Small Smiles Dental Centers employees kept in the dark

This letter was received last week from a Small Smiles employee. It is one of two received last week alone. Hopefully any identifying info was scrubbed, if not, oops, sorry.

My job is obviously a nightmare. I have been an employee with the company since March. A lot of funny business goes on. We are a profitable clinic probably when I first started in we were averaging 100 patients a day which is close to $10,000 a day now we see approx. 50.

I  for the last year have been miserable at my job but as a single mom with no child support I struggle to leave and possibly lose my apartment, etc.

It's not so much that i think what we do at my office in unethical most times I do agree on the treatment.  Big changes in the last year obviously after the Medicaid fraud we have a million compliance meetings, the state cracked down on reimbursement for stainless steel crowns. We no longer papoose (for the most part) as I was seeing many in a day we may have one a month..everyone's scared.

[well at least I’ve accomplished something!]

They are acting as if we will stay open and tell us very little.  Always constant changes weekly at small smiles..such as bill out what was before a periapical as an occlusal etc...no more papooses for Dr's etc.

[ so was it fraudulent billing before or now?]

All I really know is when they filed they told all 67 clinics over the phone a big 67 clinic phone conference and we were encouraged to ask questions basically it was that Tori guy who said business as usual...they don't want the company morale to be down so they don't tell us any new news.

Steve Adair told the Dental hygienist's if they see an HIV patient to double glove spray the room and leave it for two hours..who says this???? Exactly the opposite of what I learned in school.

Anyway the anxiety level I have when I get to work and the fear the boss puts in you and the company morale is terrible. They have us going out now doing ten minute marketing in which I have to walk the streets and pass out toothbrushes to passerby's encouraging them to come to Small Smiles.

Well in a city it’s the same damn people everyday. My bosses are acting like nothing is happening but a few of us follow your blog closely. It's the only truth we get. Dr (intentionally removed) is the current lead dentist "owner "of the office I work at, he is (age removed) spinning in circles and about to have a heart attack. I actually feel for this guy he is so going to get thrown under the bus. He does whatever they say no matter what he thinks

[ He is exactly right. He will be, the whole business is designed to protect the quarterback; Corporate Headquarters.]

But it's his own fault I said to him, “you actually own this place and he said no, I paid $100 and they put my name on the building.  I think what he said is BS.

I was venting sorry so basically I was wondering if no one bids on this hellhole by the 11th this Friday could it be the doors are locked Monday?????????? or probably not going to happen until after the 22nd...??????????

Can they possibly prolong the agony and then file chapter 7? I wish I could quit and go collect unemployment and state how horrible stressful and much anxiety this job gives me but I know they would fight it and I would lose and then put my daughter and I in a poor situation...

I wish there was something I can do..we started seeing adults in November 2011. I think they got a huge tax break for that or maybe are just desperate for any patients we can get.

I feel terrible telling these adults go see the oral surgeon get your teeth extracted then come back and we will fit you for dentures and I have no idea if we will be here???? Any thoughts,  any advice????

I thank you for your blog..it's my only knowledge and when they told us in a morning huddle that Lori Steiner-chief compliance officer was going back to her roots and leaving CSHM.  I was silently cracking up thinking about your blog which usually is the topic of our lunch room conversation and her last day (Lori Steiner the compliance officer) is May 31st how convenient.

Another dentist concerned about or lead/owner told me privately that she spoke with our lead/owner, and told him he should get a lawyer since he's the owner. He told her he had corporate lawyers.

The dentist looks at me and laughs and says “he's going to fry....”

[yes he is! so things must still be a bit shady around there, maybe?]

I feel that those of us who read your blog know more than they do. I just wonder if no one buys CHSM are we definitely closing??? Could they possibly only close some clinics and keep some open???  We have had a few people leave  and they are not replacing them.  But they tell us they aren’t replacing them because we have slowed down...everything is a lie.

I’d love to say thanks again for sharing your story Debbie...I just want it to end for me the girls I work with and the patients.

I appreciate your blog. Thank You

[You are welcome!]

Medicaid Dental Patients For Sale

This one blows my mind. This was an ad that landed in many dentists email box on Monday. 1-800-Dentist selling "leads" for prospective new patients on "state aid". Now, I ask you, what medical provider is patient shopping for potential patients in a program most all says reimburses way too little? Only a big dental mill would be willing to pay $25 per lead for 'state aid' patients.

Is 1-800-Dentist selling patient contact information or are they a third party broker and selling the names of patients which would be (assets) of bankrupt dental clinics such as Small Smiles and All Smiles? Someone needs to be asking?

HIPPA violations??  Anyone??  Bueller?

Where did 1-800-Dentist get these names? At the Corporate Dentistry Going Out of Business Sale?

 

 

 

 

 

 

 

 

 

 

 

 

What's really fantastic, is they can sell the same stuff over and over and over and over again. This is really not unlike the paid patient hunters where dental clinics have employees hit the food banks and food stamp office and get paid per head to bring them directly to the dental office. The patients want to come to get their wal-mart gift cards and such!  Win win!

How prepared is your dentist?

How prepared is your dentist?

One local family's mission to keep children safe

How prepared is your dentist?: wavy.com

 

Updated: Monday, 14 May 2012, 6:30 PM EDT
Published : Monday, 14 May 2012, 4:49 PM EDT

• David Culver

CHESAPEAKE, Va. (WAVY) - A trip to the dentist can evoke pain, anxiety or fear. Those feelings generally subside once your appointment is over. But for one Chesapeake family the pain will never end. It's been five years since their traumatic visit.

Today, they want to challenge parents; they want them to question their child's dentist.

On March 9, 2007, the Blanco family took their 8-year-old daughter Raven in for a simple procedure. She would be sedated, worked on, then awakened from her sleep.

But Raven never woke up.

Raven's father, Mario Blanco, often visits Norfolk's Forest Lawn Cemetery ; that's where Raven is buried. He brings a chair and sits a few steps from her headstone. It's time alone with his eldest daughter. He opens up to her.

"I don't hear her talk back, but I feel her presence," Mario said.

There is a picture of her at the burial site and Mario meditates on her sweet smile. The same smile still fills the Blanco's Chesapeake home. There are family pictures in every room.

Raven's mother, Robin Blanco, still finds her young daughter's death hard to accept.

"For me, the longer the time goes by, you learn to cope with it. But the longer the time goes by, I miss her more," Robin said, her voice cracking.

Raven was sedated for a routine dental procedure. While getting the work done, complications arose and her heart stopped. Robin watched as staff members performed CPR on her little girl. Crews rushed the child from the dental office to the hospital emergency room.

"I remember a doctor coming out and telling... you know, that they've done all that they can do," Robin continued tearfully. "And did I want to see her - you know I just couldn't believe it. And I said, 'Yes I want to see her. I want to see her.' I just couldn't believe it. And she was gone."

In Raven’s memory, the family started The Raven Maria Blanco Foundation, Inc. They follow and share the stories of other children who’ve died following complications at the dentist.

By their count, 11 have lost their lives in the past year.

Today they're on a mission to educate parents and they want dentists to be prepared. Raven's cousin, Nicole Cunha, is spearheading those efforts.

"People have to go to the dentist, people have to have these things done, there are children with anxiety that have to be sedated, they have to have the work done on them, so no you can't take that away, you have to know what to do if something goes wrong," Cunha said.

Virginia Beach Oral Surgeon Dr. Scott Goodove puts into practice what Raven’s foundation wants in every dental office. He told us, "If we have an emergency, our assistants are prepared. They have stations to take if we have an emergency from the back to the front."

Each morning he holds a staff meeting and goes through the patient list. They discuss any medical complications that could arise.

Dr. Goodove sedates hundreds of patients each year. That's far more than a general dentist. But he points out that oral surgeons also undergo years of specialty training. His advice for any dental office, whether they sedate or not, be ready for a worst-case scenario.

"What we have here is sort of a more organized central emergency station.... (Our) patients walk in, they feel comfortable, 'Hey ... these guys are prepared.'"

In a corner of his office he has an automated external defibrillator (AED), a tank of oxygen, a range of medications and drugs. There's also an emergency response guide.

CLICK HERE FOR THE RAVEN MARIA BLANCO FOUNDATION'S SIX LINKS OF SURVIVAL

"It's as simple as picking the emergency - someone passes out - and it will give you the step-by-step guide. But you don't want someone reading this for the first time during the emergency itself, so you run through these drills."

And Dr. Goodove holds mock drills every month. For general dentists, not doing deep sedation procedures Virginia dental regulations don’t go nearly that far. That’s where the Blanco’s want the public to help.

"If we get a group of the whole country coming together, and demanding these things, you'll see a big change," Mario said. Mario eventually wants to see these preparedness practices become law - Raven’s law - as he sees it.

Meantime, much of his time is spent sitting across from Raven burial site, as they keep each other company. Her epitaph reads: "'The most beautiful girl in the world a beloved daughter and sister who is missed and loved so much. One day we will all be together again....' And we will."

Raven's parents want you to ask certain questions before you make a dentist appointment for your child. Click here for a list of those six questions.

Click here to watch the portion of our interview in which the Blanco's discuss taking their other children to the dentist for the first time, following Raven's death.

---

After this story aired, I received the following:

 

Kimberly Asercion

Hello,
After going to the link that showed all the children that had lost their lives due to "complications" at the dental office, I felt like I just needed to tell someone briefly what I have experienced as someone "in the field". I live in Va. Beach and was a dental assistant for almost thirteen years. (I left the field in 2004 after working in an adult practice, and since that time I actually work in the cemetery industry as a General Manager at a cemetery in Va. Beach) I worked five of my thirteen years in a pediatric office. (Drs Sundin and Bullock) and about two months after that at Drs Hechtkopf and Cox. (1998) I did not work long at the last office because the unsafe practices that they undertook actually scared me.

When a child had to have a lengthy procedure they were given Chloral Hydrate for the procedure as well as Nitrous Oxide. (and Lidocaine of course) The dental assistant would come out to the waiting room and get their patient and bring them back. Then the assistant would mix the Chloral Hydrate based on the dose prescribed by the Dr. and give it to the child. Within about ten minutes the children would literally just start getting drowsy and then basically pass out. We would then have to hold them until it was time for them to have their work done...if the office was busy that day then sometimes that could be up to 45 minutes. During that time (and this happened A LOT) the children would begin vomiting...while unconscious and we would have to try to hold them upright while this was happening.

When the procedure would start, the child (who was already completely unconscious) was given Nitrous. It was jacked up way over the necessary level (about 70%) and to the point that it would induce nausea and vomiting even in an adult...but especially on a child that was already sedated. While the child was being worked on (with the papoose board) they had a heart monitor on...when their heartbeat would start to increase the Dr. would say, "Okay...get ready...here we go!" (Because the heart rate would increase when they were getting ready to vomit.) They would not reduce the Nitrous strength and we would just have to keep suctioning as they were getting sick.

After the procedure was finished, they would turn on the straight oxygen and start to try to wake the child up. They would still be very groggy when we would carry them back out to their parents, however we were not allowed to tell them that their little child had just spent the last two hours vomiting while unconscious. We did give them precautions for them to eat lightly and to watch them while their mouth was still numb so that they wouldn't bite the inside of their mouth, etc. They never had any idea what had happened back in the office though. That is the part that was so upsetting to me.

I happened to be CPR certified, however this was not a requirement for the job. I was never asked before I was hired if I was. That I know of, none of the assistants were ever shown emergency procedures. I know I was not. This happened on an almost every day basis. Now, when I started the job, I did have eight years of experience and five of those had been in a pediatric office...however the requirements to get a job in Dr. Hechtkopf and Cox's office were very minimal.

I am saddened to hear these stories...I can very easily see how these tragedies could take place. The dentist most of the time very heavily relied on their assistant to have already checked the child's health history without every looking at it themselves. (This was the story in every office I worked at unfortunately.)
I'm truly sorry that this happened and I hope that you sharing these stories will help to regulate the requirements of dentists and their assistants in the future. I just felt like I needed to tell what it was like behind the scenes because I can easily see how this could have happened.
Sincerely,
Kim

WAVY TV to air “Deadly Dangers at the Dentist Office”–May 14, 2012

David Culver of WAVY 10 TV reports on the deadly dangers at the dentist office. Full piece to air on Monday, May 14, 2012 starting at 5:00 PM. Please watch and share.

What a waste of 1042 words about a precious child–Amazing of how the victim remains on trail and never the Dental Boards or the dentist at fault.

On May 5, 2012 Kevin Rector of the Baltimore Sun devoted 1042 words to an article questioning the mental and emotional health of Jenny Olenick who died April 6, 2011during a sedation procedure to extract 4 3rd molars (wisdom teeth). Jenny was  17 years old. One has to wonder who actually wanted that many words devoted to this case, it certainly wasn’t Jenny’s mom, Cathy Garger. I doubt the writer was actually monitoring the civil case in the courts, so who handed over this piece to Rector? I doubt it was an idea from the bankrupt media conglomerate Tribune newspapers, which is the Chicago Tribune, Los Angeles Times, WGN TV and others. Whoever it was, should have thought more about it and made another choice. Below is the link to the article.

By Kevin Rector, krector@tribune.com May 3, 2012

Lawyers question Olenick's health prior to surgery death

I’ve spoken with Cathy and the article from Mr. Rector cut her to the core.

Thank goodness someone in Cathy’s community spoke up and thank goodness the Baltimore Sun published the “Letter to the Editor”.

Letter to the Editor:

Lawyer's assertions in dental death lawsuit 'ridiculous and insulting'

May 13, 2012 | 2:22 p.m.

My heart goes out to the family of Jenny Olenick, who by all accounts was a talented and wonderful teen. The May 5 article detailing events surrounding the filing of a malpractice suit, "Lawyers question teen's health before death," got my attention for several reasons.

To imply that pre-exiting conditions, such as stress, anxiety and heart disease would have contributed to or caused her death seem far-fetched. As reported in the article the autopsy report found "no evidence of a physical process, like cardiomyopathy having occurred," according to the state's chief medical examiner. Regarding the premise of "undisclosed medical conditions," the article states that Ms. Olenick had a medical evaluation and was "cleared" for anesthesia and surgery.

FINALLY, someone asking Church Street Health Management to “prove it”, “fork it over”, “show us from where the money comes” and more.

Bankruptcy Watchdog Protests Wind-Down Process Of Small Smiles

Katy Stech May 11, 2012 (c) 2012 Dow Jones & Company, Inc.

A federal court watchdog wants to put a hold on the $25 million sale of the operator of Small Smiles Dental Centers to a private equity firm--a deal that a bankruptcy judge has yet to approve--until the Tennessee-based chain sheds light on its post-closing moves.

U.S. Trustee Samuel Crocker, who monitors bankruptcy court pleadings for the Department of Justice, wants company executives to be clearer about the financial professional who would take over the bankruptcy estate once distressed investor Garrison Investment Group purchases its operations on May 31, according to papers filed in U.S. Bankruptcy Court in Nashville, Tenn.

I heard the the infamous Doug Brown and Kirk Huntsman might be involved before it ends. if so, Doug Brown would be involved in more Private Equity “Medicaid dental mills” and “pull every tooth in your mouth and slap in some cheap denture” operations in the world.

The Order

Upon the motion of The Official Committee of Unsecured Creditors, by and through counsel, it is ORDERED that individuals designated by Fireman’s Fund Insurance Company shall appear for examination pursuant to Fed. R. Bankr. P. 2004 on May 16, 2012 at 9:00 a.m. C.S.T. at the offices of Baker,Donelson, Bearman, Caldwell & Berkowitz, P.C., 211 Commerce Street, Suite 800,Nashville, Tennessee 37201. 

IT IS FURTHER ORDERED that individuals designated by Fireman’s Fund Insurance Company shall produce the documents as specified in Exhibit 1 to the Committee’s counsel at the above address not later than May 15, 2012 at 4:00 p.m. C.S.T.

IT IS FURTHER ORDERED that the attorney for the movant shall serve a copy of this order on the party or counsel for the party required to appear and to the U.S. Trustee.

The attendance of an entity for examination and the production of documentary evidence are compelled in the manner provided in Fed. R. Bankr. Proc. 9016 for the attendance of witnesses at a hearing or trial.
Dated: May 4, 2012

Who wants to bet they do all they can to postpone this one?!!  LOL

Appears just about anyone can motion for a Rule 2004 Examination.

Exhibit A of Exhibit 1 – List of Small Smiles Dentist Names
I’d bet a whole crap load of these 916 dentists are on Santa’s Naughty list. No wonder I was told some of the folks in the below list are spinning in their shoes and support employees are afraid some are going to have a heart attack.

 Church Street Health Management Rule 2004 Examination and Document Request - Names of 916 Dentists Doc 319-2

Manalapan Dentist's License Revoked by State Board

“Dr. Weber violated the trust of his patients, by hiding the true nature of his relationship with the credit financing companies, and through the substandard care he provided,” said Eric T. Kanefsky, Acting Director of the State Division of Consumer Affairs. “Egregious violations such as these cannot, and will not, be tolerated by our licensing boards.”

Story here

I guess this guy didn’t know about Waller, like Richard Malouf and the folks at Church Street Health Management

Illegal immigrant tied to massive Medicare fraud gets 3 years in prison

ByBrooks Egerton/Reporter
begerton@dallasnews.com | Bio

11:52 AM on Thu., May. 10, 2012 | Permalink

A Nigerian man who lied to become a U.S. citizen has been sentenced to three years in federal prison for immigration fraud and Medicare fraud.

Plano resident Okey Nwagbara, 45, is the first person to be imprisoned for crimes connected to Medistat Group Associates -- the DeSoto business run by Dr. Jacques Roy (right), who federal prosecutors say orchestrated a record-setting home health-care fraud scheme.

Nwagbara, who owned a company in Richardson called Advanced MedEquip and Supplies, cut a deal under which prosecutors recommended letting him serve his sentences for both crimes simultaneously. U.S. District Judge Sam Lindsay agreed to this in assessing punishment Monday.

The defendant had asked for an even more lenient sentence. Prosecutors objected last month, calling Nwagbara "a fraudster of the highest order" whose immigration fraud "merely laid the groundwork for his next fraud scheme: accessing Medicare and stealing as much as he could without getting caught."

When pleading guilty in January, Nwagbara admitted paying kickbacks to Roy employee Jerry C. Bullard in exchange for business.

"Upon receiving cash payments from Nwagbara, Bullard would sign 'JRoy MD' on Medistat prescription pads, durable medical equipment information forms (DIFs) and 'Certificate of Medical Necessity' for enteral nutrition products falsely indicating among other things that the beneficiary required tube feeding," according to a summary of facts signed by Bullard. He has also pleaded guilty to Medicare fraud and faces sentencing June 4.

Read the rest of the story here

The $700,000 cure for Church Street Health Management

This morning at 9:00 a hearing was to be held in Nashville Bankruptcy court whereby Church Street Health Management, LLC was asking the court to modify the final Debtors In Possession (DIP) Order and to reschedule the closing of the sale of Church Street Health Management ,LLC to CSHM, LLC. They want to set it for May 31, 2012 instead of May 30, 2012 and they want to remove a legal service agreement with King and Spalding. (lol…they are gonna miss that income!)
Church Street Health Management , LLC and CSHM, LLC are two completely different companies now, so keep that in mind from this point forward. Church Street Health Management, EEHC, LLC, FORBA NY, LLC and Small Smiles Holdings, LLC are now combined into one company, namely CSHM, LLC. At least that is what it will become when the sale closes with Garrision
In their “Assumption Notice” (Doc 301, 302, and 302 Schedule A) is listed all the contract and obligations the new buyer will assume and have possession of at closing of this Rule 363 sale. The first one filed May 1, 2012 had 14 pages of those phony Management Service Agreements with phony clinic owners and employment agreement contracts, intellectual property such as trademarks, non-compete contracts with the original founders-The DeRose-Padula family- and other miscellaneous agreement, contracts and business agreement. A new and amended Schedule A was filed the next day, May 2, 2012. Yes, there was a change, a tiny one; King and Spalding were removed as having a Legal Service Agreement with the new CSHM, LLC.
From reading the “Assumption Notice” , the new new CSHM, LLC will only “assume” a little over $700k ($707,399) (see assumptions and "cure" amounts here)of Church Street Health Management, LLC, EEHC, LLC, FORBA, NY, LLC and Small Smiles Holdings, LLC $23,607,147.40 of debt. (According to Form 1 Schedule F here-Doc 213, starting on page 51)
Suspiciously missing from the debt the new buyer would now assume is $4,911,378 listed as still being owed to several states on a March 23, 2012 report. (Here on page 51)
BTW, who were those $10,000 loans made to that were listed on the March 2012 expense report?! Who loans money when they are broke? (see here on page 6)

These things seldom work as planned. Saving $5 billion sounds good, but not if it will loose $50 billion from additional fraud. There must be an algorithm for this?

Didn’t they report in February they recovered $4 billion in fraud in 2011. That’s $4 billion that escaped from the hands of CMS, right?

FOR IMMEDIATE RELEASE
Thursday, May 10, 2012

HHS finalizes new rules to cut regulations for hospitals and health care providers, saving more than $5 billion
Changes will reduce costs and allow more focus on medical care

[Reduce costs for whom? I’ve heard this for years now, and my costs keep going up, how about yours?]

Today, Health and Human Services (HHS) Secretary Kathleen Sebelius announced significant steps to reduce unnecessary, obsolete, or burdensome regulations on American hospitals and health care providers. These steps will help achieve the key goal of President Obama’s regulatory reform initiative to reduce unnecessary burdens on business and save nearly $1.1 billion across the health care system in the first year and more than $5 billion over five years.

“We are cutting red tape and improving health care for all Americans,” said Secretary Sebelius. “Now it will be easier for health care providers to do their jobs and deliver quality care.”

The new rules are being issued today by the Centers for Medicare & Medicaid Services (CMS). The first rule revises the Medicare Conditions of Participation (CoPs) for hospitals and critical access hospitals (CAHs). CMS estimates that annual savings to hospitals and CAHs will be approximately $940 million per year.

The second, the Medicare Regulatory Reform rule, will produce savings of $200 million in the first year by promoting efficiency. This rule eliminates duplicative, overlapping, and outdated regulatory requirements for health care providers.

“These changes cut burdensome red tape for hospitals and providers and give them the flexibility they need to improve patient care while lowering costs,” said CMS Acting Administrator Marilyn Tavenner. “These final rules incorporate input from hospitals, other health care providers, accreditation organizations, patient advocates, professional organizations, members of Congress, and a host of others who are working to improve patient care.”

Among other changes, the final rules will:

Increase flexibility for hospitals by allowing one governing body to oversee multiple hospitals in a single health system;

Let CAHs partner with other providers so they can be more efficient and ensure the safe and timely delivery of care to their patients;

Require that all eligible candidates, including advanced practice registered nurses and physician assistants, be reviewed by medical staff for potential appointment to the hospital medical staff and then be granted all of the privileges, rights, and responsibilities accorded to appointed medical staff members; and

Eliminate obsolete regulations, including outmoded infection control instructions for ambulatory surgical centers; outdated Medicaid qualification standards for physical and occupational therapists; and duplicative requirements for governing bodies of organ procurement organizations.

To view the final rules, please visit www.ofr.gov/inspection.aspx.