Hearings in Washington today of Medicaid fraud

Hearings in Washington today of Medicaid fraud and it includes managed care and dental fraud testimony!

Live Feed Here:

http://oversight.house.gov/hearing/joint-hearing-is-government-adequately-protecting-taxpayers-from-medicaid-fraud/

 

There are a whole lot of questions from just about everyone on this Oversight Committee hearing wanting to know why no one is in jail, be it individual dentist or corporate executive.

That the same question I’ve asked for 4+years. Of course CMS Director Cynthia Mann and Commissioner Lucinda Jesson of Minnestoa dhs don’t know. Maybe they will ask Attorney General Holder.

Here Dr. Chrisinte Ellis, DDS was asked if she had been contacted by the Federal AG office in Texas about her findings of fraud with the orthodontics program. Her answer was no.

Representative Michael Burgess of Texas is outraged at that no one from the state, to CSM, to OIG had a clue that Texas paid more for orthodontics than the rest of the entire country or that no one investigated why there were advertising billboards for “Free Braces”. Representative Burgess also said that this would have the full attention of his office.

Commissioner Jesson can’t seem to explain why UCare, a corporation, would donate $30 Million dollars to the state of Minnesota and why it was characterized as a donation when in reality it was a refund for being overpayment. By it being a donation, the state would get to keep it all, if it were a repayment from over payment, some would be returned to the Federal Government.

This was one bang up 3.5 hour long hearing!

Hearing Audio
Part 1 of the hearing
I missed about 30 minutes in the middle of it, sorry folks.
Part 2 of the hearing

Dr. Edward Dove has claimed another victim and pissed off another dad. Dr. Dove should be jailed.

Of course it’s simply a matter of time before Dr. Edward Dove puts another child on the “Killed by the Dentist” list. We also know he does this to just about every patient he touches. But, he’s pissed off another dad who has decided to tell his story. Dr. Dove is a public health hazard! The California Dental Board is fully aware Dr. Dove and they too should be held responsible! His colleagues should be all over him over this.

Sign the petition to revoke this monster’s dental license

Here is Bella’s story-Visit the website and read the comments.:

After going through a few days of regret, anger and tears over Bella’s recent experience at the dentist office, Gia and I felt that we simply could not let the experience go, and have to share with whoever might listen.  

My sole motivation for sharing is that prospective clients of pediatric dentist Edward Dove of Fresno (and Chatsworth, Bakersfield, and Lancaster) might read this and simply pass on his services — so that no other child has to endure what my daughter did this week.  please read this whole post.

Bella was referred to dr. Edward dove of Fresno through her health insurance with Kaiser.  she took x-rays a few weeks ago, which according to the dentist, showed she needed fairly extensive dental work (several crowns and “baby” root canals).  The dr recommended “oral conscious sedation,” which involves taking medicine that supposedly makes the child VERY drowsy and loopy — enough to where they “don’t care” that dental work is being done.  We had this work done once before at USC school of dentistry, and they were fantastic, so although we asked many of the same questions, we felt like a dr. who “specializes in pediatric dentistry” and has done this for a long time should be the expert. We followed his plan.  In our conversations, Dr. Dove made me feel like a complete idiot for asking certain questions — as if he was an excellent dentist, this was completely routine, and the questions were virtually worthless to even ask.

We arrived at the 11 am appointment at least 30 minutes early, and Bella was given her medicine around 10:45.  We immediately noticed LOUD music from the back and wondered why in the world the dentist would play music like this (more on this below).  It took a while for the medicine to seem to work, but Bella began to be very drowsy and loopy.  Around 11:20, a big, burly nurse came in and virtually ripped Bella from my arms — saying nothing to me.  I began to follow her into the room, when Dr. Dove stepped in front of me, firmly placed his hand on my shoulder, clearly wanting me to stop — I said, I’ going in there to comfort my daughter and say goodbye to her.”  Dove said flatly, “what’s that going to help?”  Then looked at my mom and said, “she’ll be right back” in a demeaning tone — as if i was a complete moron to want to comfort my daughter.

Ayman Risha–not a dentist, but neither is Midwest Dental Corporation, but it appears that’s not an issue

Star Tribune

St. Cloud dental clinic owner denied license

• Updated: April 21, 2012 - 5:16 PM

An unlicensed St. Cloud dental clinic owner who altered billing codes and directed staff to perform unnecessary procedures was denied a license last month, according to an order by the Minnesota Board of Dentistry.
In 2009, the board received a complaint about Ayman Risha, who holds a foreign-issued Bachelor of Dental Surgery degree.
In addition to finding Risha unlicensed as a clinic owner and a practitioner, a board investigation determined that he had "engaged in fraud or deception ... by providing diagnoses and preparing treatment plans that were not warranted," the order stated. Risha directed staff to follow the plans, falsify periodontal probing numbers and take unnecessary X-rays, as well as scratching expiration dates off products and changing billing codes to justify procedures, the order said.
The investigation also determined that Risha's clinic lacked adequate infection control procedures, including a disposal program and a plan to handle exposure to infection.
In March 2010 the board ordered Risha to cease his unlicensed activities. Two months later, he applied for a license by examination.
After a board committee recommended in 2010 that he be denied a license, Risha contested the decision but lost by default when he missed a 2011 hearing, the order stated.
The board ordered Risha to pay $8,794 in costs, including expenses for an administrative law judge.

Can I legally purchase dental supplies?

Let’s say Debbie Hagan decided to open a Dental Management company. In my “service agreement” with a dental clinic I agreed to order and pay for all dental supplies for the dental clinic.

What laws would I be breaking?

ROTFL–Aspen Dental propaganda quoting the group who promotes illegal practice of dentistry; The DGPA

From the Aspen Dental Blog

Dispelling misconceptions about Dental Service Organizations

March 5, 2012 by Bethany Tuzzolino

A recent online article¹ based on the results of an August 2011 survey of 1,500 dentists asked participants to rank what they consider to be their highest concerns as practitioners and small business owners. They identified “Growth and Influence of Corporate Dentistry Companies that Hire Dentists” as a high priority challenge to their success. The respondents ranked this “frustration” about the current state of the profession the third highest category in the Priority 1 section of the survey, right behind “Third-Party Dictation of Treatment Plans and Setting Fees” and mid-level or expanded-function dental practitioners, and right above “Overpopulation of Dentists and Hygienists.” The author notes that “some of these firms have moved into geographic areas already saturated with dentists.”¹ This situation is understandably concerning to private practitioners, who are essentially entrepreneurs trying to establish a territory and stable patient base. It is, however, a well-known fact that dental school does not teach graduates how to successfully find the ideal location for, or run, a private practice.

Small Smiles Dental - Church Street Health Management Auction Postponed Until May 11-May 22 Hearing to Approve Any Offers.

Small Smiles Dental - Church Street Health Management Auction Postponed Until May 11

Church Street Health Management LLC will auction the business on May 11, rather than April 20. The provider of management services for 67 dental practices in 22 states reported a $2.1 million net loss in March on total revenue of $11.6 million.

Unless outbid, existing first-lien lenders are to buy the business in exchange for $25 million in debt. Other bids are now due May 4, rather than April 16. The hearing to approve the sale will take place May 22.

Isn’t this a nice way of saying it’s being “repo’d”?

The official creditors’ committee was given the right by the bankruptcy judge to require the company to turn over copies of insurance policies. The committee says that the largest unsecured claims are held by patients who say they were given services unnecessarily. Seeing the policies will help, the committee says, in deciding if the insurance company was entitled to deny coverage of the claims.

Church Street said in a monthly operating report filed with bankruptcy court that earnings before interest, taxes, depreciation and amortization in March were $867,000. Depreciation in the month was $986,000 and interest expense was $120,000.

Church Street specializes in providing dental care to children whose medical expenses are covered by government- sponsored programs. Bankruptcy resulted from a $24 million settlement in January 2010 with state and federal authorities that led to negative publicity and lawsuits.

The company’s debt is structured in compliance with Islamic Shariah financing regulations. There is about $131.5 million owing on first-lien obligations, plus a $25.6 million second- lien. There is an additional $152 million on three subordinated debts.

It’s only Shariah compliant because they created several companies between it and the First Islamic Bank a/k/a Arcapita.

Assets are on the books for $895 million, with debt totaling $303 million, a court filing says.

The case is In re Church Street Health Management LLC, 12- 01573, U.S. Bankruptcy Court, Middle District of Tennessee (Nashville).

Selection of Bankruptcy Documents

Texas State Board of Dental Examiners General Counsel Admitted–“If you own a clinic you are practicing dentistry in the state”

There is such a HUGE GI-NORMOUS difference in the way North Carolina’s Dental Board understands the responsibilities given to them and the way the Texas State Board of Dental Examiners understand theirs. It’s truly mind blogging, yes I mean “blogging”.

North Carolina’s dental board hopped all over one dentist trying to skirt the laws and has now taken it to the legislature to make sure the laws against corporations coming between the dentist and the patient are clear.

After 5 years of work and 3 years of jumping through hoops, some Texas citizens finally got a hearing with the state legislature. Three years, now! Three years! Expect at least another 3 or more to clean up the damn mess down there. One good thing, Sherri Meeks, the former Executive Director, resigned just days “We do regulate dentistry. If you own a clinic you are practicing dentistry in the state."- Joy Sparks, TSBDE General Counsel before the hearing, and on more than one occasion it was highly suggested to the board that they now have the opportunity to hire someone who can and will do the job they are paid to do. I guess Texans will just have to wait and see.

At the hearing held on Wednesday, April 11, 2012 by the Texas Legislature Public Health Committee I heard some of the most outrageous statements I think I have ever heard come from members of any governing body, well, other than Nancy Pelosi saying they would have to pass a the Affordable Healthcare Act to see what was in it. That was huge.

Dr. Tammy Gough, the presiding officer of the Texas State Board of Dental Examiners, told the committee they were researching corporate dentistry laws and wanted to “act as advisors to stakeholders and elected officials on the topic because we feel it will probably be addressed in the future with legislation.”
Joy Sparks, general counsel, said this was a “relatively new” issue. And all they do with people who are suspected of the corporate practice of dentistry is turn them over to the local or state prosecutors. She also, indicated they don’t even follow-up on that useless action.

I bet if someone asked the local and state prosecutors how many cases the dental board has ever turned over to them, I could count them on one hand. If I remember, someone on the committee did ask that question. The dental board was also asked they had ever asked for guidance as to what they laws said hat their duties were. Want to guess what that answer was?

Glenn Parker, acting Executive Director, who has been Director of Administration and Licensing since September 1, 2011 said: “I think everybody knows The Board of Dental Examiners is the agency that regulates the practice of dentistry in Texas.”

“We do that by regulating individual practitioners. We have no authority to regulate clinics or clinic owners.”
“We strictly license individual people”

“We report fraud to the HHSC, OIG the AG and recently we’ve been reporting it to the FBI.
When Glenn Parker was asked about why there was a big jump in Medicaid Fraud, Joy Sparks answered for him by saying, “My guess, Representative is that the reimbursement rates increased by Medicaid.”
Representative Carol Alvarado asked if the clinics committing most of the fraud were Corporate owned clinics , franchises or clinics owned by individual dentists or independent.

Joy Sparks stammered, “Representative, I’m not comfortable saying that. We are seeing both. We are seeing individual and we are seeing individual practitioners who are, we have dealt with and we are seeing…uh uh….clinics, who have done it also. I’m not sure what the % would be.”

Rep. Charles Schwertner asked Lisa Jones – TSBDE Director of Enforcement-if there were the same safeguard against the corporate practice of dentistry as there were corporate practice medicine.

Her answered, “Honestly, I don’t know if I can answer that question, we don’t regulate the clinics in any way. We have no jurisdiction over them whatsoever. We don’t keep statistics on how many clinics there are in Texas or how they operate.”

She stumbled and stammered several times trying to not say “corporate” and just use the word, “clinic”. That part was fun.

Glenn Parker then added, “The Dental Practice Act requires the dentist to make all the decisions regarding the treatment of a patient. The dentist who is in charge of…stutter…according to the law …stutter…stutter… of the dentistry decisions”

He then tells what the dental board has “heard” about what is happening. He says they have heard some corporations are requiring their dentists to bill $1000 if the child in 10 or younger, if they are 10 or older, or bill them $1,500 worth of work.

Could possibly the dental board have “heard” these in a Complaint!!!!!???
He then went on to say, “To the degree on which that happens we don’t really Representative Carol Alvarado – “If you guys have been concerned about this, what have you all done?”know.”
To the amazement of the legislative committee he added, “Can we prove that yet, no, we can’t. But I think that is what’s happening to a degree. We do not know how many clinics there are in Texas, dental clinics. We don’t know where they are. We don’t know who the legal own of them is, cause none of that is in the Dental Practice Act to require it.”

Dr. Tammy Gough, the presiding officer followed with, ”we regulate the licensed dentist who is performing the care in these clinics” .Their not running “willy nilly” as far as the actual patient care.” The license dentist is held responsible for maintaining records..and there can be no patient abandonment…”
Representative Carol Alvarado asked, “If you guys have been concerned about this, what have you all done?”  

Pure silence!

Of course there was a lot of testimony on horror stories that would curl your toes. After all the hearing did last for 4 hours, 21 minutes and 21 seconds.

The big admission on the part of the dental board came with Joy Sparks, their general counsel admitted, “We do 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…….when we asked if they own the clinic they say “I do”.

Then there was this, “They are practicing dentistry without a license. We don’t do anything with people who are practicing dentistry without a license.”
Well, there ya go.

You can continue reading or stop here.

North Carolina HB 655–The story of the campaign ads and commentary

 Yes, this is a repost but last time I didn’t have time to comment, today I made time. The people of North Carolina need our support to pass HB 655, this is my part.

Dentists take battle over regulations to the public WRAL -TV

Posted: April 12
Updated: April 13
One commercial warns that "out-of-state special interests" are going to put your local dentist out of business. Another 30-second spot says viewers should be concerned about "powerful lobbyists" pushing a bill that will close your local dental practice.
Given the similar style and claims, viewers might think the same group is behind both ads. But the 30-second spots actually come from different groups of dentists battling over how North Carolina regulates their profession. A legislative proposal likely to be heard this May would restrict contacts dentists can forge with dental service organizations. 

The legislature of North Carolina has the opportunity to cure this cancer before it metastasizes and before they end up in the exact situation Texas has now found it’s self-which is run over by corporate dental clinics. Many of which are stealing every penny they can from the not only the taxpayers of Texas, but yours as well.  I’m talking about the Medicaid system – 1/2 paid for from state funds and 1/2 paid for by federal funds. You want a good look at North Carolina's future, see the Recent Hearings in Texas dated April 11, 2012. Or read this from the hearing: Texas Dental Board Accused of Ineptitude

"The North Carolina Dental Board has denied my patients what I feel is the best dental care," said Dr. Gary Cameron, an Asheboro dentist who faced state sanctions after affiliating with an Illinois company. His case helped spark the push for the new law. 

Dr. Gary Cameron is either stupid, brainwashed, or being paid very handsomely by Private Equity firms for him to say such things, in my opinion. They only thing being denied is poor care, dental care based on corporate bottom lines not treatment needed, and his personal bank account. Ask yourself why Dr. Cameron was sanctioned. It was because he and Heartland Dental tried to skirt the laws already on the books in North Carolina. The laws are clear! Check them here.

Ashton–Nearly died a year ago today. Hear Ashton’s story from his mom! Don’t miss this!

 

This is Ashton.  It’s been a year today since this child almost lost his life from carelessness and overdosing by a dentist. When I watched this video, I realized that I was watching a child being euthanized, it’s just didn’t take.

Here Aston’s is story:

It was April 13, 2011... We took our 6 year old son Ashton to see Dr. Zhu (pediatric dentist) in Troy, Michigan to have fillings and a baby root canal done. What I thought would be an ordinary day turned out to be every parents worse nightmare.

Ashton was ignored, neglected, overdosed on sedation medicine and sent home unresponsive and unconscious. Dr. Zhu told us to take Ashton home and "put him to bed". Dr. Zhu clearly did not value Ashton's life and because his office was operating like an assembly line, he had to turn my son over as quickly as possible. As of this month which would mark one year, he has continued his practice and has not faced a consequence.
Jason carried Ashton out of the dental office like a rag doll. As he was driving Ashton home he heard a scary sound that later was determined to be the sound that occurs when a person's airway is blocked. At this point, he knew something was wrong and took him to the hospital to seek medical attention. If we would have chosen not to respond, Ashton could have died at home in his bed.
My son didn't die despite this negligence. There are many people that are "surprised" at his outcome and many other children who's outcome was catastrophic.
I can't help but want to warn other parents who hand their children over to medical professionals. I am not saying they are all like Dr. Zhu but there are some. ALWAYS trust your instincts and don't EVER be afraid to ask questions or walk away from any situation you are not comfortable in. I knew something was wrong here and I should have walked away.
If you want to know more about Ashton's story or you have a similar one, please let me know.
Thanks for listening!
Rebekah

Just a wild guess, but I’m thinking the ADA and the DGPA are none too happy about the hearings on Corporate Dentistry in Texas

Yes, the ADA is a different group and as we know the ADA rules, since they have the gold. But honestly, they might as well be the one and the same.  If you dig deep enough everyone with the DGPA is with the ADA, right?

Just two short days before the Texas Hearings on April 11, 2012, the ADA issued this:

 

 

ADA explores growth of large group practices

By Karen Fox, ADA News staff
April 09, 2012

The ADA is taking steps to increase dialogue with large group practices and gather information regarding this rapidly expanding career option.

This sector of the dental workforce has experienced significant growth in a relatively short period of time. According to the ADA Health Policy Resources Center, in just two years the number of large dental group practices has risen 25 percent.

For now, it’s still a small piece of the overall dental delivery system pie. In a 2008 sampling frame, the Health Policy Resources Center concluded that solo dentist practices account for 92 percent of all dental practices, and very large group practices with 20 or more dentists make up only 3 percent.

However, in analyzing its data on individual dentists, the HPRC has concluded that the rate of solo practitioners is falling. In 2010, 69 percent of dentists were solo practitioners compared to 76 percent in 2006.