Saturday, April 09, 2016

Is Florida paying dentists a “per patient” fee on top of reimbursement for services?

Is Florida paying dentists a “per patient” fee on top of reimbursement for services? It sure sounds that way in this sworn statement by Dr. Jodi Mason.  Dr. Mason was interviewed in connection with the Florida Medicaid Fraud Contol Unit’s investigation into Howard Schneider, DDS.  Her last statement was a bit more revealing that I suspect was expected as the interview concluded.  Personally, I think that is where the real questioning would have started if the goal was learning more about the widespread dental fraud in Florida.

This interview was posted by News 4 in Jacksonville and can be found here:

State of Florida Office of Attorney General Medicaid Fraud Control Unit
Howard Schneider, DDS, Jacksonville, Floridia
OAG Number: MFC-15-00381
May 12, 2015 Interview of Dr. Jodi Mason by David Schwab
Dr. Mason worked at the Duval County Health Department from 2007-2008 and from 2009-2011, before opening her own practice.

Dr. Mason was asked by Schwab to tell him about working on patients after they had seen by Dr.
Schneider. Dr. Mason said that she spent the majority of her time that she was at the Health
Department working on patients that had been treated by Dr. Schneider. Any of the patients of the
Health Department that needed a pediatric dentist, which was a significant number of patients, were
either referred to either Dr. Schneider or Dr. Klein. Those patients would then return to the Health
Department for their care after their treatment needs were taken care of by Dr. Schneider or Dr. Klein (Dr. Klein passed away in 2008).

Schwab asked Dr. Mason what kind of issues the patients that had seen Dr. Schneider came back with.
Dr. Mason said "As best as I can recall. There were a lot of abscessed teeth that had been restored with
nerve treatments and a crown and the crown had come off. I mean, it was like if Dr. Schneider had
done crowns the crown was gone, if Dr. Schneider had done a filling the filling was gone. So, the teeth
that he had done fillings on they needed crowns or needed to be taken out, or the teeth that he had
fixed needed to be taken out, um, because they either had an infection and he fixed that, instead of
taking it out or, um, they got an infection after he fixed it. Um, so a lot of infections, um, so, yeah."
Schwab asked Dr. Mason if the crowns that she had to replace looked like they had been cemented on
or just forced on the tooth. Dr. Mason said "At the point I saw them the crowns were gone, there was
no crown there, usually we didn’t see a loose crown or anything it was, the crown was gone. Um, very
rare that the patient or parent actually brought the crown in you know, and if they did I don’t think that
I would’ve, I would remember, if there would have been cement inside of it or not, though."

Schneider pull quoteDr. Mason said that she has some patients at her practice now that were patients of Dr. Schneider, but she said it is a very low number. The patients that she does have that went to Dr. Schneider have the same issues as the issues the patients she saw when she was with the Health Department; as far as crowns being gone. Schwab asked if the patients that she sees from Dr. Schneider now at her practice are Medicaid. She is not a Medicaid provider and the Medicaid patients that she does see pay cash for the procedures that she performs. Dr. Mason said that she would work on putting together a list of Medicaid patients that she is treating at her practice.

Dr. Mason said that parents of patients that had been treated by Dr. Schneider told her about their child having scratches and bruises. Dr. Mason said that when she heard those types of stories she would encourage the parent to report the abuse. She said that she never saw any of the scratches or bruises by the time the child got to her. She also stated that even when she was at the Health Department she encouraged people if they didn’t think that the work was done properly or the child was abused to report it.

Schwab asked her if she ever used the papoose board. She said that she has used it twice in the last
year; she said that she usually will use it only for frenectomies (a procedure to cut a piece of skin
under the tongue, or lip, to allow more movement of the tongue or lip). Usually if they are under two,
or three years old, and the parents uncomfortable or unable to hold the child still enough to do certain
procedures which are short procedures she would use the papoose board. Dr. Mason also said that she
did use one a little more often when she was at the Health Department, but she only used it on cases
where there was an infected or broken tooth that had to come out. She said that she does not practice
like that and advised Schwab that she does not do conscious sedations at her office for safety reasons.

Schwab asked Dr. Mason if she was treating a patient that was "fighting” did she ever hold them down
by their throat. Dr. Mason said "No." Schwab then asked Dr. Mason have she ever held a patient
down by their throat, pinch their nose and put your hand over their mouth. Dr. Mason said "No. I
know that was a technique hand, hand over mouth was a technique that was used, somewhat used you
know, with a couple of generations ago dentists, you know back before they had gloves." Schwab
asked Dr. Mason about putting their hand in the child’s mouth so they could not breathe. Dr. Mason again said "No, I think that would be counter intuitive."

Dr. Mason said that if there are behavior issues that preclude doing procedures safely she has an
Anesthesiologist that comes in and can do I.V. sedation. It is expensive because the Anesthesiologist
set their fees and is usually out of network. She said that based upon her experience as being a Dental
Assistant, then working at the Pediatric Dental facility at the University of Florida, she has the ability
to determine if she is going to be able to get through to the end of the procedure safely.
Dr. Mason said unless it’s an emergency they don’t hold anyone or against their will. The parent is in
the room and either the parent will be holding the child or they would be right there. I would tell Mom
"I am going to hold her head and I need you to hold her arms." We would do that for a couple of
minutes and then we would take a break.

Schwab asked Dr. Mason if she thought that having the parent in the room with the child helps the
child stay calm. Dr. Mason replied sometimes it does, sometimes it doesn’t, but it depends on the type
of parent. She clarified saying that any time it gets to that point or if you have those behavior issues,
even if they are less calm with Mom in the room, she would still want Mom in the room to see what
was happening. That way if you hear screaming you know what is going on. Dr. Mason said that there
are some of her patients’ parents that do not want to be in the room, therefore, she lets the parent

Schwab asked Dr. Mason if the children that had been to Dr. Schneider showed more fear, and
anxiety, than children that had not been to Dr. Schneider. Dr. Mason said, "That part of it, it wasn’t
just fixing the work at the Health Department. It was working through or trying to work through all
those behavior and anxiety issues, you know, here, it’s a lot less of it. But, the children are truly afraid
and very, very scared, and it just takes a little more time to build that relationship, ok, we’re not going
to do anything that is scary here, um, and there are some of those we have been able to work through."

Dr. Mason then said, "This is part of the reason I left and it was because I kind of got tired of
censoring my words from parents because I didn’t want to bad mouth other people’s work." Dr.
Mason continued "It got back to my supervisor that I wasn’t happy with the care that people were
receiving there, and he made me have lunch with Dr. Schneider. He like set up a lunch so that I could
meet him and see what a nice man he was to provide this service for these children, and um, that was
the day I decided to leave, was after I had to have lunch with him."

June 13, 2016 is the date set for the fraud case against Dr. Howard Schneider of Jacksonville, Florida

April 4, 2016
- A trial date has been set for embattled pediatric dentist Dr. Howard S. Schneider, who is facing 11 counts of Medicaid fraud.

Schneider, 78, pleaded not guilty to those charges and one count of scheme to defraud.

More Jacksonville Headlines

His lawyers argued unsuccessfully last month to have the charges dismissed.

Schneider's trial is set to begin June 13.

Schneider remains free on $110,000 bond and is now living in St. Simons Island, Georgia.

Read the entire story here.

Friday, April 01, 2016

14 Month Old Daisy Lynn Torres dies after visit to Austin Children’s Dentisry

Austin Children's DentistryAustin, Texas – 14 month old toddler, Daisy Lynn Torres, died March 29, 2016 after visiting Austin Children’s Dentistry in what spokesperson, Sarah Marshall, says was a “fairly routine” procedure that required anesthetics.

As pale and frightened as Marshall looked on camera, I suspect she was scared to death to actuall “speak”. Marshall also said, they have been in business for 40 years! Really? She also  told KVUE-TV “these types of procedures are done all the time”. Really?

I wonder if the routine part actually means that their office routinely sedates children unnecessarily for unnecessary procedures in order to bilk Medicaid or other insurance.  Let’s face it, we are talking Texas here, right?

According to Daisy’s mom—as reported in a follow-up report by KVUE-TV—Daisy was only supposed to have two cavities fixed, then about 15 minutes into the procedure, they came and told Daisy’s mom they were going to go ahead and do 6—4 stainless steel crowns on top, and 2 on the bottom.

Daisy’s mom told KVUE reporter Kris Betts, about 10 minutes later, the dentist returned saying Daisy was having a “difficult time”. After taking her mom back to see her, they assured her mom that she was fine. Shortly thereafter, an ambulance was called. The ambulance took Daisy to North Austin Medical Center. Her mother followed the ambulance to the hospital. Upon arriving she was told Daisy was already brain dead.

So what happened?