Blowing the Whistle Pays

http://therolladailynews.com/article/20130131/NEWS/130139669/-1/opinion

Attorney General Chris Koster said today that his office has awarded $8,239 to a Medicaid fraud whistleblower who alerted the state to fraudulent billings by a group of dental clinics. The award money is 10 percent of $82,000 that the dental provider is paying in restitution and penalties to the state of Missouri, as allowed by Missouri law.

“Medicaid fraud tips are an important part of our efforts to investigate and punish Medicaid fraud,” Koster said. “We encourage anyone who suspects a health care provider is engaged in Medicaid fraud to contact our office so we can investigate.”

Koster said the whistleblower contacted his office in January 2011 with concerns about Ozark Family Dentistry, and the clinics’ owner, Dr. Arrash Ahmadnia. Dr. Ahmadnia, based in Rolla, owns dental clinics in Rolla, Thayer, Osceola and Springfield.

The whistleblower, who worked briefly at one of the clinics, alerted the Attorney General’s Office that Dr. Ahmadnia had instructed him to perform unnecessary work on patients, presumably to bill the costs to Missouri Medicaid. The Attorney General’s investigation found that the clinics had billed Medicaid for treatments under the code for dental fillings, but had actually performed different procedures – preventative resin restorations – which are not covered by Medicaid. The investigation also found some instances of double billing and billing for ineligible adults.

Under a settlement, Dr. Ahmadnia is required to pay more than $208,000 in restitution and penalties to the state and federal Medicaid programs. He is also required to immediately stop submitting reimbursement claims to Medicaid for the preventive resin restoration treatments. The agreement is a compromise of disputed claims and does not contain an admission of wrongdoing by Dr. Ahmadnia. The Attorney General’s Office is continuing to review billing procedures at the clinics.

Trueblood Dentistry and their string of Carousel chops shops finally forced to close!

In all the raw data I’ve seen out of Texas, this one would nearly always fall in the top 5.  This one alone is said to have stolen $18 million from taxpayers.  Just imagine the hundreds and hundreds of millions, if not billions stolen from scam dentists and dental companies in the state of Texas!  Perp walk please!!

I’m sure the “pity” party has begun.

 

By Chuck Lindell

American-Statesman Staff

Carousel Pediatrics began shutting down its Austin dental practice Tuesday night, displacing about 28,000 low-income pediatric patients, after state health investigators cut off Medicaid payments over allegations of fraudulent activity.

Carousel’s owner, Dr. Glenn Wood, who disputed the fraud allegations, said the loss of about $400,000 a month in Medicaid payments required him to shut down his dental affiliate, Trueblood Dental Associates, and lay off about 40 staff members and six dentists.

13 more pages of allegations in latest Aspen Dental Complaint

Aspen Dental - Amended Class Action Complaint Filed 1-18-2013 by Dentist The Menace

Two reports on poor quality of care by dentists claiming expertise in implants

A story by the Bakersfield Californian, reports the California Dental Board has filed a complaint against Dr. Robert Tupac, DDs to the state’s department of consumer affairs.

Dr. Tupac reportedly told one patient “not to worry about a thing, I wrote the book on (dental) implants,"

The report says, the complaint was issued by the state Attorney General raises numerous issues that should result in his licenses being revoked or suspended: for discipline" against Tupac, including gross negligence, altering patient records, aiding and abetting an unlicensed person to practice dentistry, incompetence and obtaining fees by fraud. The document requests that the Dental Board revoke or suspend his license and pay restitution.

According to the report, his dental licenses remain squeaky clean, despite his own professional regulatory board having multiple complaints against him on file AND have filed their own complaint to the California Department of Consumer Affairs!!

“The Dental Board issued Tupac's dental license in 1974. The board's website does not show any previous disciplinary actions against him.”

In a report on KGET-TV’s website it says “The California Dental Board wants to suspend or revoke the license of…”  Well, then why don’t they??  

Newspaper report: Bakersfield dentist accused of incompetence, negligence

California AG Marc Greenbaum’s complaint filed against Robert George Tupac, DDS

Dr. Li Skelton

This situation with Dr. Tupac sounds much like a situation with an implant dentist in Texas who says their office “specializes” in dental implants – Dr. Li Skelton.  Heck her new clinic even promotes tourism dentistry, just to see her.

Missouri’s Medicaid Fraud Control Unit reclaims $’s from Comfort Dental

January 25, 2013

Today’s Medicaid Fraud Recover story is from Missouri, where Attorney General Chris Koster has announced a $50M recovery by Missouri’s Medicaid Fraud Control Unit.

Of course crowing about the recovery and actually recovering the money are two completely different things. Personally, I read it as “We found $50M we were snookered out of and have they con artists an invoice.”

Of interest to me was this part of the statement:

• Comfort Dental (3 cases):  Comfort Dental – a franchise dental chain based in Colorado with offices in the Kansas City area – billed Medicaid for services provided to individuals who were not eligible for Medicaid, resulting in a total loss to Medicaid of more than $17,000.  Additionally, the Attorney General’s investigation revealed that each clinic double-billed services to Medicaid, resulting in a loss of more than $4,200, and also charged Medicaid recipients for services paid for by the program.

In three separate settlements, the entities paid $66,265.22 to resolve claims of both the Medicaid Fraud Control Unit and the Consumer Protection Division.  The Consumer Protection Division sent checks totaling $6,265.22 to those Missouri citizens who were improperly billed for Medicaid covered services.

Joseph Bernat, DDS now associated with two dental organization nailed for Medicaid fraud.

New York Attorney General, Eric Schneiderman released a statement this week saying the state had recovered $335M in Medicaid that has been fraudulently obtained in 2012. 

The part I found interesting was the dental, of course.  Media outlets are reporting $1.6 million recovered from Kaleida Health’s – Buffalo Women’s and Children's Hospital Dental Clinic.

From WGRZ:

The state also recovered $1.6 million for excess Medicaid payments on claims for dental services provided by Kaleida Health through the Buffalo Women's & Children's Hospital Dental Clinic.

 

“Kaleida” and “Buffalo” rang a bell. Then I did some checking, and low and behold there it was: Dr. Joseph Bernat, DDS – Chair and Program Director of Women and Children’s Hospital of Buffalo.

 

 

 

 

 

 

 

Amazingly, Dr. Joseph Bernat, DDS — who is was so highly respected; who supposedly carries such influence — now has two organization nailed for Medicaid Fraud under his belt: Small Smiles Dental Centers in 2010 and Women and Children’s Hospital of Buffalo in 2012.

Way To Go, Dr. Bernat!!

Kool Smiles–NCDR, LLC still mistreating children according to parents complaints

Kool Smiles continues its dirty practices and children still suffer the previous trauma this company brought to millions of children over the last 9 years  according to posts over on Topix.

NINE YEARS!!! 

That’s a long time for authorities and dental boards to allow this.  How can any of them explain their lack of action?  I have to assume they think it’s OK.  What a screw up way of thinking!   

 

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Wednesday January 23, 2013 - Be very leery about fraudulent diagnosis from this office. This facility is only interested in taking advantage of low-income families who have access to Hoosier HeathWise and/or Medicaid ... preying on the fact that most of these parents will not question any diagnosis given; ultimately, this facility is billing the government for services NOT needed.

My personal experience:
First of all, parents are not allowed in the back (a BIG red flag), nor shown x-rays, nor consulted in any way. Took my son to this dentist and was "told" that he had FIVE cavities (mind you, I was never shown his x-rays). The office tried to keep us there to do the fillings right then and there. I had an extremely uneasy feeling; therefore, I declined, and stated that I would schedule another time.

We have since consulted another pediatric dentist. Imagine my surprise being told that my son had NO cavities. None. Zero. Zilch. In fact, they told me that he had done an exceptional job keeping his teeth clean and healthy.

My recommendation: Do NOT give your business to a fraudulent business such as Kool Smiles in Terre Haute. Any facility taking advantage of low-income families and the Indiana state government should be audited and shut down for fraudulent business practices.

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Tuesday January 15, 2013 - My daughter went to Kool Smiles when she was four for fillings. They put her in a straight jacket and she screamed until her nose bled.

Dr. Kristi Ayn Liebau-Grassi doesn’t want to go to jail.

Remember the Erie, Pennsylvania dentist who headed to Texas for a more lucrative position with Pacific Dental d/b/a Modern Dental?  Well, she’s not wanting to go to jail. Didn’t work very well for Robin Lockwood in Oklahoma, however Lockwood’s dental license still appears squeaky clean! Amazing!

 

 

Published: January 22, 2013 12:01 AM EST
Updated: January 22, 2013 1:38 AM EST

Former Erie dentist seeks to avoid prison term

By LISA THOMPSON, Erie Times-News
lisa.thompson@timesnews.com

A former area dentist who pleaded guilty to defrauding Medicaid is hoping a judge will spare her a term in federal prison so she can better care for her family.

Federal sentencing guidelines recommend a prison sentence of a year to 18 months for the dentist, Kristi Ayn Liebau-Grassi, who admitted in September that she repeatedly billed the government for dental work that was unnecessary or never provided.

Her lawyer, however, is hoping to convince a judge to give her a lighter sentence because of her clean prior record, her family's needs and she accepted responsibility.

"The defendant is a loving and devoted parent whose maternal responsibilities may be greater than almost anyone who has stood for sentencing before this Court," the lawyer, David Ridge, wrote in a sentencing memorandum filed in U.S. District Court in Erie.

Bileca sells to Matzkin or Towncare affiliates with Dental Care Alliance, it’s the same either way.

So it was announced last week that Florida State Representative Michael Bileca’s Towncare Dental Partners d/b/a Towncare Dental and Main Street’s Children Dentistry and Orthodontics is now “affiliated” with Dental Care Alliance based in Sarasota, Florida.  Of course that means he unloaded the clinics. Who knows he may stay on as CEO, President or whatever he claims to be.  Wonder if Mr. Bileca has bigger political ambitions and needs to rid himself of the DSO?

So, who is Dental Care Alliance?  Beats the hell outta me!  There’s a timeline after the press release.  You figure it out. 

What I do know is Steven Matzkin and Michael Bileca , their respective CEO’s are founders of that nasty group the Dental Group Practice Association (DGPA). So swapping control of dental clinics they illegally operate among themselves is akin to one of those underground “swingers” clubs.

Dental Care Alliance Press Release

Dental Care Alliance Acquires Towncare Dental Partners

Posted on January 16, 2013 by dca

Sarasota, FL – Dental Care Alliance (DCA) announces the affiliation of Towncare Dental Partners (TDP).

“Towncare is an outstanding, well regarded company, and we are excited to have their team join DCA and expand our administrative resources to better support the needs of our affiliated dental professionals,” says Mitch Olan Co-CEO/COO of Dental Care Alliance. “Both DCA and Towncare place the same emphasis on quality care, provider support and patient satisfaction.”

The Florida-based companies have similar operating philosophies and more than 40 years of combined experience supporting the dental profession. The combined company will now manage the administrative services of 145 dental practices in 8 states.

February “Children’s Dental Health Month”– Parents and School Personnel Beware!

It’s almost that time of year again; February “Children’s Dental Health Month” or as I’ve come to call it “Chop Shop Victim Month”.  Like so many things, what started out with good intentions became a way for the crooks and unsavory dental mills to increase patient volume.  I suspect with their business model taking such a financial hit this past year, patient shopping is high on their list of priorities.

Here’s how it works. 

Schools and daycares in low income areas are called by the dental mill and asked if they would like to have a free dental screening day. All it is, a dental assistant doing a quick visual in each child’s mouth, no instruments used.

TEXAS LEGISLATURE: Health care bills aim to reduce fraud

TEXAS LEGISLATURE: Health care bills aim to reduce fraud

By Matthew Waller Scripps Texas Newspapers
Published Wednesday, January 16, 2013

AUSTIN — Texas lawmakers are looking at ways to cut down on billions in fraud and waste in Medicaid, health funding for the poor, they announced Wednesday.

The question is whether the proposed laws will discourage medical practitioners from operating or accepting Medicaid as payment, a Texas Tech professor said.

Medicaid fraud and waste cost Texas $6 billion from 2004-11, lawmakers said Wednesday.

Sen. Jane Nelson, R-Flower Mound, and chairwoman of the Senate Committee on Health and Human Services, plans to tackle that number with two pieces of legislation aimed at reducing Medicaid fraud and improving Medicaid services based on quality of care.

"It's depressing," Nelson said of the reports of Medicaid fraud. "I feel like we're playing Whac-A-Mole. We have one problem uncovered, and we try to deal with it, and then we see another one emerge. … We have to assume our responsibilities and head off some of these problems before they begin. … It's infuriating to hear report after report of the kind of abuses that are taking place."

Earlier this month, for example, the attorney general announced a $36 million settlement with pharmaceutical companies Pfizer and Endo on claims that the firms overcharged Medicaid for drugs.

Texas Vows to crack down on dental Medicaid fraud

I’m guessing Texas is not exactly the best market anymore for the Medicaid dental mills and DSO’s in general.

by BYRON HARRIS
Bio | Email
WFAA
Posted on January 16, 2013 at 6:48 PM
Updated yesterday at 9:55 PM

NEWS 8 INVESTIGATES

AUSTIN — State Sen. Jane Nelson (R-Flower Mound) put it simply Wednesday, speaking to a group of reporters at a news conference in Austin:

"It is infuriating to hear of the kind of problems that are taking place... problems that are particularly serious in Medicaid dental, orthodontia and transportation for Medicaid patients," she said.

For the past two years, News 8 has been investigating the Texas Medicaid Dental program and hundreds of millions of dollars the state has spent on orthodontics under Medicaid.

Sen. Nelson specifically mentioned the parents of Medicaid children who had been solicited by "marketers" bearing free gifts and cash, the subject of several News 8 stories.

Senate Bill 8 is designed to cure some of those abuses.

• READ: Senate Bill 8

"It strengthens the prohibitions against solicitation of Medicaid clients," Nelson said. "We heard story after story about that. We are going to prohibit that and make sure it doesn't take place."

So far, the bill does not specifically prohibit handing out gifts and cash to parents to induce them to take their children to certain dentists. Nelson says hearings over the next two months will flesh the bill out.

The legislation also articulates the Inspector General's role in uncovering and reporting fraud, and bans a dentist from participating in Medicaid if found guilty of fraud.

The bill moves Medicaid Transportation into managed care, and directs the Department of Health and Human Services to reduce inappropriate ambulance use.

Even though the specifics of this bill haven't yet been hammered out, there's already huge opposition to it. That's a sign, Nelson says, that as it is, some dentists are making lot of money.

E-mail bharris@wfaa.com

Over 11,500 comments just 24 hours after Yahoo news picks up the story of child’s mouth of metal in Arizona.

January 17, 2013 10:55 AM CST

Since being picked up by Yahoo News, “Arizona mother gets shock after daughter’s trip to dentist” now has over 10,000 comments since it’s post on Yahoo, 22 hours ago.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Photos courtesy of AZFamily.com and 3 On Your Side

3 On Your Side Reporter Gary Harper:

Gary Harper Bio
gharper@azfamily.com

Follow: @GaryHarper3TV

3 On Your Side
5555 N. Seventh Ave.
Phoenix, AZ 85013
602-207-3333 (phone)
602-207-3477 (fax)

If Dr. Richard Chaet is what is representing Pediatric Dentistry in Arizona no wonder there are so many dental abuse stories coming from that state. At least 1 in 3 that I received come from there.

A Quote from the story and Dr. Richard Chaet, “ Chaet explained that while Savannah's dental work is shocking to look at, it was probably necessary. "This is a child who is obviously very high risk for decay," he said, noting that crowns will save other teeth from deteriorating.

Seriously Dr. Chaet?  Well then for heavens sake let all American’s all get crowns on every in their head to prevent “deterioration”.  Then we won’t need assholes like yourself!

Better yet, let’s all run down to Aspen and have every tooth jerked out of our head and get a crappy set of dentures slapped in!  That would work too wouldn’t it?

Can anyone say, “Agency Capture” well it’s been captures in Arizona and if nothing else this story revealed that much!

 

Sadly this is probably the best that could be done to repair what the monster dentists did to this beautiful child. 

Another Phoenix child abused by an crooked dentist.

As readers of this blog knows, it’s much more serious than this story has lead anyone to believe. Dr. Richard Chaet is a huge part of the problem and should be ashamed!

This reporter drank the Kool Aid and note the greedy dentist’s who did this didn’t get his name mentioned. I bet the reporter isn't buying what Dr. Chaet is selling any longer.

 

 

by Gary Harper

Bio | Email | Follow: @GaryHarper3TV

See all 11 photos »

PHOENIX -- A Valley mom took her daughter in for some routine dental work, but the mom said there was nothing routine about the procedure.

At first, Alecia White thought a mistake had been made so she tried to get some answers. When White didn't, she contacted 3 On Your Side.

White has two beautiful and healthy children, Zach and his little sister Savannah.

"They're my everything," she said. "They're my entire world."
On a recent trip to the dentist, White discovered that little Savannah had four cavities. So, White allowed the dentist to fill them.

"They took her back and I was allowed to go back when they sedated her and after she was sedated, they had me go back out to the waiting room," White said.
White brought her groggy, little girl home when the procedure was done and let her take a nap. However, when Savannah woke up and White looked in her mouth, she saw that every single tooth, top and bottom, were capped with stainless-steel crowns.

 

Dentist acquitted of Medicaid fraud cannot pursue a defamation claim against prosecutors.

 

Defamation claim dismissed over prosecutors' press release

January 10, 2013
By Jessica Dye

NEW YORK, Jan 10 (Reuters) - A dentist acquitted of Medicaid fraud cannot pursue a defamation claim against prosecutors whom he claimed falsified information in a press release announcing his indictment, a Brooklyn federal judge ruled Thursday.

Brooklyn dentist Leonard Morse was ultimately acquitted of the fraud in 2007. He then sued current and former members of the New York attorney general's office over the indictment and the press release, which announced he had been charged in a "million dollar Medicaid fraud."

In a ruling from the bench, Chief U.S. District Judge Carol Amon said Morse had not shown the press release was false, a necessary element of a defamation claim, as well as two other claims Morse brought in connection with the release.

"A showing of falsity is critical for these claims," Amon said in granting the attorney general office's motion to dismiss the claims.

Sentinel Capital Partners has played big role in DSO cancer spreading across the states

In an article dated January 4, 2011, AltAssets published a story about Sentinel Capital Partners.  It had been announced Sentinel Capital had acquired Chase Doors on the same day it unloaded ReachOut Healthcare. If I remember correctly this is where Morgan Stanley stepped in, with the help and assistance of R. Kirk Huntsman. 

As what usually happens in these type of things, a little history is given; that is where the bodies are found buried.

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January 4, 2011

 

Lower mid-market private equity firm Sentinel Capital Partners has acquired US door manufacturer Chase Doors, on the same day that it announced the sale of dental support service ReachOut Healthcare America.

In both cases, financial terms were undisclosed.

Chase Doors, founded in 1932, produces specialty door systems employed in a variety of industrial and commercial settings including corrosion-resistant doors used for hazardous material handling; cold storage doors used in walk-in freezers and refrigerators; double impact traffic doors used in supermarkets and restaurants; and strip and roll-up doors used in warehouses.

The company’s revenues are evenly distributed across new construction, remodeling and replacement, and maintenance in the retail, industrial, pharmaceutical, food processing and markets.

“One of Sentinel’s areas of focus is branded, niche manufacturing businesses,” said Scott Perry, a vice president at Sentinel.

“Our previous investments in the niche manufacturing sector have given us a keen understanding of how to foster growth for businesses like Chase and financial guidance that positions our team to enhance Chase’s current market position while continuing to grow.”

New York-based Sentinel’s investments in other specialty niche manufacturing businesses include pressure regulator provider Engineered Controls International, industrial lubrication equipment maker Alemite, and Fasloc, which produces roof support systems used in underground mines.

• ReachOut, which the firm has just sold, provides a diagnostic, preventative, and restorative dental services to underserved children in schools and foster programs, the aged and disabled in residential facilities, and to US Army National Guard units.
• Sentinel made its initial investment in the company in 2007 in partnership with its two founders.
• In 2008, ReachOut acquired its largest competitor, Mobile Dentists, acquiring Georgia-based Help A Child Smile in early 2010.
• Today, (January 2011) ReachOut operates in 25 states and provides dental care to more than 425,000 underprivileged children, seniors, and military personnel each year.

“It has been extremely rewarding to work with the ReachOut and Mobile Dentists management teams,” said David Lobel, managing partner at Sentinel.

• “ReachOut is now firmly established as a powerful growth platform that delivers critical dental care to large and underserved segments of the population. We are proud to be affiliated with a business that not only has done well for its investors, but also provides a greatly needed healthcare service.”
• “We are fortunate to have enjoyed considerable success investing in the dental industry and will continue to seek new dental investment opportunities in the future,” said Paul Murphy, a partner at Sentinel.
• In the past, Sentinel has taken stakes in Castle Dental Centers, sold to Bright Now! Dental in 2004, and Metro Dentalcare, sold to American Dental Partners, in 2007.

Plea Agreements Reached by Two Dentists Admitting to Fraud

 

 

Dentist admits fraud charges

By Gordon Dritschilo
Staff Writer | January 12,2013

A Rutland dentist has admitted to billing the government for fake procedures.
Dr. Peter Gray pleaded guilty Friday in Rutland criminal court to four of the 23 charges against him — two felony fraud charges and two misdemeanor charges of false pretense — in a Medicaid fraud case.

The remaining 19 charges are expected to be dropped at sentencing.
Gray’s plea agreement with the Vermont attorney general’s office calls for a sentence of six months to six years in prison, suspended with probation except for 110 days of home confinement. Sentencing is scheduled for late February.
“The resources being what they are, this provided a certainty of a felony conviction and provides protection for the public,” said Assistant Attorney General Linda Purdy.

While Gray will not go to jail under the deal, Purdy said, home confinement is considered a form of incarceration.

“It’s really not as nice as it sounds,” she said, noting that the conditions of his confinement must be approved by the Vermont Department of Corrections. “Nonviolent crimes, money crimes like this, people do not get incarcerated.”

Purdy also said there were “collateral consequences,” such as a five-year prohibition against working in any practice that receives Medicare, Medicaid or Tri-Care funds, and the likelihood that the Vermont Board of Dental Examiners, which has already seen fit to suspend Gray before, could take action against him.
Gray is also required to pay $50,000 in restitution. Purdy said the state had put a hold on roughly $80,000 in Medicaid claims Gray made and that the restitution will be taken from those funds.

Gray’s attorney, Kerry DeWolfe of Barre, did not immediately return a call seeking comment Friday afternoon.

The charges were the result of a 2010 investigation in which prosecutors said Gray repeatedly bilked the Medicaid system by billing for phony procedures. Investigators said Gray claimed to be removing cysts from patients when he was unnecessarily removing healthy tissue.

Gray has another case pending in Rutland criminal court — a lewd and lascivious conduct charge stemming from a claim that he took advantage of a female patient who was under anesthesia. Purdy said the fraud case should have no bearing on the lewd and lascivious case.

Question to Texas Attorney General Greg Abbott

I demand an explanation why not one dentist is in jail for kidnapping children right off the street and taking them for medical treatment - without a parents consent - before being released.
At the very least the van driver should be jailed!
I'm sure there must be a good legal explanation or surely someone's ass would be in a jail cell down there. Also I'm curious in what other instances is it legal to kidnap children in the Great State of Texas!!
Please point to the law that allows for the kidnapping of minors for medical treatment.

Also is there a minimum age or social status on legal kidnapping for medical treatment. For instance would the kidnapping of Richard Malouf's child for medical treatment be as acceptable as it is for Juan Valdez's child? This is a question that needs to be asked and citizens deserve an answer!

Thank you very much,
Debbie Hagan

The Phew (Pew) Institute latest greatest

In 5 plus years of watching the dental profession continuously reach all new lows, the Pew Institute never disappoints in its complicity. 

Every year, in January and February – sometimes well into March – The Phew (Pew) Institute issues some research or report - usually landing them an audience on Capitol Hill – in which they give reason and need for the latest and greatest scam cooked up by the dental community. This year is no different.

For the last several months I’ve been inundated with information about the “Sealant” scam and how it’s being used to inflate profits while endangering dental health of children. While many may believe this blog is laser focused on papoose boards and stainless steel crowns, don’t be fooled, I hear about ALL kinds of scams!

While I’m going to leave the reporting of the “Sealant Scam” to the professional news people, I’m going to say there is one and the Phew Institute is once again showing evidence of how it they give the scam a façade of legitimacy. Amazing how every time Pew and the scams correlate.

The Phew Report for 2013

Many States are Missing an Opportunity to Prevent Tooth Decay and Reduce Medicaid and Other Health-related Costs

• Contact Matt Jacob 202.540.6310

January 8, 2013
Pew’s 50-state report finds that most states are not doing enough to use a proven strategy for preventing tooth decay, unnecessarily driving up health care costs for families and taxpayers. 

Introduction: Grading the States

In both 2010 and 2011, the Pew Children’s Dental Campaign released reports grading all 50 states and the District of Columbia on children’s dental health, relying on eight evidence-based policies that cover prevention, financing, and workforce issues. However, this year, Pew’s 50-state report focuses on prevention, examining states’ efforts to improve access to sealants for low-income kids.

Texas tries to crack down on dental chains that put profits ahead of patients

 

By David Heathemail

January 8, 2013

A leading Republican in the Texas legislature, who says she’s outraged by allegations that corporate dental chains put profits ahead of patients, has introduced a bill that would allow the state to regulate chains and forbid them from forcing dentists to meet revenue quotas.

A joint investigation by the Center for Public Integrity and PBS Frontline last summer found that two of the largest dental chains owned by private-equity firms, Aspen Dental Management and Kool Smiles, put pressure on its dentists to meet production goals, prompting complaints of overbilling and unnecessary treatments.

Both companies deny this. And a coalition of dental chains in Texas contends that their dentists have total control over patient care. But the chief sponsor of the bill remains skeptical.

“Several reports, including the Frontline program, have uncovered outrageous activities involving the illegal enticement of patients, especially among our Medicaid providers and often involving dental service organizations,” said Republican Sen. Jane Nelson, who chairs the Senate’s Health & Human Services committee.

Nelson did not name a specific chain. Aspen Dental does not accept Medicaid and has no offices in Texas. But Kool Smiles has clinics throughout Texas, and public records show that the state Attorney General has been investigating Kool Smiles for Medicaid fraud.

Read the entire story at Center for Public Integrity

WARNING to Scotland County, North Carolina Health Department

Apparently Scotland County, North Carolina and it’s Health Department hasn’t gotten the memo about Reachout Healthcare America, Morgan Stanley Private Equity and Elliot P. Schlang, DDS.

What I’m concerned about is this “partnership” between Reachout Healthcare America (RHA) and the Scotland County Department of Public Health. Teaming up with an income motivated private equity firm and ANY department of public health seems to be a VERY bad idea!

Someone needs to warn the county about who they are jumping in bed with. At the very least they should be warned about the astronomical number of  cancer causing X-Rays these children will be subjected to; you know the staff has to make that daily production goal!

 

Mobile dental clinic returns

by Staff report

01.04.13 - 12:01 am

The mobile dentist program — Smile North Carolina — will return to Scotland County three times over the next three months.

The Scotland County Department of Public Health will host the first session on Jan. 9. The dental team will be at the county health department AT 1405 West Blvd. in Laurinburg from 9 a.m. to 12 noon and 1 to 3 p.m.

There are also visits planned for Feb. 13, and March 12.

Children from 12 months to 18 years of age are eligible for the preventive dental services provided by this program.

“The Smile Program will continue to collaborate with our agency to provide dental care to children under 18 years old” said Cardra Burns, WIC program director at Scotland County Department of Public Health.

Smile North Carolina teams include a licensed dentist and registered dental hygienists. The team will provide and complete all paperwork as a state mandated requirement for the dental exam and provide permission forms in English and Spanish and letters to the parent for every child.

Dental referrals are provided by Smile North Carolina if additional dental work is needed.

Most dental insurances, including Medicaid, cover 100 percent of the services that are provided by Smile North Carolina. For those children without dental coverage, charity care services are available with a parent’s signature on a charity care application. No proof of financial status is asked, health officials said.

Smile North Carolina has been coordinating dental care to children, families, and communities for almost 15 years and is OSHA and HIPAA compliant.

Burns said about 132 Scotland County children have received dental care since June 2012.

In the wake of Sen. Nelson’s Bill introduced in Texas, two of the worst DSO’s rush to self-promote

December 21, 2012 Texas Senator Jane Nelson introduced SB 151 to require, among other things, DSO’s to stop hiding behind fake owners as they do now. A few months ago, several DSO’s formed a coalition in preparation for their fight in Texas. Evidently, they want to remain in hiding.

Today two DSO’s who are members of the coalition of DSO’s issued a press release; throwing down the gallant so to speak. It’s a great piece of fiction you must read:

AUSTIN, Texas, Jan. 3, 2013 /PRNewswire via COMTEX/ -- National Recognition Includes TCDSO Members in its Inaugural "Hire Power" List of "Real Heroes of the American Economy"

The Texas Coalition of Dental Support Organizations (TCDSO) - whose members provide non-clinical business support services to Texas dentists - today congratulated four of its members - Great Expressions, Heartland Dental, Pacific Dental Services, and Smile Brands - who were recognized on Inc. Magazine's "Hire Power" list of "Real Heroes of the American Economy."

Inc.'s inaugural list of 100 Hire Power Award honorees recognizes businesses that are making a substantial contribution to the nation by "adding jobs and rebuilding the economy."

Of note, two TCDSO members - Pacific Dental Services and Heartland Dental - were included in Inc.'s list of the "Top Ten Heroes of the American Economy." They were featured as creating the 4th and 6th most new jobs in America in 2012.

Great Expressions and Smile Brands were similarly featured as creating the 25th and 31st most new jobs in the nation.

Destroying evidence? Shredding documents? Alerting records? You might want to reconsider participating in such action by ANY employer.

December 17, 12012 -United States District Judge Robert G. Doumar sentenced Lynette Smith of Suffolk, VA to 10 months in prison for altering records to conceal Medicaid fraud  The fraud was committed by A Caring Hand Home Health Care Services, Inc. between January 2008 through October 2011. A Caring Hand is owned and operated by Janice W. Holland.

http://www.justice.gov/usao/vae/news/2012/12/20121217smithnr.html

“Holland submitted to the program approximately 900 fraudulent claims for payment representing that respite care services had been provided to thirty (30) Medicaid recipients, when in fact no such services had actually been provided.  As a result, Holland obtained health care benefit payments totaling approximately $630,000 to which she was not entitled. 

During the period from in or about September 2010 through October 6, 2011, Holland and Smith, and members of the staff of A Caring Hand at their direction, altered, falsified and made false entries in the office records of A Caring Hand to conceal and cover up the fact that Holland had submitted false and fraudulent claims for payment to the Virginia Medicaid program.  On multiple occasions, Holland and Smith met with staff members and directed them to alter, falsify and make false entries into office records, including the creation of false and fraudulent time sheets, in order to make it appear that the respite care services for which Holland had billed the program had actually occurred, when in fact they knew that no such services had been provided.  Approximately twelve staff members knowingly committed the alteration and falsification of office records at the direction of Holland and Smith, who were aware of an upcoming scheduled audit of the office records.  Holland and Smith committed these acts with the intent to impede, obstruct and influence the proper administration of the Virginia Medicaid program, which is a matter within the jurisdiction of the Department of Health and Human Services.

Holland has pled guilty to health care fraud, alteration of records and aggravated identity theft, and will be sentenced on January 22, 2013.”

New DSO Regulations on tap for Texas–Batter up!

Texas legislators to consider new DSO regulations

By Donna Domino, Features Editor

December 28, 2012 -- Dental service organizations (DSOs) in Texas would be subject to greater oversight under a bill being introduced by a Texas legislator who accused the groups of "outrageous actions" involving unnecessary pediatric procedures.

SB 151 is designed to "strengthen the Texas State Board of Dental Examiners' ability to ensure that dental treatment is directed solely by licensed dentists, not by corporate entities." The measure would also require DSOs to register with the board and prohibits them from "interfering with dentists' treatment decisions."

“These types of entities have been involved in some of the illegal and, quite candidly, outrageous actions.”

— Sen. Jane Nelson

The bill was prefiled on December 21 by Sen. Jane Nelson (R-Flower Mound) in advance of the 83rd Regular Session of the Texas Legislature, which reconvenes on January 8. It would require DSOs to register with the state dental board, and it also would allow the dental board to impose administrative penalties and disciplinary actions against DSOs that violate the Texas Dental Practice Act. Similar to in many states, the law states that only licensed dentists can own and operate dental clinics.

Currently, DSOs in Texas are not subject to any state regulation, Nelson noted.

"We need to ensure that these organizations are accountable to the board and, more importantly, that they are not substituting their judgment for that of our trained, licensed dentists," Nelson said in a statement.

Read the entire story at Dr. Bicuspid

Related:

Dental Patient Protection SB 151

Dental Patient Protection: SB 151 strengthens the Texas State Board of Dental Examiners' ability to ensure that dental treatment is directed solely by licensed dentists, not by corporate entities. It requires dental service organizations (DSOs) to register with the Board and prohibits them from interfering with dentists' treatment decisions. It also allows the Board to impose administrative penalties and take disciplinary action against a DSO found in violation of the Texas Dental Practice Act. Before performing dental treatment on a child, SB 151 requires that a dentist inform the child's parent or guardian that they have the option to be present in the treatment room, and it prohibits a dentist from performing the dental treatment or procedure without the parent or guardian present if they desire to be in the treatment room. Currently, DSOs are not subject to any state regulation. "We need to ensure that these organizations are accountable to the Board and, more importantly, that they are not substituting their judgment for that of our trained, licensed dentists. No child should undergo complicated, painful procedures without a parent being involved at every point in the process. These types of entities have been involved in some of the illegal and, quite candidly, outrageous actions involving the enticement of children to undergo costly and oftentimes unnecessary procedures at the taxpayer's expense."

Senator Jane Nelson
P.O. Box 12068, State Capitol
Austin, Texas 78711
Tel. (512) 463-0112
Fax (512) 463-0923

Goldstein, Garber and Salama now a Heartland Dental Clinic

Heartland Dental has bought the cosmetic dental center – Goldstein, Garber and Salama in Atlanta. Goldstein, Garber and Salama also offers online education, via DentalXP, which including lectures, videos, courses and production information.

Run for the hills patients and doctors. If you are messing around with Goldstein, Garber and Salama or DentalXP you are playing with fire.

http://www.prnewswire.com/news-releases/heartland-dental-care-affiliates-with-the-leading-atlanta-dentist-goldstein-garber-and-salama-llc-185048191.html

In other Heartland Dental News -

S & P rates Heartland at a B- plus.

Dekalb Dental Group may be robbing you (don’t miss comment #164)

Dr. Walter Dawkins gets a year and a day, maybe the shaft as well.

Dr. Roy Shelburne received 2 years in prison (served 19 months) and Drs. Michael and Eddie DeRose got a football stadium.

Dr. Robin Lockwood received 18 months in prison – Dr. Chad Brandon Hoecker got a private jet, lavish lifestyle and near death experience.

Sixty year old, Dr. Walter Dawkins got a year and a day in jail, then 3 years probation – Dr. Richard Malouf got a sprawling mansion with a lazy river, water park and bowling lanes.

Money talks.

 

Dentist sentenced to year in prison for fraud

Published 3:15 am, Saturday, December 22, 2012

Read more: http://www.beaumontenterprise.com/news/crime/article/Ill-dentist-sentenced-to-year-in-prison-for-fraud-4140164.php#ixzz2FtSmJRHG

BENTON, IL (AP) — A southern Illinois dentist has been ordered to spend one year and a day in federal prison for defrauding Medicaid and illegally distributing a prescription painkiller.

Sixty-year-old Walter Dawkins of Fairfield was sentenced Friday in U.S. District Court in Benton.

Dawkins pleaded guilty in September to felony counts of fraud involving a health-care program and unlawfully distributing the controlled substance hydrocodone.

Federal prosecutors say the offenses involved hundreds of prescriptions written outside the course of Dawkins' medical practice.

Dawkins also was sentenced to a $900 fine and three years of post-prison supervised release. He also must reimburse the Illinois Medicaid program.

This “corporate structure” Kool Smiles graphic is too funny for words

I suppose since not a soul can get in front of a legislative body (i.e. Diane Earle at Texas Hearing) and explain the lies, they figured a picture might do the trick.

The fact they need this speaks volumes! Imagine the fun one could have with this thing. Just saying.

Don’t miss the interactive flags over at their website. It’s a hoot! Just mouse over each red flag in the various departments for NCDR’s explanation of each one.

 

 

 

 

 

 

 

 

 

 

Statement of Bullsh*$

NCDR provides Kool Smiles with state-of-the-art software that runs scheduling, ... NCDR's IT department assists Kool Smiles dentists, hygienists, and office staff.

http://www.koolsmilesfacts.com/corporate-structure/

Remember Kool Smiles Regional Director – Diane Earle Texas Hearing October 15, 2012

East Naples Florida practicing dentistry out of his apartment

Two thing I thought when I read this:

1. Suddenly some state is concerned with sanitation??  OMG!
2. Is in home dental offices in our near future to escape the corporate dental care? Hey, as long as they are licensed, have the equipment and supplies they prefer instead of the cheap shit dentists are forced to use by corporate idiots, I’d be a patient.

Man accused of performing dentistry without license

 

Staff Reports

Friday, December 21, 2012

An East Naples man who has been practicing dentistry out of his apartment is not actually a dentist, according to Collier County sheriff's deputies.

Detectives got wind that Luis Fernando Suarez-Paz, 51, was taking patients at his apartment at 108 Santa Clara Drive, reports said. Last week, an undercover deputy set up an appointment with Suarez-Paz to be examined because of a toothache. The undercover deputy was taken into a small room in the apartment with a reclining chair, dental instruments and a dental exam light, according to an arrest report.

Suarez-Paz examined the deputy, told her to get x-rays taken "at a real dentist office" and then bring them back to have a root canal performed. Suarez-Paz said the exam was free but the root canal would cost $350 over four visits, reports said.

Detectives found no record for Suarez-Paz with the state's department of health and could not find a medical or dental license issued for him in Florida.

On Thursday, deputies executed a search warrant and found "a very dirty and unhygienic environment that had outward appearances of a dental office," reports said.

Suarez-Paz faces charges of practicing dental hygiene without an active license and operation of a dental office by a non-licensed person.

What’s happening at your clinic after hours?

 

 

Fake dentist arrested, says Montgomery County DA

Author: 69 News, (follow: @69news), news@wfmz.com

Published On: Dec 17 2012 03:19:44 PM EST
Montgomery County, Pennsylvania

Cheryl Laing and Jessica Gullickson, both of Broomall, Pa., were arrested after an investigation into the unauthorized practice of dentistry at the “Smilz 4 Life” dental office located on Old Lancaster Avenue in the Bryn Mawr section of Lower Merion Township, Montgomery County District Attorney Risa Vetri Ferman and Lower Merion Police Superintendent Michael J. McGrath announced on Monday.

Laing and Gullickson are charged with Corrupt Organizations, Criminal Conspiracy, multiple counts of Theft by Deception, Unauthorized Practice of Dentistry and Recklessly Endangering Another Person.

The investigation, which was assisted by the Montgomery County Investigative Grand Jury, revealed that during regular office hours, Laing was employed as a dental assistant at Smilz 4 Life. The practice was operated by a licensed dentist. After business hours, Laing set up her own dental practice at Smilz 4 Life while holding herself out to patients as a licensed dentist.

A special Christmas blessing goes out to the orthodontists who have volunteered to see these victimized children!

For the past several years, hundreds of Texas Orthodontic clinics have put braces on children who didn't need them, all to bilk the Medicaid system - stealing your tax dollars. Now that the Feds and State of Texas are hunting down the dirty dogs. What did the owners do? Well they locked their doors and ran; being the cowards they are. Now, ten’s of thousands of children have been abandoned, braces still on and treatment unfinished. Now, volunteers are stepping in.

 

 

Roderick Williams, 11, got his braces more than two years ago. When we met him, all that remained were brackets. His wires were broken. His orthodontist was out of business.

His mom, Denecia Williams, was at a loss.

"Now what do I do?" she said. "And it's been a hassle ever since."

Like hundreds of other Texas kids,  Roderick was stuck without anyone else to remove what was still left in his mouth. Now there is.

 

The loons I deal with

Below is a direct Email from some loose cannon who thinks is due my time - calling itself Donna Valens dvsee1982@gmail.com.
You are so NOT normal in any capacity of the word. Cowardly rant? Since when is asking someone a question and giving them the chance to back up their crazy statement a cowardly rant. You could REALLY benefit from the dictionary.com tool. You are an idiot. I am done here. YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T ANSWER MY QUESTION! YOU CAN'T

Heartland Dental $650 Million in Buyout Loans Rise

http://www.businessweek.com/news/2012-12-20/heartland-dental-s-650-million-of-buyout-loans-rise-in-trading

After 18 months of reporting, WFAA’s Byron Harris reports; black market for Medicaid Dental patients is going strong

Thank you Phyllis Gonzales! You are one brave woman! We need more Phyllis Gonzales’ that’s for sure.

WFAA
Posted on December 18, 2012 at 10:13 PM
Updated today at 9:01 AM

NEWS 8 INVESTIGATES

The black market for Medicaid Dental patients is going strong, despite the state’s tightening of the payment system for providing dental care to poor children.

Phyllis Gonzales said she was paid more than $1,000 by 1-Stop Dental in Hurst over a two-month period. In exchange, she said she brought about 60 kids and their parents to the dentist’s office.

There, she said parents got between $20 and $35 for switching their children to the dentist working there.

It’s illegal to pay a parent to switch dentists under Medicaid, according to the Texas Department of Health and Human Services.

The 1-Stop story came to News 8’s attention because of flyers stuck under car windshield wipers at DART station parking lots.

“The policy was basically to bring as many patients as possible,” Gonzales said. “The payment [to Gonzales] was $10 per child, with bonuses of $100 once you reached ten children."

North Carolina–Crackdown on healthcare fraud laughable

Is this not ridiculous; in so many ways?!

WRAL

December 18, 2012

 

 

 

I suppose some could read this as message that they are very serious in NC when it comes to Medicaid fraud. HOWEVER, since one set of clinics in particular defrauds Medicaid more than this in an hour, it’s laughable.

Dr. Robin Lockwood–arrested, convicted, sentenced–dental license remain squeaky clean

 

http://www.dentist.state.ok.us/lists/ddsl.htm

Heartland Dental–Fact or Fiction–Propaganda

Anyone find it funny Heartland Dental even needed to publish this propaganda piece.

Fall 2012 – Smiling Magazine – A Heartland Dental Care Publication

Pennsylvania dentist charged in prostitution sting–Ooops

Dentist Charged in Prostitution Sting

If Gallup Poll is correct–the public is in serious danger

December 5, 2012 – The ADA published this article - "Dentists rank high in Gallup poll" —5th to be exact — this taken from a Gallup survey published December 3, 2012.

Thinking what dentists could come in at 5th place, I started a list. Not revealing what actually made my list — as not to anger some of my friend dentists —I’ll just say that “ethics” was not in the top 50!

December 11, 2012, the same day, NBC aired their explosive investigation about the horrors still happening to children at Small Smiles Dental Centers, the Richmond Institute for Continuing Dental Education followed up on the ADA article — their headline read — “Dentists Rank #5 as Most Ethical Profession”

It’s said the Gallup survey asked 1,015 adults from 50 states to rate — on a five point scale ranging from “very high” to “very low” — how they perceived honesty and ethics of 21 professions. The survey concluded the American public believes dentists are 62% honest. The survey also concluded Congress and cars salespeople are perceived as the least ethical.

If Gallup Poll is correct, then maybe the statements each year by the '”Pew Institute” is more spot on that thought; at least their mantra — “There is a Dental Crisis in America”.  There is now little doubt public health is in danger. Either abandoning educational programs in classrooms on dental hygiene — brushing and flossing — completely or at least enhancing the programs with additional instruction more like:

• “Recognize a Dentists Who Wants in Your Pants, Not in Your Mouth” —101
• “You Were Safer at the Barber Shop" — 101–103
• Playground in the Waiting Room = Playground in Your Mouth — K – 12

I can only conclude the 1,015 people who were asked must have been:

A.  grandparents of freshman dental students; who also happen to be picking up the tab for their grandchild’s education.

B.  the surveyed all have a family member named in a current lawsuit for dental malpractice

C. none have seen a dentist since at least 2006, and don’t have a clue.

Thousands more children abused at private owned “chop shops” - 1-Stop Dental, First Impressions Dental, Gold Star Dental. Parents are paid $35 to bring their child for “treatment”!

These are just 3 of 30 or more operated by a very close knit group of criminals with DDS after their name in Texas. I’m sure we will be hearing more on this cartel.

Hey, Ms. Lisa Re, is this one ok with you as well? I assume it must be, it’s the same story we hear about Small Smiles of which you are such a big fan!!

Here is Byron Harris’ latest report:

by BYRON HARRIS

Bio | Email
WFAA
Posted on December 12, 2012 at 10:38 PM
Updated today at 9:35 AM

NEWS 8 INVESTIGATES

The darkest side of Medicaid dental

DALLAS -- In the eighteen months since News 8 began reporting on the Medicaid dental program, we’ve discovered hundreds of millions of dollars paid out by Texas that other states don’t pay for at all. We’ve discovered children being lured from their neighborhoods into dental chairs, just for the Medicaid dental fees they’d bring. And we’ve outlined how gift cards have been used to entice parents to bring their kids to certain dentists.

The State of Texas is now cracking down on those practices through enforcement and new systems for reimbursing dentists. But that’s only increased the competition for new, young Medicaid patients and the income they can bring to a dental office. In their worst forms, might be described as tempt and torture.

The Switch Bonus
In the parking lots of Dallas DART stations, crude flyers are being tucked under commuters’ windshield wipers.

“Get paid to take ur [sic] kids to the dentist. The dentist is giving $20.00-$35.00 per kid,” the flyer reads.

Health and Human Services or Health and Hedge-fund Services? When it comes to Medicaid dental mills, it’s the latter.

December 11, 2012
On Tuesday, December 11, 2012, The Today Show aired an investigative report about the on going troubles at the Small Smiles Dental Centers. Interviews included one with Health and Human Services (HHS) officials in charge of overseeing the compliance of the notoriously troubled clinics.

If you’ve not seen the report, please take time to do that here.

The segment included an interview with a HHS-OIG Branch spokesperson. However, if not for the HHS-OIG seal displayed one would presume it came out of the the PR department at CSHM headquarters.

NBS News Senior Investigative Correspondent, Lisa Myers asks HHS-OIG spokesperson, “They’ve had 4 bites at the apple, when is enough, enough?”  

HHS-OIG responded with this check list:

1. “Dentists have been fired” – Well, dentists are fired there every day!! They are fired every day because they don’t meet the production numbers set by the corporate office. Their turn over had been setting at 48% since the beginning!

What about the Chief Dental Officer – Steven Adair, DDS?  He actually got a promotion. Dr. Adair is the author of the news letter for CSHM in which he suggests instead of the papoose board, try the “superman cape” method.

What is the Superman Cape Technique? Here, read this!

Compliance officers? – Yes, a few. They have burned through 3 in 2.5 years. CSHM will not hesitate to been throw one under the bus, blaming them for falsified reports to the OIG.

2. “Clinics have been closed” – Yes, they have filed bankruptcy! The started closing clinics in early 2011! HHS only forced 1 clinic in actually close – Manassas Virginia.

3. “This is not the same company” – True, it simply filed for bankruptcy, reorganized with some of the same investors in the background, and changed it’s name, replaced the CEO and President. But that was in 2011!

3. “The Independent Monitor is telling us that Quality of Care is consistently improving” – The same independent monitor in place for 3 years! The one CSHM pays. The one whose head dental investigator is buddies with the company’s Chief Dental Officer. So exactly when did that “improvement” begin? June of 2012? Certainly not in April 2012? The new people in charge actually  stepped in October 2011. It just wasn’t on paper with the bankruptcy court until June 2012.

The company has been in the news, how many times since 2007?
Countless!!!

4 Dental Service Organization in the top 40 job creators in 2012

Inc. has listed it’s top job creators for 2012, giving the top 100 their  “High Power Award”.

They called them “The Real Heroes of the American Economy”. I almost choked when I checked the list, there were 4 DSO’s in the top 40.

 

Rank	DSO	Jobs Created in 2012	Total Employees	Revenue	Location
4th	Pacific Dental	1451	3422	$250-$500 million	Irvine, CA
6th	Heartland Dental Care	1150	3201	$250-$500 million	Effingham, IL
25th	Great Expressions	660	1770	$100-$250 million	Bloomfield Hills, MI
31st.	Smiles Brands	551	4483	$250-$500 million	Irvine, CA

Each of the above company claim they are Dental Service Organization or Dental Management Companies and are merely hired by dentists who hate mundane office work. Each claim they simply provide much needed day to day operational support, such as bookkeeping, payroll, human resources, software, records keeping, etc.  Ya know, the office crap everyone hates. The duties normally an office manager and one assistant could probably handle.

Let’s see how that adds up.

Pacific Dental – Ranked at #4 in new jobs in 2012.  It’s hard to nail down a number but it’s around 300 offices, they claim to simply support/manage. Let’s just say it’s 275. That means for each and every office they provide support takes 12.44 “support” employees. WOW!

Heartland Dental – Heartland Dental, ranked # 6, claims they do not own any dental clinics, but simply manager 370 across the US. According to “Inc.” they employ 3201 people. That means they have 8.6 employees to do the bookkeeping, filing, banking, and scheduling, for each and every clinic, that is supposedly owned and operated by self employed dentist who hates office work. Does this sound logical?

Great Expressions – Great Expressions says it “manages” 170 dental centers and it takes 1770 people to manage them. That is 10.4 employees per clinic to “manage” the day to day office duties. 

Smiles Brands – Smiles Brands includes, Monarch, BrightNow!, Castle Dental and Newport Dental. Like the others, Smile Brand’s say they simply “support” about 400 clinics that has 1300 dentists and hygienists, in 18 states. Does this mean it takes 11 Smile Brands employees to manage each clinic, already staffed with dentists and hygienist?  If this is the case, then their employees really suck at “supporting”.

Does it add up? Make any sense whatsoever?

No! Not unless these companies in truth illegally own and operate the clinics and all these employees include licensed dental professionals who are actually employees of each of these companies.

Fox News has picked up the Small Smiles Dental Centers story

Dental clinic Small Smiles criticized for performing poor, unnecessary procedures

Read more: http://www.foxnews.com/health/2012/12/12/dental-clinic-small-smiles-criticized-for-performing-poor-or-unnecessary-dental/#ixzz2ErFLtEpx

December 12, 2012 - The national children’s dental clinic Small Smiles is under fire after an investigative report revealed allegations that the chain’s clinics have been performing substandard work and unnecessary dental procedures – responsible for increasing taxpayer cost.  The accusations come from numerous parents, former employees of the company and government investigators, who are concerned about the exploitation of children’s health.

According to an NBC News investigation of 63 Small Smiles clinics over the past three years, the alleged practices are in direct violation of a settlement the chain made with the Department of Justice in early 2010.  The settlement was in response to previous allegations accusing the company of performing unnecessary and substandard dental procedures on low-income children.

CSHM media response after Today Show investigation

Here is the letter the company’s new CEO sent in response to inquiry by NBC during their investigation. Note, David Wilson, the new CEO’s name is blurred out. Mr. Wilson also declined interview. Makes me wonder if Mr. Wilson has gone into hiding or something.

After the story aired December 11, 2012, the company put out a response statement; again, names of any person associated with the company omitted. However, they sure want the public to believe they have the ‘stamp of approval’ from HHS-OIG. Read statement..

BTW, the 50 new dentists HHS-OIG spokesperson Lisa Re and CSHM bragged about hiring – they employ between 200-250, (maybe more) dentists in the 66 clinics. Their turnover rate is approximately 48% for dentists. They hire 50 news dentists every month dang near it! The last week of every month is “new hire training week” in Nashville and you will find between 15-20 or more at any of those training sessions.

2012 Small Smiles investigation by NBS shows abuse of children continues despite actions taken by HHS

By Talesha Reynolds and Lisa Myers

It’s just over 5 years since HHS-OIG and DOJ began an investigation of Small Smiles Dental Centers.
It’s 3 years after the company was put under a Corporate Integrity Agreement.
Small Smiles abuse continues. In the new investigation -  HHS-OIG sound more like the company's PR firm than protectors of public health; Senator Grassley calls for the company to be closed down and says it’s all about the dollars.

Click here for the full report you don't want to miss!

Click here for the full report.
Transcript of the video


____________________________

Visits to the dentist can be upsetting for little children, but when Autum Archuleta took her son Nathan to a Small Smiles dental clinic in February 2010, it was beyond anything she could have imagined. The dentist gave Nathan, then almost 3, three crowns, two baby root canals and six silver fillings in 25 minutes.
While in the waiting room, Archuleta says she heard her son screaming and burst into the treatment room. She says Nathan was crying and struggling to move while being held down by three clinic employees and wrapped from his head to his feet in a stabilization device called a papoose board. She thinks he wasn't properly numbed.
"He wasn't the same for a long time after we brought him home," Archuleta said. "He cried a lot...He wasn't my little boy. He didn't smile...The night terrors were the worst. I mean it was a lot of sleepless nights."
A dentist who later reviewed Nathan's records said the work was shoddy and many procedures unnecessary. A dentist who saw Nathan the following year wrote that he had "severe situational trauma."
"To me I think they did it for the money," Archuleta said of Small Smiles. "Flat-out did it for the money. Because it was Medicaid and Medicaid would pay them."
An NBC News investigation of the performance of Small Smiles' 63 dental clinics over the last three years found repeated allegations of substandard work and unnecessary procedures which drove up the cost to taxpayers. The allegations came from anguished parents, government investigators and former employees around the country.
Such practices violate a settlement the company reached with the Justice Department in January 2010, following allegations that it was bilking taxpayers by doing unnecessary and substandard procedures on low-income children.
At the time, Tony West, Assistant Attorney General for the Civil Division of the Department of Justice said, "We have zero tolerance for those who break the law to exploit children in need."
The company that managed Small Smiles and affiliated clinics agreed to significantly alter its practices and subject itself to independent monitoring. It also agreed to pay $24 million, without admitting wrongdoing.
But three years later, records show the company has not cleaned up its act.
"This company sees dollar signs in the eyes of every child they bring in," Senator Chuck Grassley told NBC News. Grassley has been investigating dental organizations whose primary source of revenue is Medicaid. He says Small Smiles practices assembly-line treatment, focused more on quantity than quality.
"This whole investigation kind of leads us to two things. To a conclusion that the tax payers are being fleeced, and children are being abused." Grassley said.
Small Smiles clinics are managed by a private corporation called CSHM, LLC, which was until June called Church Street Health Management.
The Department of Health and Human Services Office of the Inspector General (HHS OIG) is responsible for monitoring the clinics and rendering penalties when appropriate.
Lisa Re, a branch chief who heads an HHS OIG team of attorneys, says CSHM is improving since it emerged from bankruptcy in June 2012 with a new CEO and leadership.
"Recently, under new management, I would say that it is getting much better."
But according to letters from HHS OIG to Church Street, the compliance has been inconsistent and sometimes alarming.
In May, the office required CSHM to temporarily close a facility in Oxon Hill, Maryland to train staff on "the appropriate use of mouth props, patient stabilization practices, appropriate use and administration of anesthesia," among other things. Nine of 30 records the independent monitor reviewed "did not provide any documentation or radiographic evidence to support the medical necessity for the treatment provided. Six of those nine records showed baby root canals were performed "without medical necessity."
The OIG required the company to divest from a location in Manassas, VA in March because of "flagrant violations." A 2011 audit at that clinic found 104 of 244 baby root canals performed by the lead dentist to be medically unnecessary. In a sample of 34 records, 20 patients were restrained and given baby root canals with insufficient anesthesia. The monitor expressed concern that the children "were resisting treatment because they were being hurt."
In June the office fined CSHM 100,000 dollars after an audit found multiple breaches at an Ohio clinic, including treatments performed without medical necessity, incomplete or poorly done root canals, crowns places on "non-restorable" teeth and "poor techniques of administering local anesthesia." Six of seven dentists performed root canals on children that were not needed.
Last year, the agency issued a 230,000 dollar penalty, the largest it has ever levied, for multiple failures to comply with provisions of the government agreement. Among the breaches, the company failed to meet training and education requirements.
Still, Small Smiles continues to rake in millions in Medicaid dollars. Despite multiple threats to exclude the company from receiving federal funds, it made 150 million dollars in revenue from Medicaid in 2011.
The HHS OIG has given Church Street multiple chances to keep the clinics in business, levying penalties against the company and threatening to exclude them from receiving federal dollars. But the threats generally come with an out — a way to repair the breaches and avoid being exclusion.
Senator Grassley believes that cycle should come to an end.
"The inspector general has given this group a lot of second chances. Every time they get their hand in the cookie jar. All sorts of excuses. So you get back to how long can this go on — the fleecing of the tax payers, the abuse of children? And you get back to the point that maybe it's about time for the inspector general to disqualify this company from Medicaid."
DENTAL CARE VACUUMS CREATE LIMITED OPTIONS IN LOW-INCOME NEIGHBORHOODS
Small Smiles treats about 500,000 children a year. Jamier Brown, 4, was one of them. His mother Jasmine brought him to Small Smiles in Dayton, Ohio at the end of 2011 because she couldn't afford her other options.
"I knew that his mouth needed attention. And he was complaining that his teeth were hurting, so I just couldn't wait around to see when I could get the money. I had to go as soon as I could," she said.
Jamier received caps and fillings in most of his mouth in January.  Months later, he is still in pain.  The gum line is discolored where his front teeth we capped and Jamier says, "It hurts all the time."
Two dentists who reviewed Jamier's records said he should have been treated by a pediatric dentist, most likely in the hospital under general anesthesia. One called the treatment on his front teeth "inadequate."
At the time Jamier was treated, Jasmine was in Job Corps and living with her mother. She blames herself for what happened to her son.
"It's kinda my fault," she said as tears rolled down her face, "Because if I would have had the money, he probably wouldn't have felt any of that pain that he had to go through."
The guilt Brown feels is common among parents who spoke with NBC News and claimed their children were hurt at Small Smiles. They all said they didn’t know where else to go.
According to the Centers for Medicare and Medicaid Services, 31.5 million children were eligible for dental coverage through Medicaid in fiscal year 2011, but only 14.7 million children utilized a dental or oral health service.
Four out of five dentists don't take Medicaid, some because they just don't treat children but others complain of low reimbursement rates. Dr. Warren Brill is the president elect of the American Academy of Pediatric Dentistry (AAPD). He has his own practice in Baltimore, MD and 85 percent of his patients are on Medicaid.
"Reimbursement rates are a large factor in terms of dentists not accepting children on Medicaid, because the fees that they get are often times lower than the cost of providing the care," he said.
According to AAPD 70 percent of its members accept Medicaid. But only 3.5 percent of all professionally active dentists practice that specialty.
Nevertheless, Dr. Brill says parents of children on public insurance can find quality care.
"It's a question of learning how to make the appointment, getting referrals from state health departments, from dental associations, from friends and relatives. Parents that find those avenues should be able to find a dentist for their children."
DOES PROFIT MODEL PUT CHILDREN AT RISK?
Because Medicaid reimbursement rates are lower than what dentists charge other patients, critics say to make a profit, the clinics rely on volume.
Dr. Kianor Shah worked for Small Smiles briefly in 2011.  He says he left after witnessing disturbing practices. The dentist showed NBC News notes he took about treatments he observed during his time there. Scattered across several pages were words like "restraint brutal," "unnecessary" and "no way."
"I observed excessive use of the papoose board and excessive use of force to restrain children as well as overtreatment for procedures that could have been done with much less invasive approach."
Shah claims dentists were coerced into abusing children and overcharging Medicaid by the promise of bonuses and pressure from management.
"I was advised, quote unquote, 'The dentists eat what they kill.' That means that they're gonna get paid for as much work as they do on those Medicaid kids. And that was about the last straw for me."
Senator Grassley's investigation involves dental management companies that are controlled by corporate investors. Many states require dentists to own the clinics but the management companies, like CSHM, effectively control the operations.
"Our investigation has found a lot of private equity money being invested in companies that are doing everything they can in the most sophisticated way to take as much money out of Medicaid as they can. And in the process of just milking the Medicaid program, we're finding a lot of abuse of children."
PROGRESSIVE IMPROVEMENT AT SMALL SMILES
The Inspector General's office says the Small Smiles clinics have progressively improved, and while that improvement has been "uneven," the company is providing essential care to a vulnerable population. The agency maintains that it is better to aggressively monitor the company than to shutter it.
"If we had closed down Small Smiles last year, there would have been an uncontrolled shut down of this company leaving half a million kids scrambling for dental care," said Lisa Re.
The issue is further complicated by the states, which are responsible for administering Medicaid. The OIG surveyed states about the impact of closing the clinics and got a strong reaction.
"Some of the states were alarmed that we were even considering closing any of the clinics because they simply didn't have enough dentists to provide any care to these kids," said Re.
The attorney said in the last couple of years the office found five clinics to have the most significant problems.
"It's important to understand that not every clinic is providing bad care. If that were the case, this is an easy decision."
According to an affidavit in the Church Street bankruptcy filing earlier this year, "more than 1.5 million patients have been served during the past five years, improving overall dental health and access to care in many low-income areas in the 22 states in which the Company has had a presence."
Chris and Loretta Trujillo are grateful for the care the Small Smiles in Denver provides their children. They say it is very difficult to find dentists who take Medicaid and their children, Jordan, Jazmin and Faith, have never had a bad experience.
"My kids have never been scared coming here," said mom Loretta. "They're excited to come."
The Inspector General's office is taking on Small Smiles on a clinic-by-clinic basis, vigorously monitoring them and assessing penalties when appropriate.
"We have taken targeted and aggressive action against the clinics that provided bad care while allowing the company to provide good necessary care at the other clinics," she said, adding that the clinics are showing marked improvements since a new CEO, David Wilson, came on in June.
"The company as it operates today is simply not the same as the company that was repeatedly violating the agreement," Re insists.
In a statement to NBC News, CSHM's Wilson wrote, "Patients are at the center of everything we do at CSHM. CSHM LLC supports our affiliated dental centers so that they can continue to provide access to quality dental care. Our dental centers serve approximately one million patient visits per year, primarily to children in communities with under-served access to dental care."
Following an alarming audit of the Small Smiles clinic in Youngstown, Ohio that found substandard and unnecessary care, the new management company, which had just been formed, fired nine dentists there. The Inspector General's office called that action encouraging.
CSHM stressed its commitment to quality care. "Under the new management team, more than 50 new dentists have joined CSHM affiliated centers and the company continues to support their ongoing efforts to recruit qualified dentists."
That is simply not enough for Jasmine Brown. "I don't want anybody else's child to have to go through what my son went through, especially being that young. That's traumatic. That's something that could follow him the rest of his life."
Jasmine is now holding down two jobs — one as a pharmacy tech at CVS, the other as a security guard at a men and women's shelter. She says she can now afford to get Jamier the care he needs.