are motivated by profit, often performing unnecessary procedures, and should be removed from the Medicaid program.

The report also says the clinics are operating in violation of laws in 22 states, including Alabama, that ban anyone other than a licensed dentist from owning a practice. The report states that CSHM actually owns and operates the clinics, and not the “owner” dentists the company enlists to skirt to get around those state laws.

Quintoya said she was never allowed to go back with her daughter to watch the procedures at Small Smiles, but the 3-year-old girl’s grandmother, Sophia, demanded she be allowed on the girl’s last trip.

Destiny began pulling at her mouth, so workers strapped her arms and legs to the board, then the dentist struggled for an hour to place the two caps on the tiny baby teeth while Destiny “kept saying she still felt it. He said, ‘No. She’s numb. It’s just the noise,’” said Sophia.

“Her heart was just beating so fast,” Sophia said. “The lady was holding her head down and was trying to get her to open her mouth by squeezing her nose.”
Destiny had a total of five stainless steel caps placed on baby teeth over four visits. One cap fell out along with the tooth a couple weeks later. Quintoya said she never heard the dentist say her daughter had cavities in those teeth, but he said the caps would help prevent them from forming.

“I’m not sure if it was a necessity to have all those silver things in her mouth,” Sophia said.

Read more: Anniston Star - Corporate dentistry criticized for unethical practices unnecessary procedures

Thursday, July 25, 2013

Anniston Star reports on Small Smiles and Aspen Dental Operating in Alabama

Don’t miss this is an in-depth report. Mr. Burkhalter asks some hard questions, the answers didn’t surprise me.  Standard responses expected. 
“We didn’t do it” 
“We didn’t know it” 
“It’s not our problem”

Alabama dental clinics operating illegally, Senate report says

by Eddie Burkhalter

07.25.13 - 08:04 am

Anniston Star Alabama Report July 24, 2013Several Alabama dental clinics are operating in violation of state law, and are putting profits before patient care, according to a report released this week by the U.S. Senate Finance Committee.

Those clinics are performing unnecessary procedures to pay the corporate investors that own the clinics, the report states. The report recommends that state and federal agencies end that practice by enforcing existing laws.
The 1,500-page report, put out by Sens. Charles Grassley, R-Iowa, and Max Baucus, D-Mont., marks the end of a two-year investigation into the practice of corporate dentistry by the staff of the Senate’s Committee on Finance.

Among the companies investigated was Aspen Dental, a nationwide chain of dental clinics that is opening an office in Oxford this year.
Small Smiles dental clinic — one of the largest dental chains in the U.S. — operates clinics in Dothan and Montgomery, and is the center of much of the Senate investigation and report.

According to the report, Small Smiles, managed by Nashville-based Church Street Health Management, skirts laws in states — including Alabama’s Dental Practice Act — that ban dental clinics from being owned by anyone other than a licensed dentist.

The company does that by entering into contracts with “owner” dentists licensed in the state in which the clinic operates, according to the report. CSHM claims to only manage the clinics, the report’s authors write.

But the company retains control of daily operation, according to the report, from hiring, firing and training staff to controlling the bank account and setting production goals that require dentists to treat large numbers of mostly low-income children eligible for Medicaid.

Read the rest of this in-depth report here.  Don’t forget to make your comments.

WTAE Pittsburgh Reports on Senate Investigation of Small Smiles Dental Clinics and Reachout Healthcare America

Senate report says Small Smiles dental clinics wasting taxpayer money
Report: No more Medicaid for Small Smiles

Jul 24, 2013


PITTSBURGH —A blistering report says taxpayer dollars are being wasted at a national chain of dental clinics, including one in Pittsburgh

The Senate began its probe following a Channel 4 Action News investigation into the Small Smiles dental clinic.

The clinics have been accused of performing unnecessary procedures on children to get more taxpayer money from Medicaid.

In its report, the Senate Finance Committee says that is still going on and so Small Smiles should not get more money from Medicaid.

None of the families interviewed outside the Small Smiles clinic in East Liberty were aware of the Senate report.

After learning of the report, the Bagley family had second thoughts about the surgery being planned for 5-year-old Christopher.


Read more and see video report, along with other investigations of Small Smiles by WATE  here:

Wednesday, July 24, 2013

Another WFAA – Byron Harris report on All Smiles Dental Centers and Dr. Richard Malouf

July 23, 2013


Bio | Email


Posted on July 23, 2013 at 10:10 PM

Updated today at 2:46 AM

DALLAS –– An unprecedented release of documents by the Dallas County District Attorney’s office tracks the investigation of All Smiles Dental Centers (ASDC) for eight years and illustrates how local, state and federal officials responded to information and complaints about the clinics.

Dr. Richard Malouf and his wife Leann displayed the trappings of wealth as owners of ASDC,  as their clinics treated children under the Texas Medicaid dental program. D Magazine named their mansion as one of the city’s 40 largest. A private water park and pair of corporate jets were theirs to enjoy as well. 

News 8 obtained hundreds of pages of documents in the investigation of Malouf and his former company, All Smiles Dental Centers, under the Texas Public Information Act.

Read the entire story at WFAA Website Here

Tuesday, July 23, 2013

Senators’ Report Reveals Oxon Hill Maryland Small Smiles As Bad Today As It Was In The Beginning.

Despite signing a Corporate Integrity Agreement with the US Government in 2010 Small Smiles Dental Centers continue with their fraud and abuse of children as reported in The Joint Staff Report On The Corporate Practice of Dentistry In The Medicaid Program issued by Committee on Finance United States Senate, Max Bacus,Chairman and Committee On The Judiciary United States Senate, Chuck Grassley, Ranking Member, July 2013.

(Despite the 1,500 pages in the report only pages 1-33 (5-37 of the pdf file) are the findings and recommendations, the rest are exhibits

Oxon Hill Maryland

Oxon Hill, Maryland was one of the dental centers reported on in 2007 which brought Small Smiles Dental Centers to the public’s attention.  It’s been 6 years and appears nothing has changed much.  Here is just some of what the Joint Senate report says about the Oxon Hill Small Smiles Clinic:

Senators Max Baucus and Chuck Grassley issue 1,500 page joint report calling for corporate Medicaid dental clinics to be ousted from the program

Today, Senators Baucus and Grassley issued a 1,500 – 1517 pages to be exact — page report on claims I’ve been making here on Dentist The Menace for nearly 6 years. The report includes 66 exhibits.
Center for Public IntegrityThe story accompanying the release of the Joint Staff Report On The Corporate Practice of Dentistry In The Medicaid Program can be found at The Center for Public Integrity, here.  In David Heath’s story, he reports the new owners Small Smiles Dental Centers state the following:
only five of the 20 inspection reports mentioned in the Senate report fell under its watch.”
…"We've taken action to help CSHM improve its quality of care and management,"
…“The new team immediately initiated an aggressive turnaround effort premised on patient care, clinical excellence and regulatory compliance,” the company said.
Well, that’s nothing to be crowing about, since the “new management”  only legally acquired the company 13 months ago putting a guy by the name of David R. Wilson in charge. That was in June of 2012, (13 months ago) so 1/4 of the inspections mentioned in Bacus/Grassley report took place under their watch. This is not a good record in my opinion — heck it’s as bad if not worse than the Michael Lindley/Al Smith or DeRose Family regimes.  Nor it does it demonstrate anything close to “an aggressive turnaround effort on patient care”.  What it does demonstrate, however, is “business as usual”. 
CPI also reports twice last year the OIG threatened to shut Small Smiles out of the Medicaid program.
“Twice last year the HHS inspector general threatened to exclude Small Smiles from the Medicaid program. But in a letter to Grassley and Baucus, Inspector General Daniel R. Levinson said Small Smiles fixed the problems by selling the Manassas clinic, paying a $100,000 penalty and addressing other concerns.”
Kids and Family Dentistry - Manassas LogoNow, did CSHM actually “sell” the Manassas, Virginia clinic?  That is highly suspect!  A guy out of Idaho left his own practice and moved his entire family to Virginia and slapped his name on the place, calling it Kids and Family DentistryFamily and Kids Dentistry - Pueblo LogoCoincidently, at the exact same time, the Small Smiles flagship clinic in Pueblo, Colorado changed it’s name to Family and Kids Dentistry, making the “owner” the same guy who was  the lead dentist working for Small Smiles at the time.  (Logos have a odd resemblance about them, don’t they?)  Anyone taking bets on whether the DeRose family — founders of Small Smiles —are somehow still involved with these two clinics?
As for the $100,000 penalty, that didn’t even cover 1/2 of the amount scammed in the x-ray scam in just one Colorado Small Smiles.  What would add insult to injury is it was probably on a payment plan, like the $24 million settlement in 2010.
The Bacus/Grassley report includes independent monitor reports on Small Smiles Phoenix, Arizona, Manassas, Virginia, Oxon Hill, Maryland and Youngstown, Ohio and others.  Small Smiles signed a Corporate Integrity Agreement with OIG in January 2010 agreeing to 63 pages of terms and conditions, including self-reporting.  Of course the “independent monitor” can only report on what they find.  But what about what they don’t find? 
I’ve not come close to reading the entire report just yet, but so far I’ve not read anything about the $200K x-ray scam in one of Colorado clinic that was NEVER self-reported, or the fact that a corporate staffer took the necessary Continuing Education courses to get the lead dentist in Mishawaka, Indiana credentialed in Indiana, making her effectively non-licensed to practice in Indiana to this very day or a host of other illegal activities going on behind the closed doors at Small Smiles Dental Centers and Church Street Health Management (CSHM). I doubt I find these things in the report, but you can find them here if you look.
It’s scary to think state dental boards and state Medicaid programs have not only turned a blind eye to the child abuse, but promoted and encouraged it.  Those of us following this industry also know this is just the tip of the iceberg. 
More on this eye opening report in the coming days.  In the meantime, I encourage everyone to read The Joint Staff Report On The Corporate Practice of Dentistry In The Medicaid Program and evidence attached by clicking here .

Friday, July 19, 2013

So a man poses as a dentist, corporations do it, so why not?

Unlicensed Boca Raton dentist claims 6,000 patients, deputies say

ssA dentist who isn't licensed in Florida told an undercover sheriff's deputy that his underground Boca Raton practice has 6,000 patients, deputies said.
Ubaldo Bittencourt, 62, only sees fellow Brazilians who speak Portuguese, according to a Palm Beach County Sheriff's Office arrest report.
As a rule, the "very cautious" Bittencourt, a dentist in his native Brazil, doesn't answer his phone, preferring instead to return voice mails within 24 hours.
So when an undercover deputy called him on May 29 as part of an investigation, leaving a message in Portuguese, the unlicensed dentist called back, deputies said.
On Thursday, the dentist was arrested, his capture the culmination of a probe that began when the Sheriff's Office received a complaint about him on March 1.
Read the rest with video here

Thursday, July 18, 2013

WARNING to all crooked dentists - 29 patients receive $35 million dollar award for unnecessary root canals–Read it and weep!


$35 million awarded to 29 Seattle-area patients for root canals

SEATTLE — More than two dozen patients of a former Seattle-area dentist accused of performing hundreds of unnecessary root canals have been awarded $35 million in an arbitration proceeding.
Former King County Superior Court Judge Paris Kallas issued that award Wednesday.

The judge found that Henri Duyzend was negligent, failed to obtain informed consent from patients, committed fraud and violated the Washington Consumer Protection Act, The Seattle Times reported.
A sworn affidavit from Dr. David To said Duyzend performed nearly 2,200 root canals on about 500 patients in the five years before he retired in 2007. To purchased Duyzend’s practice and says a typical patient has fewer than two root canals.

State Health Department spokesman Donn Moyer said his agency has received 76 complaints about the man.

Duyzend started practicing dentistry in Shoreline, north of Seattle, in 1977, the Health Department said.

Moyer said the man surrendered his license in 2010 after negotiations, agreeing to never practice dentistry in the state again.

Both The Times and KING-TV said calls for comment to Duyzend and his lawyer were not returned. An Associated Press call to his home was not returned Wednesday night. Court documents show that in 2012 he denied any wrongdoing.

KING reports that more than 200 patients filed malpractice claims against the dentist but the arbitration award benefits a smaller group of 29 who declined to settle their claims.
Construction worker Dan O’Neal had 20 root canals; he was awarded more than $2 million, KING reported.

Laurel Stuart told The Times she was Duyzend’s patient from the early days of his practice.
“We thought he was fabulous,” she said Wednesday, adding he made patients feel comfortable.
She said she started questioning his work about 15 years ago because “of all the root canals.” She had four, plus “lots of crowns” and said she had to go to a specialist to have implants when she lost four teeth.

Seattle dentist Dr. Fred Quarnstrom looked at records of Duyzend’s former patients and sat in on testimony earlier this month.

He told The Times that root canals are not uncommon, but a patient with four root canals is unusual.
--The Associated Press

Saturday, July 06, 2013

CSHM’s Small Smiles Dental Centers Up to Same Old Crap

No, this is not big surprise; it’s been around 18 years. This business has been hanging on since 1995 when Eddie DeRose, Michael DeRose, Adolph Padula and John Parrish open its second dental clinic in Colorado.  Then came the first phase expansion with the creation of DeRose Management in 1998, operation Children’s Medicaid Dental Centers in Colorado and New Mexico.  Becoming so highly lucrative in the business of abusing children and defrauding Medicaid under the guise of providing dental care to the “underserved”, FORBA was formed by the “family” and expansion across the country began.  In 2006 the “family” found a group of idiots, including a Bahraini banker, to buy it for $435 million dollars.  In 2012, this group filed bankruptcy after 10 years of reports of child abuse and fraud finally caught the attention of Health and Human Services and they were investigated and fined $10 million.  The first reports were around 2003.

Lately, I’ve received two emails from people who CSHM have tried to recruit. As you can see emails dentists have shared nothing has changed.

From: Scott Shue []
Subject: Lead Dentist Opening

Employment with guaranteed base salary and monthly bonus.  Benefits include medical, dental, vision, disability, etc.  Malpractice is covered.  We offer 2 days of CME and 401k with 5% match and a 4-year vesting schedule.  General dentistry with an emphasis on pediatrics.  Salary range of $150,000 to $180,000 for the Lead position.  Efficiency-based model utilizing DA’s with expanded functions, office manager and clinical coordinator.  The requirements for the Lead Dentist position is to establish conformity, a congenial work environment, development of other Associates, etc.

…Salary is determined by experience, clinical expertise and interview/leadership skill which would be part of a discovery effort throughout the interview process.  Monthly bonuses are a % of the location’s net profit.  Basically, the pool is 35% of the total profit would be split between the dentists.  The Lead would then get an additional 10% and the Owners get an additional 5% for each location.  We do not have production “quotas”, just daily/monthly expectations

Scott M. Shue | Recruiter | CSHM LLC |
618 Church Street, Suite 520
Nashville, TN 37219
C: 770.855.1877 | O: 615.750.0342 | F: 615.986.1705




FYI – Dr. Jodi Kuhn, DDS the scam owner dentist for Small Smiles Dental Centers has now worked her way up to being called “owner of at least 11 clinics.  Five in Colorado, Five in Ohio and 1 in Kentucky. 

There are two types of management companies and below is a comprehensive comparison of the two.

Corporate DMSO

Dental Consultants and Managers

View Dentistry As A Business

View Dentistry As A Medical Profession

Employ The Dentist and Staff

Are Employed by The Dentist Who Owns The Practice

Own The Dental Offices

Manage Dental Offices As Needed by The Dentist

Are Backed By Wall Street Investors

Recommend Funding Solutions

Award Themselves with Dentist’s Earnings By Sweeping The Practice’s Bank Account

Invoice Dentist Practice and Take Payment Only For Services Rendered

Focus On Production Per Patient Agenda

Focus on Assisting Dentist With Quality Non-Medical Service.

Exploit Dentists’ Lack of Business Training

Teach, Mentor, and Assist Dentists With Business Needs

Have Fiduciary Duty To Financiers And Shareholders

Have Fiduciary Duty to the Dentist Who Hired Them

Convince Dentists They Don’t Need To Get Involved With Back-Office Operations

Encourage Dentists To Be Involved In All Management Decisions Of The Practice

Retreat and Hang Dentists Out To Dry In Times Of Trouble

Support Dentists And Offer Guidance Through Any Problem

Deploy Corporate Employed Office Managers To Reinforce Who’s In Control

Respect They Are Employed By The Dentists.

Understand High Profit Business Models

Understand Business Solutions For Dentists

Have an Master of Business Administration Degree

Have a Doctor of Dentistry Degree

Violate State Laws i.e. Dental Practice Acts To Hide True Ownership

Do Not Violate Laws When They Own A Dental Practice

Best Financial Gain Strategy With The Patient-Doctor Relationship

Do Not Come Between The Patient and The Doctor When Determining Treatment Options

View Dentists As Assembly Line Workers

Understand Dentists Are Medical Professionals Delivering Medical Care

Follow An Assembly Line Cookie-Cutter Business Models In Each Clinic

Provide Á la Carte Custom Services Per Owner Dentist Request

Set Quotas, Reward Top Producers With Bonuses and Dispose Of Non-Producers

Recommend Office Policies for Long Term Sustainability

Choose Suppliers And Vendors Offering Sub-Standard Materials

Recommend Trusted Suppliers and Vendors

Goal To Increase Profits Simply For Future Sale of Company

Goal To Promote Mom and Pop Practices

Control Every Aspect Of The Profession From Appointment To Patient Treatment Options

Provide Non-Medical Business Support Never Interfering With The Doctor Patient Relationship

Here is an example of a legitimate contract with a management service company looks like.

North Caroline DSO Management Services Agreement