Don’t become part of the crime and cover-up–Report it!

This goes out to any Small Smiles or Church Street Health Management employees.

The Office of Inspector General and Health and Human Services take Corporate Integrity Agreements seriously, especially Quality of Care CIA’s and even more important the agreements that have to do with the treatment of children.

I know many of you are afraid to speak up about the violations and breaches of the Corporate Integrity Agreement.  I know many of you are concerned about other misdeeds happening at the dental centers as well as at corporate headquarters. 

I encourage each of you to report any and all violations.  If you don’t feel comfortable using the Hotline that is set up, and I understand that completely, then at least report directly to the OIG/HHS. 

You may direct complaints of suspected Medicaid fraud to
OIG's Hotline1-800-HHS-TIPS (1-800-447-8477) or directly to a

State Medicaid
Fraud Control Units

If the monitor is visiting your center, please talk to the monitor.  I’m sure all reports and allegations are taken seriously.  If you can’t talk freely right then, surely you can find a way to get the monitor’s attention to slip them a phone number or a note or something.  Get the name of the monitor and contact them later….do something.

Heck do all of the above if you don’t feel comfortable talking to the monitor and your concerns swept under the rug.  Even though I doubt that is the case.  But I understand just about every one of you are terrified. 

You guys are the first line of defense against children being mistreated and Medicaid fraud prevention.  Please do the right thing.  For example, if you see procedure being coded and billed improperly, please report it, please.  Don’t become part of the crime and cover-up.

Dr. James Crow sentenced to prison for Medicaid Fraud - using wrong billing codes

Medicaid Fraud and Perjury by Brownwood, Texas Dentist. Perjury(emphasis added).

Who at these Medicaid mills are willing to leave your family, newborns, sick parents and head off to prison? Better be thinking about it.
_____________

September 21, 2011
SAN ANGELO, Texas — A Brownwood dentist convicted in federal court in San Angelo of defrauding Medicaid has been sentenced to 70 months in prison and ordered to pay more than $1.6 million in restitution.

James Crow, 67, was ordered by U.S. District Judge Sam Cummings to surrender to the Bureau of Prisons on or before Oct. 26. He also was ordered to pay $1,653,474 to Texas Medicaid and forfeit that amount in cash, a truck, several Harley Davidson motorcycles, a residence in Brownwood and additional real estate elsewhere in Brown County, a camper, a boat and a trailer.

Cummings also issued a finding that Crow had committed perjury during the two-week, May 2011 trial in San Angelo.

Crow was convicted on evidence that he filed claims to Medicaid for services he didn't perform and for services billed under improper billing codes. Crow billed Medicaid for resin-based fillings when the service weren't performed or services were performed that were not reimbursable under Medicaid.

The case was prosecuted by the U.S. Attorney's office in Lubbock using investigations conducted by the Texas Medicaid Fraud Control Unit and the FBI.

Obit sheds light on DeRose family tree

Grove, Jean P.
Jean P. Grove - Pueblo Chieftain - March 12, 2001 - Longtime Pueblo resident, passed away March 9, 2001. Preceded in death by husbands, Frank G. Palladino and Arthur E. Grove; sister-in-law, Veronica DeRose; and brother-in-law, Bruno DeRose. Survived by nieces and nephews, Dr. Edward J. and Neta DeRose, Sel and Vivian Elizondo, Dr. Rudy and Berni Padula, Alfred J. and Rose Schiavoni, Mary Lou Keating; and sister in-law, Jada Willard. Mrs. Grove resided in Pueblo for 50 years and was a loyal member of Sacred Heart Cathedral and St. Pius X churches. Service will be held at Sacred Heart Cathedral on March 13 at 10 a.m. The family respectfully requests the omission of food and flowers. Contributions may be made to the Fellowship of Christian Athletes, 7 Glen Eagle Court, Pueblo, CO 81001, in memory of Mrs. A.E. Grove. Interment, Roselawn Cemetery.

How to slow the child abuse, tortuous dental overtreatment and fraud

If states want to stop the influx of these substandard dental mills; if states want to end the continued overtreatment and child torture perpetrated on the poorest and most vulnerable of our citizens; if states want to cut the Medicaid fraud by same dental mills by billions; the solution may be as simple as slowing down the reimbursements.

Many think they gravitate to states with the highest reimbursement rates or those states that pay for more procedures, but that’s not always true.  If you were to ask an exec at one of the mills, you may well be told it’s actually how fast the money flows into their coffers.

Look at the states who are slow to pay; you won’t find many dental mills there.  Take Illinois for example, they are considered to be slow to pay; no Small Smiles or Kool Smiles there. 

Of course that’s just one of the factors considered, but it’s a huge one!  Other factors could be:

How quickly dentists can be credentialed
How quickly dentists can be licensed with the state dental board
Who they know and can control at the state dental associations

Just Saying….

Being lectured about wasting taxpayer dollars by a Medicaid Fraudster is off the chart ridiculous.  Just saying….

Attorney Tom Crosley Taking The Smile Center Cases–Was your child injured?

SAN ANTONIO - More than 70 parents are preparing to sue a local company of dental clinics called The Smile Center.  A News 4 WOAI Trouble Shooters investigation unleashed a flood of complaints by parents who say their children got poor dental treatment at the San Antonio clinics.  The San Antonio clinics have made millions on work paid for by Medicaid
.
Tom Crosley runs the firm that is preparing to file suit. “In the last few weeks we've been approached by the families of 60 or 70 children to investigate whether their kids were victims of unnecessary dental work, shoddy dental work, excess dental treatment," said Crosley.

The Smile Center handed out letters to potential new patients that state the allegations are gross misrepresentation of the facts. The Smile Center also claims they are saddened and shocked that we would report this story without telling their side of the story.
 
See video and further story information here

Tom Crosley, Attorney At Law
2632 Broadway St
Suite 101 South
San Antonio, TX 78215
210-354-4500, 877-535-4529
Fax: 210-244-2744
info@crosleylaw.com

The Smile Center in San Antonio, Texas Under Investigation

WOAI TV

Published: 9/07 4:05 pm

Updated: 9/08 10:04 am


The Smile Center Investigation
Posted on 09/08/2011 by bcollister
A criminal investigation is underway into a chain of dental clinics here in San Antonio that targets children on Medicaid.  This comes after I uncovered complaints of poor treatment at The Smile Center.
The Texas Attorney General now confirms it has launched criminal and civil investigations into The Smile Center.
The Attorney General’s office wants to know if the clinics defrauded Medicaid by billing for dental work that did not need to be done.  I’ve been reporting since February about complaints from parents who say the clinics did unnecessary and shoddy work on their children.
These parents were unhappy with dental work done on their children and paid with millions of your tax dollars through Medicaid.
A representative from the Attorney General’s office confirms it’s Medicaid fraud control unit has 180 bankers boxes of records taken from The Smile Center locations here in San Antonio.  The agency’s civil Medicaid department has also filed a complaint in civil court against the business. But we don’t know what’s in that complaint because it’s sealed.

Medicare fraud strike force charges 91 individuals for approximately $295 million in false billing

 

FOR IMMEDIATE RELEASE
September 7, 2011

Contact: HHS Press Office
(202) 690-6343

Medicare fraud strike force charges 91 individuals for approximately $295 million in false billing

WASHINGTON – Attorney General Eric Holder and Health and Human Services (HHS) Secretary Kathleen Sebelius announced today that a nationwide takedown by Medicare Fraud Strike Force operations in eight cities has resulted in charges against 91 defendants, including doctors, nurses, and other medical professionals, for their alleged participation in Medicare fraud schemes involving approximately $295 million in false billing. 

Attorney General Holder and Secretary Sebelius were joined in the announcement by FBI Executive Assistant Director Shawn Henry, Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division and HHS Inspector General Daniel R. Levinson.

Busy week for wasteful and abusive dentistry in the news–Corporations should be feeling the heat about now

In Rick Perry's Texas: Medicaid Is Wasting Millions -- On Braces

Sat, 09/03/2011 - 12:22am — Joe Conason

Republican presidential frontrunner Rick Perry complains constantly about Washington’s “culture of runaway spending,” wasteful government programs, and federal intrusions into the affairs of the states. In Fed Up, the book he published last year, the Texas governor bitterly criticizes Medicare (which he terms “unconstitutional”) as well as the health care reforms passed by President Obama and by Mitt Romney in Massachusetts, which he regards as infringements on freedom.

Before Perry goes after Romney and Obama on medical spending, however, perhaps he ought to try putting his own state’s government in order first. According to a new investigation by a Dallas television station, the Medicaid program in Texas – overseen by Perry – is wasting millions of dollars annually on orthodontic braces for children who may not even need them.

But the story gets worse: Texas Medicaid wasting big money on unnecessary braces due to lax regulation by the state –and those millions are going straight to for-profit clinics owned by hedge funds.

Reviewing Dallas ABC affiliate WFAA’s investigation, health care expert Trudy Lieberman explains in the Columbia Journalism Review how the teeth of poor children in Texas became a golden opportunity for wealthy investors on Wall Street. Last year, the state spent more than $184 million to provide braces for 120,000 children – many of whom apparently did not qualify for orthodontic care under the state’s own criteria, according to WFAA investigative reporter Byron Harris. That is more than twice as much as Texas spent on the same program three years ago –and the same amount as all of the other 49 states combined.

“Judging by the increased payouts,” Harris noted, “the teeth of Texas children are growing more crooked each year.”

Read complete story here

Corporate dentistry receiving a lot of press lately isn’t it?

Columbia Journalism Review:

Golden Teeth
Dallas’s WFAA shows crooked Medicaid spending on orthodontia
by Trudy Lieberman

These days it’s rare for local TV stations to produce anything resembling an expose. With their steady diet of crime, weather, and canned medical news, there just isn’t room for the hard reporting. WFAA, the ABC affiliate in Dallas, has earned a reputation as a notable exception. Throughout the summer, the station and its investigative reporter Byron Harris have taken on the Texas Medicaid agency and its spending spree for braces for poor kids.

Now there’s nothing wrong with these children getting braces. Many, no doubt, will benefit in the long run. The problem, Harris reported, is that last year the state paid more than $184 million—nearly double the amount it spent in 2008—to supply braces for 120,000 kids, some of whom may not have met the state’s criteria for orthodontic work.

Read the full article at CJR