Representative Lois Kolkhorst tips hat to those reporting on the dental Medicaid fraud in Texas

Dedicated to all those who are not deterred from speaking out

During a Texas Public Health committee meeting on October 15, 2012, committee Chair Rep. Lois Kolkhorst, tipped her hat to the public, for speaking out about the massive amount of dental Medicaid fraud taking place in Texas.

“…This wasn’t a huge issue on this committee or others would have maybe been a little more privy to it—it took a lot of news reporting for us to really, and thank goodness for the Bill of Rights, because that’s really what brought it to a head, “ s

“…I want to tip my hat to Channel 8 and WFAA in Dallas, certainly the Texas Tribune has given this a lot of coverage…”

Without the public and company insiders speaking out, without Mr. Harris at WFAA, listening, Representative Kolkhorst and the Public Health committee would still be in the dark.. And I suspect the Texas Inspector General and Attorney General’s office would still be turning a blind eye to the red flags they found in 2008.

However, since Richard Malouf -  under fraud investigation himself - filed a SLAPP lawsuit last week against WFAA TV; investigative reporter, Byron Harris; Mary C. Jones and his neighbor, Laura Wilson, I’m guessing he’s not as appreciative of the “reporting” and our “Bill of Rights.” 

Note, Rep. Kolkhorst said it took a “lot of news reporting” to get their attention. So don’t quit; keep blowing those whistles and beating your drums. Don’t be intimidated by even the sleaziest of those who may try to twist the truth.

On a side note: I don’t live in Texas and I don’t have a clue who Lois Kolkhorst is. But I would vote for her over the two loons we have running for President based on the October 15, 2012 hearing alone.

Go Lois!

Who owns Aspen Dental? Leonard Green & Partners (LGP) Private Equity

Leonard Green & Partners are the true owners of Aspen Dental Centers. They own or are heavily invested in several popular brands. (see below)

The one that concerns me is U.S. Renal Care - a renal disease management company.

Now that we see how they operate Aspen Dental,  I shutter to think how this company maintains it’s production numbers or how they keep costs down at U.S. Renal Care. Might be worth someone looking into. 

Aspen Dental Class Action Complaint

 

 

 

 

 

Other Leonard Green & Partners Investments:
Aspen Dental	Neiman Marcus
BJ's Wholesale Club	Petco
The Container Store, Inc	Rite Aid
David's Bridal	Savers
DelTaco	Sport Authority
Equinox Fitness	TireRack.com
J. Crew	Tourneau
Jo-Ann Fabrics	Whole Foods

NCDR, LLC’s clinics - Kool Smiles Dental - pitch to Texas House of Representatives

On Monday October 15, 2012, Dr. Diane Coopwood Earle, DDS, Senior Regional Dental Director of Kool Smiles Dental centers gave a 4 page statement, and subsequent testimony before the Texas House of Representatives committee on Public Health.
Summary of her statement:
- She’s been a licensed dentist in Texas for 30 years.
- Kool Smiles has 38 offices in Texas.They employee 85 dentists in 38 offices in Texas (only 34 show up in 2011 data).
- All 38 Kool Smiles are owned by dentists.(Liar, Liar, Pants on Fire!)
- All clinical and patient treatment decisions are made by the treating dentist
- NCDR, LLC handles non-clinical administrative, critical business support and purchasing. (more lies including the fact, only licensed medical professionals are legally able to purchase many medical supplies)
- DSO’s are “innovative” business models. (Bernie Madoff too was “innovative”)
- As a dentist, DSO’s help her do what she “does best – providing high quality dental care to my patients and spending more time with them.” (she billed Texas for performing 833 procedures on 643 patients in 2011, that’s about 12 patients a week.)
- Non-clinical leaders “DO NOT interfere with clinical decisions of the dentists”
- She has “NEVER been told by a corporation or corporate entity how to treat our patients.” (I bet that statement comes back to bite her in the ass)
- “Without that necessary separation between delivery of professional quality dental care and administrative support, the model would not work.” (this will be another bite on the back side, I bet)

Is Dr. Richard Malouf cracking?

Class Action Filed Against Aspen Dental–They operate illegally.

Aspen Dental Class Action Complaint 3:12-CV-1565

Brian S. Cohen, Esq. 

COHEN LAW GROUP, P.C.
2 Greenwich Office Park - Suite 300
Greenwich, CT 06831
Phone: 203-485-7525
Fax: 203-485-7526

10 East 40th Street - 46th Floor
New York, NY 10016
Phone: 212-967-2879

Fax: 646-349-2567
Email: brian@cohenlg.com
Web: www.cohenlg.com

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Aspen is not alone, most, if not all of these are operating illegally as well:

Affordable Care, Inc – American Capital
Allied Dental Practices
American Dental Partners
Aspen Dental Management, Inc
BrightNow!
Children’s Dental Group
ClearChoice Dental Associates
Dental Care Alliance
DentalOne Partners, Inc . – MSD Capital – Michael Dell
Dentistry For Children
Gentle Dental Group / Northwestern Management Services – Linden Capital
Gentle Dental of New England/Gentle Dental Associates
Gentle Dental/InterDent, Inc
Great Expressions Dental Centers
Heartland Dental Care – Code Hennessy & Simmons, LLC
ImmediaDent - James Ferrell – Samson Capital
Kool Smiles – FFL Partners
Lumino The Dentists
Midwest Dental – FFL Partners
Monarch
Mountain Dental
Ocean Dental
Pacific Dental Services, Inc – Scott A Beck and Jeff Butler
Perfect Teeth – Birner Dental Management
ReachOut Healthcare America – Morgan Stanley
Refresh Dental
ImmediaDent – James Ferrell – Samson Capital
Small Smiles – Garrison Investment
Smile Brands, Inc – Welsh, Carson, Anderson & Stowe
TownCare Dental Partnership, Inc - FL. State Representative Michael Bileca
West Coast Dental Services, Inc
Western Dental Centers

Texas expands Medicaid dental fraud estimates to $154 million

 

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by BYRON HARRIS Bio | Email WFAA-TV Posted on October 17, 2012 at 10:03 PM Updated today at 12:01 PM Story

NEWS 8 INVESTIGATES

Texas Medicaid dental expenditures quadrupled in recent years, from $400 million in 2006 to $1.43 billion in 2011. The Office of Inspector General is now tracking more than $383 million of potential fraud and overpayment, it told a Texas House of Representatives committee.

In a House hearing on Monday, News 8's investigations of Medicaid dental fraud were praised by state representatives. "I have to tip my hat to WFAA in Dallas for doing what they've done," said Rep. Lois Kolkhorst (R-Brenham), chairwoman of the Public Health Committee.

The state has suspended payments to 26 orthodontic organizations under a policy called Credible Allegation of Fraud (CAF). The state can hold money back from Medicaid providers if it suspects it was billed fraudulently. Texas estimates that $229 million in Medicaid payments to put braces on kids' teeth may have been improper.

Audits show as many as nine out of 10 payments may have been fraudulent. For general dentistry, more than $154 million may have been overpaid. Expert analysis shows half the bills checked were erroneous. Eighty-nine dental providers have had payments withheld under CAF.

The OIG told a the public health committee of the Texas House that more manpower, more interest in fraud, and improved software are helping catch more fraud going forward. E-mail 

E-mail bharris@wfaa.com

What will Harlingen Family Dentistry fight for, and what will they not?

The same Harlingen Family Dentistry that killed ten year old Marcos Tirado in September won a skirmish with the Office Of Inspector General’s  (OIG) office yesterday. But that is far from winning this war.
Harlingen Family Dentistry is one of the top 25 Medicaid billers in Texas and under investigation by the OIG. The Texas Tribune has Harlingen Family Dentistry rated at number 17 in claims for fiscal year end 2011.
Dr. Juan Villarreal, owner of Harlingen Family Dentistry is a former member of the Texas State Board of Dental Examiners, appointed by Governor Perry in 2001.
As standard practice, while under investigation,Office of Inspector General (OIG), began to withhold 40% of all reimbursement payments.
Not very happy about that, Villarreal appealed OIG’s decision. Despite OIG having evidence that 84 of 85 records reviewed failed to meet requirements necessary.
Harlingen hired their own witness who said he would have approved all but 8 of those 85.

WOW, that’s a HUGE difference!! Too huge to not look a bit suspicious on Villarreal’s part. After all he’s the one wanting “you” money and looks like he’s willing to kill children to get it.
Yesterday, Administrative Law Judge Susan Fekety, agreed to reduce the payment hold from 40% to 4%.
Always the victim, Villarreal said, "I am afraid to say that it appears that honest dentists are being ‘gamed’ rather than the other way around so the state can try to collect back funds its contractor had pre-approved years ago and that they want to claw back regardless of consequences to providers and patients. It just shows how broken Medicaid really has become.”
Would Marco still be alive if Villarreal were not such a greedy man? One thing is clear; what Dr. Juan Villarreal will fight for and what he will not.
Father claims no one tried to save his son

All About Dentistry–Dr. Farahani confronted about kidnapping. One dentist flees the country.

 

 

DALLAS — This summer, News 8 discovered some dentists were luring kids to their offices with pizza and pocket change without their parents' permission, then billing Medicaid for dental procedures that were unneeded.

Tiara Truelove said she and six other kids were offered cash on the campus of Dallas Can Academy in March when they were on their lunch break. A dental recruiter then drove them to All About Dentistry on Scyene Road.

After the recruiter fed the students pizza, their teeth were cleaned and they were each given $10, Tiara said.

When her mother, Tiffney Truelove, found out, she went to the office to complain and said she was met with indifference by the staff.

"You picked up my — at the time 16-year-old — and took her to the dentist, and you bribed her, and you basically kidnapped her," Truelove said. "And after you fed her, you supposedly cleaned her teeth. And then you brought her back and you don't think that you did nothing wrong?"

Challenge to recent studies on DSO’s by Laffer, Winegarden and Arduin: Put your mouth where your studies are.

October 15, 2012 Sally Pipes, President of Pacific Research Institute, published an op-ed piece at Forbes.com whereby Wayne Winegarden and Donna Arduin had studied Arthur Laffer’s study and yep, they agreed, dental management services organization are simply scrumptious. [cough]

Here is a chance for each of them to put their mouths where their “studies” are.

Here is the challenge to each; Laffer, Pipes,Winegarden and Arduin:

1. Go to your regular dentist for a check-up. Keep any treatment plan you receive or report on the state of your dental health.
2. Pick two DSO clinics that treat adults and two that are geared toward children on state insurance programs. I’m sure there are some nearby. It probably won’t cost you a dime, all of them have coupons for free exams and x-rays.
3. Go for your appointments. Voice record the entire visit or it doesn’t count.
4. Bring back any treatment plans, credit applications and other paperwork you receive.
5. Next grab one of your toddlers, better yet, a grandchild, preferably under the age of 5 years old.
6. Take them to their regular dentist for a check-up. Keep any treatment plans you receive or report on their dental health.
7. Run them down to each DSO Medicaid clinic you chose for a check-up.
8. Here too, you must record each visit. Don’t be scared. if you are brave enough to put your name on these “studies”, you should balls enough to send you “child of choice” back there alone.
9. You must get copies of their treatment plans as well, if any. I say that since chances are good the treatment will already be completed when you get your child back.
10. Interview the child after each visit.

When you’re done, each of you should have 6 reports, 3 for you and 3 for the “child of choice”.

Now, you have some real life data!

Tell us how it went.

Student denied dental degree after failing to meet production quota at New York University College of Dentistry in 2009, gets her degree in 2012

There are hoards of evidence that dentists and employees of dental chains owned and operated by Wall Street fat cats have production quotas to meet. Some chains call a daily “budget” amount, while others call it “goals”, “targets” or “forecasts”.  Be it the number of patients or dollar amount the company expects the employee to bill or sell, it’s still a quota.

The pressure to meet these quota’s appears to be the foundation on which the overtreatment, mistreatment, malpractice, and brute force used on children is based.

It’s not just the private equity firms, like Morgan Stanley, or the regionalized dental management organizations like Dental Professionals of Texas (now MB-2) bilking the Medicaid system.  It’s also our medical colleges it appears.

A  student used to be denied his or her degree because they were short credits. At New York University College of Dentistry (NYUCD), graduating is based on meeting a production goal.

 

Katie Kickertz attended NYU College of Dentistry. The day before graduation in May of 2009, Dr. Harry Meeker, Katie’s instructor, told her degree would be denied. Not because she was a couple of credit hours short, not because she had failed to meet clinical training expectations.

It was because she had failed to meet the $38,000 in production quota at NYU’s David B. Kriser Dental Center.

What does New York University College of Dentistry call its production quota system? It’s called “Practice Model Value” (PMV). It is purportedly to train dentists to treatment real patients for a fee. Well, golly gee, wonder if they had no clue that would happen if they used their skills after graduation?

I wonder if it’s some kind of scoring system to see how much value any particular student can be to a corporate dental chain. That seems to be what the name of the program implies.

We know for sure it is a revenue generating system for the college at the expense of patients health and the taxpayer. NYUCD accepts several Medicaid managed care programs.

I know what you’re thinking, maybe this was some kind of program to aid in payment of her education. That answer is, no. Meeting the $38,000 quota is required by each student in addition to the $70,000 a year tuition.

According to court documents, students were required to meet a quota $38,000 in their last two years of dental school. In the spring of 2009, Dr. Harry Meeker, Katie’s instructor, says he notified Katie about her deficiency. But the earliest records showing any communication to the fact was May 25, 2009.

So, what did Katie do? Again, according to court documents, after hearing of her situation and before she planned to move to Boston in two days, Katie did what others pressured to meet quota’s do. She fabricated patient records. She charted she  she provided patients with 16 extractions, and bleaching on one afternoon and ponied up the $2000 herself. The treatments never happened.