So here is my question for all of you readers - when are you going to wake up and say you've had it, too? Do you not realize that the mouth and bank account of you and every person you love, is at risk? This crap started almost a decade ago. Did you really think that a decade of DeRose trained dentists would simply put in their time and then go into humble private practice without retaining any of their bad habits?
Don't be foolish.
Just like a fart stinks up a whole room, the fraudster dental clinic alumni started a stink that goes DEEP into the dental biz. Think I'm wrong? Tell me if this sounds familiar?
Case in point number one:
Your friend has a 14 year old boy who has had braces on for 3 years. The new pediatric dentist who recently bought the practice where this boy is seen announces right before his braces are removed that he has developed 5 new cavities. Because his brushing was probably not so good with those braces. And his orthodontist isn't really looking for decay so didn't mention it. These aren't your run of the mill pit and fissure cavities - these are the multiple surface (expensive) kind. Might as well get them fixed and give that kid a lecture about how his lousy toothbrushing just cost you $1700 ON TOP of the braces, which weren't cheap!
So the dentist "fills" 5 teeth with itty bitty wholly enamel contained occlusal surface only goop and sends the bill to the parents. Oh, I forgot to mention that the parents are both corporate lawyers. With no dental insurance. But nice cars and kids in private school so odds are that bill is going to be paid.
If you think Medicaid has no oversight, guess how much you get when you pay cash? ZERO. That 14 year old boy is a real kid - his parents paid $1700 for Dentally (Medically) Unnecessary care. But how the heck are they going to know that? Right now they think their son is a lousy brusher who will probably need a few more cavities fixed in the near future. They may be corporate lawyers but their son is a sitting duck.
Do you really think that none of the DeRose trained dentists who have since moved on to private practice would not sense an opportunity if presented with such a scenario? Or the ones who did some time at Kool Smiles? Or maybe All Smiles? Perhaps Comfort Dental? Or maybe Aspen dental?
Case in point number two:
Last week the state of Texas startled citizens when it settled a $16 million dollar fraud case for less than the cost of a kitchen remodel!
Last week (August 28, 2014) the Texas Health and Human Services Office of Inspector General (THHS-OIG) setting a $16 million dollar dental fraud case against one of their top stainless steel crown fraudsters for $39,000! That’s right! Just about one quarter of one percent!
Someone please tell me how that is possible!!
In an article by “The Austin American-Statesman” it says:
“The deal represents the latest underwhelming outcome for state regulators who say they have identified hundreds of millions of dollars in dental and orthodontic fraud between 2007-2012, yet have struggled to produce decisive legal victories.”Rachel Trueblood says the reason for the lowball number is, “There was a complete lack of evidence.”
I disagree fully and completely about the lack of evidence. She was one of the state’s single most obvious abusers, coming in ahead of any one Kool Smiles location when the stainless steel crown and baby root canal scam was at it’s peak.
(By the way, this only represents what was billed in Trueblood’s own Texas Provider number, and does not include the untold number associate dentists who worked there)
Senator Jane Nelson (R-Flower Mound) said lawmakers would examine the inspector general’s office during the upcoming performance review.
Well, that should be very interesting. I hope they start with a physical examination; checking who has a spine! Next stop would be to check who’s sleeping with who.(or is it whom, I never can figure that out).
The Statesman reported:
“THHS-OIG spokeswoman Stephanie Goodman said the Trueblood settlement is a satisfactory conclusion in its pursuit of a dentist the agency had once held u pas among the worst of the worse. She said official decided to stop spending time and money pursuing her further for practical reasons: Investigators believed Trueblood couldn’t afford to pay any more restitution because she had been driven out of dental practice.”WTF!
Let me get this straight. Even though a person (or corporation) can defraud, pillage and steal millions, if you can’t afford to pay it back, it’s ok, just pay what you can!!!
SERIOUSLY! I’ve never heard a more outrageous statement made; EVER! Is this some sort of new “hardship” plan for criminals! Anyone in Texas heard of jails; or are those just for illegals and drug dealers?
To add further insult to my somewhat limited intelligence, The Statesman reported that Rachel Trueblood is still at work seeing patient daily at her “busy new Cedar Park dental practice” as well as working out of “Big Top Dentistry”. So Ms. Goodman, 1) knew not what she was talking about and figured no one would check or, 2) made a poor attempt to cover-up yet another “sweetheart deal.”
I’m going with number 2. (pardon the pun).
In April 2012,—only after WFAA’s acclaimed investigative reporter, Byron Harris exposed it—Texas lawmakers brought this massive unbridled fraud issue to the legislative floor for a hearing. Among those who testified, where Tammy Gough, the then presiding officer of the Texas State Board of Dental Examiners appointed by Governor Rick Perry, and Joy Sparks, then General Counsel for the dental board.
Gough told lawmakers her team—I suppose she meant the board members—had spent 200-400 of their own person time reviewing all the patient complaints to be sent to the enforcement and legal departments; those being the ones who actually earn a paycheck.
Lisa Jones was then the “enforcer” and Joy Sparks was the “legal”—General Counsel.
During the hearing Sparks told lawmakers and I quote, “My guess, Representative is that the reimbursement rates increased by Medicaid. That’s probably the reason you are seeing more Medicaid fraud, is because it became more profitable. There are clinics, that’s all they do is Medicaid.”
When Sparks was asked if most of the fraud was from franchise clinics or was it from clinics owned by individuals, Sparks said, “we are seeing both.”
Sparks further told lawmakers– “We regulate dentistry. If you own a clinic you are practicing dentistry in the state. The problem is our remedy is we sanction a license. So if someone is practicing dentistry under a corporate clinic or private equity they are not licensed so we refer those cases, if we think, their … ya know what I’m saying.. we refer those cases to the Attorney General’s office…cause we don’t regulate.”
Glenn Parker to lawmakers, “We report fraud to the HHSC, OIG the AG and recently we’ve been reporting it to the FBI.”
At one of these hearing (maybe the one in October 2012) those representing the dental board backtracked said they didn’t know where at OIG to send cases for criminal review, but had recently made some calls and now they knew whose desk to make sure those cases landed.
Was that call to their own Joy Sparks?
By November 2012, Joy Sparks was no longer legal counsel for TSBDE, she moved over to Texas Health and Human Services-OIG. Yep, sure did! Here is a document she issued in November 2012 to prove it. A repot by Dr. Bicuspid shows Sparks was still at TSBDE in June 2012.
My eyebrows raised when I learned of this move. As far as I can tell, the criminals had a good thing going with the Texas State Board of Dental Examiners and seemed to have a “friend” in place. When the heat was turned up, seems they now have a “friend” inside Texas Health and Human Services Office of Inspector General.
Now, I’m not saying Sparks or anyone else at THHS-OIG actually is perpetuating criminal behavior. I’m just saying none of this passes any kind of smell tell. And letting come fraudster off the hook because of some imaginary inability to pay the consequences is at best ludicrous!
If there were ever a doubt why Texas is the hotbed for dental fraud and abuse, I think that answer is now perfectly clear, don’t you?
Protect your own, the criminals certainly are and lawmakers and regulator are protecting their own as well. The proof, as always in the the pudding.
Caveat emptor, folks!