Byron Harris was in Washington for the hearing on Medicaid fraud. You don’t want to miss his report.

by BYRON HARRIS
Bio | Email

WFAA
Posted on April 25, 2012 at 10:11 PM
Updated today at 7:36 AM

WASHINGTON — "It took a reporter to unlock the mystery that Texas is spending more on braces than the rest of the country put together?"

That was the half-humorous question Rep. Trey Gowdy (R-South Carolina) asked his fellow members of the House Oversight and Government Reform subcommittee in Washington on Wednesday.

Looking at Medicaid fraud, the committee talked to whistle-blowers and lawyers from Minnesota and New York, all of whom discussed scandals in their home states.

But the witness at the heart of this hearing was from Texas.

Dr. Christine Ellis, a North Texas orthodontist, credited News 8 with revealing a "flagrancy of fraud that is truly unbelievable."

News 8 spent thousands of dollars to acquire Medicaid records from the State of Texas and discovered that the state paid out $424 million to put braces on poor kids' teeth from 2008 to 2010.

News 8 also obtained spending totals on orthodontics from other states individually, after the federal government said it did not compile them.

"As they say, everything is bigger in Texas," Dr. Ellis told the panel. "Thanks to the investigative reporting of WFAA's Byron Harris, we now know that orthodontic Medicaid fraud is no exception."

American Dental Association asks Centers for Medicare and Medicaid Services to back off the audits. Seriously! While, upstairs, the Academy of General Dentistry wants more taxpayer funding. Seriously!

The American Dental Association sent this letter to Centers for Medicare and Medicaid:

ADA Letter to CMS July 2011

American Dental Association,211 East Chicago Ave.,Chicago, IL 60611-2678

Then ABC ran this, by Chris Como, (his brother is NY Governor Andrew Como who said a month or so ago Medicaid audits were just way to hard on corporations.)

By CHRIS CUOMO (@ChrisCuomo) , GITIKA AHUJA (@gitgirl) and ENJOLI FRANCIS

April 24, 2012

With more than 16 million low-income U.S. children on Medicaid not receiving dental care -- or even a routine exam -- in 2009, according to the Pew Center on the States, dentists and ERs say they are treating very young patients with teeth blackened from decay and bacteria and multiple cavities.

"I see it in their eyes before they tell me it's that way," Dr. Gregory Folse told ABC News. "We are able to intervene and take the pain away from their teeth and it brings the spark back. And that's my goal."

Folse's Outreach Dentistry mobile clinic travels to schools around Louisiana, filling cavities and teaching children and parents about the importance of oral hygiene.

In 2007, Congress held a hearing on the issue of children's dental health after Deamonte Driver, a 12-year-old Maryland boy, died when a tooth infection spread to his brain. His mother, Alyce Driver, had been unable to find a dentist to treat him on Medicaid and could not afford to pay out of pocket.

At the time, Leslie Norwalk, then-acting administrator for the Centers for Medicare and Medicaid Services, called his death "a failure on many levels."

A dentist and a vet want their corporate dental clinics- Pacific Dental-to have more access to the teeth of New Mexico citizens and taxpayer coffers.

By “vet” I don’t mean “veteran” of the military, I mean “veterinarian”!!!

Pacific Dental-Smile Care-Coast Dental-InterDent, wants to open more than just the current 2 clinic limit in New Mexico. They want in there in a bad way, and Derek and Adam Diasti are willing to go to the mat to get that access. Brother, Derek is the veterinarian.

Best known as Pacific Dental, it seems to be financed by Dimensional Fund Advisors (DFA) or at least Coast Dental was before the merger.

DFA website

Below is a letter sent to the New Mexico Dental Board, dated March, 2012.  In it, they actually say it would be unconstitutional to refuse to allow the company to violate the state Dental Practice Act. Yep! Pure madness!

And unless there is a real and serious pushback, the state laws are likely to be changed to allow them in. New Mexico citizens are sitting at home right now, not knowing the danger to their public health that is taking place. Scary!

Of course corporate dentistry is being pushed throughout the land. As we learned last week at the Texas hearings, the states say have they no authority over the entities. It’s the Wild West! Unchecked and unregulated, or should I say,not regulated.

Pacific Dental Services, Inc

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.

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