Thursday, October 11, 2012

Texas Task Force Hunting Down Medicaid Dental Fraudsters

Texas finally appears serious about the state’s extraordinary Medicaid dental fraud. Hopefully indictments will soon be coming. I hear at least one bunch of merry bandits, are locking doors on some of their clinics and owners are scurrying like the nasty rats they are.

tribune

 

 

 

Joint Task Force Tackles Medicaid Dental Fraud

by Becca Aaronson October 10, 2012

Through a new joint task force, the Texas attorney general’s office and the office of the Inspector General at the Health and Human Services Commission have teamed up to strengthen investigations of fraud and abuse in the state’s Medicaid dental program for children. And because the task force allows the agencies to coordinate limited resources, state officials say, the state can advance investigations and recover misused taxpayer funds more quickly. 

“The Medicaid and orthodontic fraud task force was convened to ensure the state had a comprehensive and coordinated response to a dramatic uptick in fraud by Medicaid providers,” said Daniel Hodge, the first assistant for Attorney General Greg Abbott. “The highest levels of all affected agencies and divisions are actively involved in advancing the investigation as efficiently and effectively as possible."

John Scott, the deputy attorney general for enforcement litigation, chairs the task force, which also includes officials from the Medicaid Fraud Control Unit and Civil Medicaid Fraud Unit at the AG's office, and officials from the inspector general and other departments of the HHSC.

In 2010, Texas spent as much on orthodontic services as every other state combined, according to a report released in April by the U.S. House Committee on Oversight and Government Reform. "The state has admitted that widespread fraud was occurring and that the organization the state hired to assess prior authorization forms was essentially rubber stamping forms for approval," the report states. An orthodontist consulted by the inspector general's office at HHSC estimated that 95 percent of approved claims should have been denied, according to the report.

State officials said the task force, which was created this year, allows the agencies to take advantage of what each group brings to the table. For example, the inspector general’s office has software to monitor whether a provider’s claims data looks suspicious and can put payment holds on providers it suspects are committing fraud. And the AG has teams of lawyers from the two Medicaid fraud units who follow through on investigations, subpoena records and press charges. 

The state is also getting an assist from whistleblowers like Dr. Morna Staffel, a pediatric dentist in Fort Worth, who said she has stacks of evidence — in the form of patient records — of children being overtreated and, in effect, abused by dental clinics seeking to profit off the state’s dental program for low-income children.

On Monday, for example, she had to remove six teeth in a child’s mouth that had abscessed less than six months after Medicaid paid for the child to be treated at a nearby dental clinic. “When I see this type of situation, I’m pulling patient records, I’m keeping patient records, I’m calling the [Office of the Inspector General],” said Staffel.

Evidence turned over to the state by whistleblowers is filed under seal. And state officials cannot disclose how many investigations they are currently pursuing. But one provider, All Smiles, which was the focus of a WFAA-TV report in October that brought the allegations of fraud into the national spotlight, appears to be in their crosshairs.

State authorities familiar with the task force’s investigations said the group is committed to recovering all taxpayer funds lost to dental fraud, from both dental providers and the Texas Medicaid and Healthcare Partnership, which was responsible for evaluating the medical necessity of dental claims and approving payment.

The state audited TMHP’s process for evaluating dental claims in 2008 and recommended that the contractor increase the number of licensed dental professionals reviewing orthodontia claims, according to a State Office of Administrative Hearings report related to a recent allegation of Medicaid dental fraud. “TMHP responded to the audit’s recommendation by saying that an increase in the use of dental professionals would require a change in TMHP’s contract, which did not occur,” the report states. 

TMHP recently renewed its state contract, and state officials familiar with the investigations said they plan to work with the company on negotiations to recover state funds lost to medically unnecessary claims.

In an email to The Texas Tribune, Ken Ericson, a spokesman for TMHP, said, “Several providers are under state attorney general investigation — and we are cooperating with that investigation.”

Most of the rise in Medicaid dental claims was probably legitimate, said Stephanie Goodman, spokeswoman for HHSC, because the state had increased reimbursement rates by 50 percent to expand access to care. “Those other factors kind of masked the fact that there was also probably an increase of bad actors in the program,” she said.

Texas became a target for dental fraud after 2007, when the Legislature allotted an additional $1.8 million for Medicaid children’s dental services, as part of a legal settlement to increase access to care.

State authorities familiar with the task force's investigations confirmed it has found that some dental clinics have illegally solicited Medicaid patients by standing outside large retailers and grocery stores and handing out gift cards in exchange for signing up for a free dental exam. And the inspector general recently issued a statement that said, “Offering inducements to Medicaid clients is a violation of state and federal law and is subject to a penalty of up to $10,000 per violation.”

As the Tribune reported in July, the crackdown on orthodontic fraud has left many patients with untended braces, and a difficult transition to Medicaid managed care has exacerbated problems with access to care. The state is currently severing ties with Delta Dental, one of three Medicaid managed care plans, in part because state officials said the company failed to establish a computer system for providers to submit claims in a timely manner. In December, 1.1 million individuals enrolled with Delta Dental will be transferred to the other two managed care dental plans.

Staffel said the transition to managed care has limited the number of orthodontists willing to take referrals for Medicaid patients, and many patients have been left "hanging in limbo," after the state shut down their orthodontic clinic by withholding Medicaid payments while the state investigates allegations of fraud.

HHSC has informed orthodontic providers that the dental board can suspend or revoke their license for abandoning Medicaid patients. 

"We’ve worked really closely with the dental board on that issue," said Goodman, adding many orthodontists have also stepped up to help address the problem with access to care. "Even providers that didn’t normally take Medicaid patients have agreed to take a few."


 

  • Dr. Staffel worked for Dr. Eugene Kouri at Eugene Kouri, DDS MSD, Inc. 2921 Lackland Road #201, Fort Worth, TX 76116

 

  • Gene M. Kouri, DDS, MSD - Dr. Kouri received his MSD in Pediatric Dentistry and his doctorate in Dental Surgery from Baylor University. He began his private practice in 1961 with a brief interruption for service as a captain with the United States Army Dental Corps. Dr. Kouri’s professional associations include the Texas Society of Dentistry for Children, American Academy of Pediatric Dentistry and the Southwestern Society of Pediatric Dentists. – http://genekouriddsmdfortworthtx.com/texas-pediatric-dentists

Dr. Eugene Kouri came in at number 8 in 2010 Texas’s Top Stainless Steel Crown  state records, topping off at 6,108. In 2011 his office billed the state over $2M, nearly $700M for stainless steel crowns alone!

2010 Top Ten Dentists to bill Texas for stainless steel crowns:

  1. Linda T. Burke -  Harlingen, TX
  2. Trueblood Dental Associates - Austin, TX
  3. Buckner Market Place Dental - Dallas, TX
  4. Smile Center – San Antonio, TX
  5. Robert Morgan DDS MSD – Irving, TX
  6. Kool Smiles Laredo, TX
  7. Valley View Smiles/ All Smiles Dental – Dallas, TX
  8. Eugene Kouri, Fort Worth, TX
  9. Bill Pope, McAllen, TX
  10. Robert Morgan DDS, Richardson, TX

 

Wednesday, October 10, 2012

Beekman Group, unloads Gentle Dental on Linden Capital Partners. Just in time?

October 10, 2012

PRESS RELEASE

Harris Williams & Co., a middle market investment bank focused on the advisory needs of clients worldwide, announces the sale of Northwestern Management Services, LLC (NMS) doing business as Gentle Dental (Gentle Dental), a leader in the dental service organization (DSO) industry, to Linden Capital Partners (Linden). Gentle Dental was a portfolio company of The Beekman Group, LLC (TBG). Harris Williams & Co. acted as the exclusive financial advisor to Gentle Dental. The transaction closed on October 5, 2012 and was led by James Clark, Geoff Smith and David Allebach.

“Gentle Dental has established itself as a clear leader in the attractive South Florida dentistry market through its commitment to quality, operational excellence and results-driven approach to physician and practice support. In addition, this transaction demonstrates investors’ continued strong interest in the DSO sector driven by investors’ desire to find scalable business models in markets positioned to benefit from positive demographic trends,” said James Clark, a managing director in Harris Williams & Co.’s Healthcare & Life Sciences (HCLS) Group.

Tuesday, October 09, 2012

A peek under the sheets at Heartland Dental

I ran across a propaganda piece today on – dentalhealthcarecenter.net. about the super duper fantastic Heartland Dental Care.
 
heartland
It tells about Heartland Dental, in Effingham, IL and what they can do for dentists who are finding it hard to develop their own dental offices. It tells dentists, that by becoming an “affiliate” of Heartland, it can “make your career better.” Their career will be better because Heartland “will increase your creditability and reputation”. It goes on to say:

  • “Working with this company will never lead you to regret”
  • ”your office will be way better”
  • “The company will help in marketing your office, providing you qualified staff,, managing your office, advertising your services and many more.”
  • ”people consider that dentists who are working under the name of the company are all professional”
  • “it is not the company that decides how your office should work. You can decide how you run your business yourself. The company just helps you reach your dream.”
  • “if you face serious problem when running your office, the company will give you effective suggestion in how to break the problem.”
  • “you will likely to become a partner of the company”

But what really happens?

Here is what I’m told

Monday, October 08, 2012

Richard Malouf’s Six Flags Over Malouf WaterPrik Park–Update!

 

WFAA

 

 

by BYRON HARRIS

Bio | Email

WFAA
Posted on October 8, 2012 at 10:03 PM
Updated today at 10:03 PM

DALLAS — There's a different kind of skyscraper going up in one of Dallas' most exclusive neighborhoods on Strait Lane. Mavericks superstar Dirk Nowitzki, former Rangers owner Tom Hicks and even Mayor Mike Rawlings live close by.

This "skyscraper" is really a three-story water slide and lazy river in the backyard of Texas' most famous dentist. 

Dr. Richard Malouf made millions from putting braces on children under Medicaid. 

In a whistleblower lawsuit, the Texas attorney general says much of Dr. Malouf's work was fraudulent. All Smiles Dental Clinics — which Malouf founded and still owns part of — filed for bankruptcy earlier this year.

Work on the water park and an addition to Malouf's huge chateau on Strait Lane continues. malouf2

A turquoise pigtail of a water slide curls over the backyard and peeks through neighbors' trees. A five-foot wide, concrete-lined Lazy River water feature is taking shape below.

But a News 8 investigation finds the Bentley-driving Malouf has a history of being sued for failing to pay his bills.

Dental Service Organization (DSO) Affordable Care/Affordable Dentures Dentist Stripped of License

Affordable Care is owned by American Capital, the same Private Equity firm who invested in the disgraces and bankrupt Small Smiles Dental Centers. Affordable Care and it’s President, Douglas W. Brown, were behind the big push in North Carolina to make life easy for Dental Service Organization in that state.
Affordable Care and it’s “affiliated” clinics go straight to the top of the nasty DGPA organization and has so many tentacles that it would make an octopus jealous!


 
By DON DARE
6 On Your Side Consumer Investigator
MORRISTOWN (WATE) - Disciplinary action taken by the Tennessee Board of Dentistry against David Harrison has been swift and decisive.
The board revoked the Morristown dentist's license, stripping him of his ability to work in Tennessee. It was the most extreme punishment available to the state.
In the consent order, "unprofessional conduct" was cited as one of the grounds for taking such extreme measures.
June McClary was one of Harrison's first patients to call 6 On Your Side and one of the first to contact state investigators about Harrison's practice.



Dr. Wendell Allen Racette sentenced to 15-30 years in prison for sexual assaulting a child patient

Now, if you can just get the same for physical assault, progress will have been made. Could this be Dr. Thomas Floyd’s future? I hope it is.

 

lsl

 

 

racette

Written Laura Misjak

A former Lansing pediatric dentist convicted last month of sexually assaulting a child patient was sentenced Wednesday to 15-30 years in prison.

A jury in August found Dr. Wendell Alan Racette, 65, guilty of five counts of first-degree criminal sexual conduct and 10 counts of second-degree criminal sexual conduct.

Ingham County Circuit Judge William Collette sentenced Racette to 15-30 years in prison for each of the first-degree charges and seven years two months to 15 years for the second-degree charges. Those will be served concurrently.

Racette also was sentenced to a lifetime of electronic monitoring when he’s done with prison, and ordered to not contact the victim’s family directly or indirectly.

Racette declined to give a statement during the hearing. His attorney, Chris Bergstrom, was not immediately available for comment following the hearing.

Prosecuters said Racette sexually assaulted a boy in his Lansing dental office between 1996 and 2000 when the boy was between the ages of 5 and 10. He came forward with his story in 2010.

Arthur Laffer’s study on Dental Service Organizations (DSO’s) is questioned

Dr. Biscupid
By Donna Domino, Features Editor

October 8, 2012 -- A new study conducted by a well-regarded economist but paid for by the dental chain Kool Smiles found that dental service organizations (DSOs) provide lower-cost treatment to underserved populations. The report also eschews criticisms about Medicaid fraud and unnecessary procedures that have been leveled against many DSOs. ellisquote

The report, released September 19, was compiled and written by Arthur Laffer, PhD, a former advisor for President Ronald Reagan who is known as the father of supply-side economics. The 17-page paper, "Dental Service Organizations: A Comparative Review," evaluated all Texas Medicaid data from fiscal year 2011, including 25.9 million procedures.

"DSOs are providing dental care to some of the poorest, most underserved segments of our society," Laffer wrote. "DSOs are not only providing much needed care, but they are providing that care expeditiously and relatively inexpensively when compared to non-DSO affiliated dentists."

DSOs have operated since the 1960s but have become much more prevalent since the late 1990s, he noted.

Full Article can be read here.

Frank Catalanotto, DMD, …said he also questions the report's integrity.

"Any time an organization is under investigation, you'd always look suspiciously that Kool Smiles has a self-serving motive in paying for studies like this," Dr. Catalanotto told DrBicuspid.com. "We have to assume the investigations are also valid and based on complaints and specific reasons. But in any organization you have to determine what's driving the organization. Is there a profit motive, and does that result in bad behavior?"…

Full Article can be read here.

Houston attorney Jim Moriarty, who is part of a whistle-blower case against Dallas-based All Smiles Dental Centers, agrees that DSOs violate state dental practice laws.

"The elephant in the room is what Kool Smiles and Small Smiles and the rest of the DSOs are doing is illegal," he told DrBicuspid.com. "No private equity firm spends a billion dollars buying a dental practice unless they get complete control over the business and complete control over the income stream. So Laffer's premise that the private equity firms that own most of them do not have control over the clinics is a lie, and he glosses over this."

Laffer did not respond to calls for comment.

Sunday, October 07, 2012

Dr. Thomas Floyd, on Dr. Thomas Floyd

Dr. Thomas Floyd was recently arrested in West Palm Beach, Florida for, among numerous other charges, beating, choking and gagging children. One such child was being stabbed in the mouth so badly by Dr. Thomas Floyd, his assistant ran through the office screaming for someone to call the police, she though Floyd was going to kill the child!

Below is Floyd’s bio he posted on classcreator.com. Sounds like such a lovely man, but I believe his bio needs a bit of updating!!  What a creepy mean old man.

Thomas Floyd Bio on ClassCreator.com

Thursday, October 04, 2012

Roben Brookhim–Arrested for using identity of deceased dentist Larry Kirkland, Jr.

A dentist in New Jersey who had his license to practice dentistry temporarily suspended in 1999 for fraudulent billing practices.  His license was permanently suspended in 2004, for continuing to practice dentistry using another dentist’s identity while under the 1999 suspension. In 2011, Roben Brookhim took on another identity.

This time it was of deceased dentist, Dr. John Kirkland, Jr. Dr. Kirkland’s dental license was renewed one day before he passed away in October 2011. It appears Kirkland and Brookhim were dentists at  Associated Dental in New Providence , Associated Dental in New Springfield and Associated Dental in Springfield in addition to Family Dental Center in West New York.  Dr. Brookhim allegedly assumed Dr. Kirkland’s identity to practice at all locations, according to northjersey.com.

The company website – associateddentalofnewjersey.com is registered to Dr. Roben Brookhim, Associated Dental NP, LLC, P.O. Box 589, Milburn, NJ 07401 973-339-2105.

Associated Dental NP, LLC was registered to do business in NJ 12-2005. But there are several companies beginning with Associated Dental in NJ, two of which were created in 1999, when Brookhim had his license temporarily suspended – Associated Dental Center, LLC and Associated Dental Group, PA.

This is just speculation, but maybe when Brookhim owns these 4 clinics. After he lost his license to practice dentistry he needed a fake owner dentist, enter Dr. Kirkland. Kirkland up and dies, leaving Brookhim in a real bind.

One thing for sure, Brookhim has been mascarading as someone else for years. I wonder who he was between 2004 and 2011?

I’m sure there is much more to this story.

Presss Release: October 4, 2012

NEW PROVIDENCE – Attorney General Jeffrey S. Chiesa and the New Jersey Division of Consumer Affairs today joined with Union County Prosecutor Theodore J. Romankow and the New Providence Police Department, to announce the arrest of an unlicensed dentist who is accused of falsely using the name and license number of a dentist who died last year, in order to treat patients.

Tuesday, October 02, 2012

Are High-Volume Dental Chains Exploiting Kids on Medicaid?

Are High-Volume Dental Chains Exploiting Kids on Medicaid?

by Olga Pierce ProPublica, Oct. 2, 2012, 2:27 p.m.by Charles Ornstein and Lena Groeger, ProPublicaby Dan Nguyen, Charles Ornstein and Tracy Weber, ProPublicaby Robin Fields, Al Shaw and Jennifer LaFleur, ProPublica

David Heath of the Center for Public Integrity recently investigated a new breed of corporate dental care chains that cater to low-income adults and children. Heath collaborated with Jill Rosenbaum of PBS FRONTLINE on "Dollars and Dentists." They found a high-volume business model that scored dentists on production and offered bonuses based on the revenue they brought in. Heath and Rosenbaum reported that Georgia-based Kool Smiles, the biggest Medicaid dental provider, has been accused by state regulators of giving shoddy or unnecessary care to some of America's poorest kids. (Kool Smiles' response is here.)

As part of our ongoing look at patient safety, we occasionally interview other journalists who've examined health care quality.

PP: What did you find in your reporting? Heath: I looked at what impact corporate dentistry is having on the care being provided. We looked at two of the larger chains, and found evidence that these companies were putting pressure on their dentists to produce at certain revenue targets, thus encouraging them to do procedures that may have been unnecessary.

PP: Can you say a bit more about the harm or overtreatment to patients that you saw? Heath: One of the chains focused on kids on Medicaid, and the reimbursement rates for Medicaid are pretty low. So in order to get a lot of revenue from these patients they were doing things like taking x-rays that were not needed, or putting stainless steel crowns instead of fillings on their teeth. They could make twice as much money from Medicaid on these crowns versus just putting a filling on a tooth. Kids were getting treatments that they really didn't need. We also looked at a chain that focuses on adults who haven't been to the dentist in years.  What were found there is again, patients would come in and everyone was given the same treatments. They were given these deep cleanings and a lot of people would get dentures and we were finding that in some cases maybe they didn't need those services. We had one example of an 87-year-old woman who had already been to the dentist and she went in to have two teeth pulled, thinking it would be cheaper at [New York-based] Aspen Dental. Instead they looked at her mouth and they came up with a treatment plan that was going to cost $8,000. They convinced her though hard-sell tactics to borrow that money through a credit card, and something like $2,000 of that was just to clean her teeth. (Aspen Dental's response is here.)

PP: So, in some cases, you're talking about pulling someone's teeth unnecessarily? Heath: There was a case where a woman went in who needed to have some teeth pulled, but they pulled all of her upper teeth, and several dentists told us she didn't need that.

 PP: What are the market forces that have resulted in private equity-owned chains providing dentistry? Heath: These days, when dentists get out of dental school, they often owe anywhere between $200,000 and $300,000 dollars. Dental school is actually more expensive than medical school. So they come out with these huge debts, in a lot of cases they can't really afford to start their own practice. These dental chains hire people, a lot of the time right out of dental school, and they pay fairly decent salaries and they have a bonus system where the more work you do on a patient the more you get paid. That's true for a private dentist as well, but the difference is that these companies are owned by private equity firms, and they're managed in a different way. You have people who are not dentists coming up with a business plan that's based on metrics. They try to get new patients in who haven't been to the dentist in a while, and they've already calculated how much revenue the average new patient should generate. If you happen to go in and you don't really have anything wrong with your mouth and you're a new patient you're not fitting the model. That creates pressure for the dentists to find things that are ‘wrong.'

 PP: Is dentistry particularly ripe for these kinds of abuses? Heath: In dentistry there's not really any peer review or oversight. So there's really not anyone to challenge dentists. And patients almost never challenge that kind of thing either. For somebody who's not ethical, there's a lot you can do and get away with in dentistry.

 PP: How is it that so many kids in Medicaid have ended up relying on corporate chains for their dental care? Heath: Not that many dentists actually accept Medicaid. There are some states where the reimbursement rates are so low that even the chains don't go there. Like in Florida, for example, the Medicaid rates are so low there that chains don't really even bother. So children end up going to the emergency room because they have a toothache and there's nothing else they can do. They end up in hospitals to treat a tooth. There was a famous case in Maryland where a 10-year-old boy had a toothache and it was abscessed and he ended up dying because he didn't have a dentist. [Note: According to a recent study, only about a third of children in Medicaid-- which covers more than 30 million American children -- will see a dentist in a given year. In Florida, where reimbursements are particularly low, only a quarter of the children in Medicaid see a dentist.] In other states, like Connecticut, Texas and Virginia, they have dramatically increased reimbursement rates. You have more options there, but not the same options a someone who can afford it. Dentistry is a little unusual from doctors because a lot of people don't have dental insurance, and even if you do have dental insurance it often doesn't cover a lot, and a lot of dentists don't take insurance any more because of low reimbursement rates. So even if you have dental insurance, finding a dentist can be a challenge. So there is a real problem, especially for children, to find a dentist if they don't have money.

PP: Are changes under way as a result of your story? Are there solutions on the table? Heath: There is a [U.S.] Senate investigation still ongoing, I don't know what will come of that. There are investigations in some of the states, Texas being one, looking at this issue. I think there are things in the works we really won't really know the full impact of for a while yet. We definitely got the attention of the dental community; we got a lot of feedback from them. This whole issue of accepting patients who have limited resources is a real issue in dentistry and something I think the dental community has to sort out.