Thursday, May 31, 2012

Shockng: some politicians in the hip pocket of dental mills and private equity

Click here for the Bloomberg story.

Who is going to protect patients?  

Who is going to protect taxpayers?

Who is going to protect the profession?

Click here for a link to the North Carolina Dental Society's views on the bill.  Here is what is at the heart of this fight: big business joined with big government to dominate the market and squeeze out the little guy.  This excerpt sums up what's at stake:
Question: If a dental management corporation is operating illegally, isn’t it the responsibility of the State Board of Dental Examiners to investigate and take corrective action?
Yes; however, some of these corporations have disguised their later-proven-illegal actions, made false assertions and withheld documents to delay the progress of litigation. These actions have greatly increased the Board’s investigation and litigation costs.
It is the responsibility of the Board to investigate, address any violations, and prevent future illegalities by the dental management companies. This legislation gives them the tools and authority to effectively preserve the dentist/patient relationship and maintain a high quality of care.
In other words, the private equity firms want your tax dollars but they sure as Hell don't want accountability.   If these fat cats prevail, then taxpayers, patients, and solo practitioners are all screwed.   

See this piece about private equity gobbling up the dental market.  And who is footing the bill?  You, Mr. Taxpayer, through the Medicaid programs.  You know something fishy is going on when private equity goes after a market that is almost exclusively funded by a government program designed to help poor people.  

May 30, 2012 -- A growing number of private equity firms are investing in dental management companies, which they see as one of the few growth areas in the current economic recession.

Small Smiles is one of at least 25 dental management companies that have been bought or backed by private equity firms in the last decade, according to Thomas Climo, a Las Vegas dental consultant. These companies account for about 8% (12,000) of the dentists licensed in the U.S., he said.

Topspin and AUA Private Equity Partners, both New York-based equity funds, announced earlier this month that they had invested an undisclosed amount in Brighter Dental Care, a regional dental practice management company that operates and manages seven affiliated dental practices in New Jersey.
Last November, private equity investment firm JLL Partners paid $398 million to buy American Dental Partners (ADP). ADP is affiliated with 27 dental group practices, which have 282 dental facilities and about 2,400 operatories in 21 states.
And in 2008, the Audax Group bought a majority stake in Great Expressions Dental Centers, expanding the platform from about 100 practices to 152 locations.
Currently, there are 24 large dental practice management companies in the U.S., with annual revenues of more than $100 million, Climo said.
Private equity buyout firms have been attracted to dental practices because they are less regulated than physician groups, and patients often go to their dentists more regularly than to their doctor, according to Sandy Steever, an editor with Irving Levin Associates, a Norwalk, CT, publisher which tracks mergers and acquisitions in healthcare.
"They attract less scrutiny because dental services are seen as more peripheral than physicians' services," he told "In one sense, I think healthcare is noncyclical because it's a regular need. I have seen a lot of private equity getting into dental servicing companies."
Some of the firms have benefited from the increase in Medicaid payments for dental care, which rose 63% to $7.3 billion between 2007 and 2010, according to the U.S. Center for Medicare and Medicaid Services.
 Click here for the rest of the story.

Friday, May 25, 2012

Federal Agents Arrest NK Man In $20 Million Medicaid Fraud Scheme

Looks like dental Medicaid fraud isn't just a problem in Texas or the Southeast.  Looks like dental Medicaid fraud is systemic throughout the Medicaid programs.

From theNorthKingstonPatch  By Elizabeth McNamara May 24, 2012

Gary Anusavice, who used to live in East Greenwich, was barred from practicing dentistry in Rhode Island and Massachusetts in 2005.
Federal agents arrested Gary Anusavice, 59, at his home on Potter Road in North Kingstown Thursday morning in connection to a $20 million Medicaid fraud case in Connecticut.
In a story first reported by NBC Connecticut, federal agents raided dental offices in New Britain and Trumbull, Conn. Also arrested this morning was Mehran Zamani, DDS, 47, of Pound Ridge, N.Y.
“As alleged, these operators of dental practices throughout Connecticut defrauded the Medicaid program of more than $20 million over a two-year period,” said Connecticut U.S. Attorney David Fein.
“Although Gary F. Anusavice was barred from Medicare, Medicaid and other government health programs back in 1998, he allegedly continued to defraud taxpayers by using an elaborate shield of companies and individuals – including Dr. Zamani – to hide his involvement,” said HHS-OIG Special Agent in Charge Susan Waddle.
Anusavice is also known as “Gary Andrews,” “Gary Andrus” and “Gary Francis." His Potter Road property is under the jurisdiction of the court, according to officials.
In November 2005, Anusavice was barred from practicing dentistry in Rhode Island, and the Massachusetts Board of Registration in Dentistry permanently revoked Anusavice’s license to practice dentistry in Massachusetts in 2006.
In 2010, he agreed to pay $237,500 in fines over allegations he illegally financed dental work, pressured patients into signing up for financing, and failed to treat people or performed substandard work.
In July 1997, Anusavice was convicted in Massachusetts for submitting false health care claims, a felony.  Based on that conviction, the U.S. Department of Health and Human Services notified Anusavice in April 1998 that he was being excluded from participation in Medicare and state health care programs, including Medicaid. As part of that notice, Anusavice was informed that, as an excluded individual, he may not “submit claims or cause claims to be submitted” for payment from the federal Medicaid program. 
The criminal complaint alleges that Anusavice established several dental practices in Connecticut, which were operated by other dentists, including Zamani. These dental practices received millions of dollars in Medicaid reimbursements from the Connecticut Medicaid program, which payments were prohibited given Anusavice’s exclusion from the Medicaid program.
The dental practices operated by the two men included Landmark Dental in West Haven, Dental Group of Connecticut in Trumbull, and Dental Group of Stamford. Despite his permanent exclusion, according to the U.S. Attorney's office, Anusavice was involved in reviewing patient charts, suggesting dental procedures to be performed, reviewing billing records, reviewing income reports, interviewing and hiring dentists, and providing overall management direction to the offices.
According to Fein, Anusavice hired Zamani at Landmark Dental in October 2008. It's alleged that Zamani soon became aware of ANUSAVICE’s disciplinary history. In January 2009, Zamani submitted a Medicaid Provider Enrollment Application with the DSS in order to obtain a Medicaid provider number for Mehran Zamani LLC, listing his group practice name as Landmark Dental.  In May 2009, Zamani submitted an application with the DSS for a Medicaid provider number for Landmark Dental. In the applications Zamani submitted, he failed to disclose that Anusavice had an ownership or control interest in Landmark Dental, even though Zamani knew that Anusavice was running the practice and profited from it. From approximately February 2009 to March 2011, Mehran Zamani LLC and Landmark Dental received more than $12.9 million in Medicaid reimbursement payments.
The government alleges in April 2009, Zamani and “Haven Consulting,” an entity Anusavice created, entered into a contract for the Dental Group of Stamford, a practice that Zamani had operated previously. Although the contract provided that Haven Consulting was a “business consultant” to the Dental Group of Stamford, Anusavice had an ownership interest in the practice and acted in an ownership and managerial capacity. From approximately June 2009 to March 2011, the Dental Group of Stamford received more than $4.4 million in Medicaid reimbursement payments.
The case also states that Zamani’s April 2010 DSS application for a Medicaid provider number for the Dental Group of Connecticut also failed to disclose ANUSAVICE’s involvement in the practice.  From approximately August 2010 to March 2011, the Dental Group of Connecticut received more than $3.5 million in Medicaid reimbursement payments.
In total, it is alleged that the Anusavice-Zamani entities collectively received nearly $21 million in Medicaid reimbursement funds. Further, according to Zamani’s accountant’s records, between February 2009 and March 2011, Anusavice-controlled entities received more than $3 million in payments from Zamani-related entities.
Anusavice and another dentist are also accused of operating a new set of dental clinics doing business as Alpha Dental Group in Cromwell, Conn., Dental Group of New Britain, Conn., and Hartford (Conn.) Dental Care. Between November 2011 and March 2012, Arbor Dental has received more than $2.6 million in Medicaid funds. Anusavice also has recently reopened a dental practice at the former location of Dental Care of Connecticut in Trumbull.

Friday, May 18, 2012

Bloomberg's story about private equity and dental abuses has legs

The Bloomberg story has really struck a nerve (I'm sure the bad guys will be complaining that the press is engaged in over-treatment and excessive coverage--well, at least you aren't strapped down in a papoose board as the press sheds some sunlight on harm being caused to kids).  It will be interesting to see which dentists with a conscience and a spine will step up and blow the whistle.  

I've re-posted some of the comments to the Bloomberg story below.

The story was also linked at these sites:

Comments posted on Bloomberg's site:
I practiced dentistry for the better part of 25 years as a dedicated, post grad educated dental hygienist.  The rationalized fraud at all levels was astonishing--and is massive.  Private practice, public health dentistry... it's all the same.  Finally, I could not stomach the unethical behavior any longer, and retired to work in health education.  The dental profession rips off its employees, overcharges patients regularly, uses "fear" words to pressure patients into accepting questionable treatment.  If as an auxiliary you do not go along with the "selling" of the treatment plan, the dentist gets rid of you.  There is plenty of need in the community, appallingly so, but organized dentistry is, believe me, all about the money.
As a physician, I can barely count the egregious breaches of practice standards enumerated here.  Can you say "malpractice" (violation of the standard of care)?  How about assault (physical harm without consent)?  I graduated with debts and still recall what an instructor told me, "be honest, do good, communicate with the patient; the income will follow".  Words to live by, they've served me well.
So long as there are lightly (or none at all) monitored government (or corporate) coverage programs, abuse will follow.  Student debt is not a factor here; greed is.  Licensing has a purpose, one of which is to protect the public from harm from practitioners like these.  Just because one in two Americans has unmet dental needs, doesn't excuse these types of actions in the name of public health.  I'd say shame on them, but it is obvious they have no shame. 

It doesn't sound like appropriate treatment even with consent.  I am sure that parents even, if poor, don't intend to have their children held down in pain while they have teeth pulled.  If that were my child, I would be absolutely livid.  My children don't need medical care of any kind in a school setting.  I take them to the doctor or dentist as needed or recommended.  For those who can't afford to take their children in, I can understand, but they should still be present to ensure that propper care is taken.  Lesson learned, if my children have any event like this at school, I will be keeping them home to avoid any confusion.
Govt. funded healthcare (Medicaid) = minimal oversight.  For-profit insurers have virtually nil provider fraud, since they are reluctant to pay for anything at all.
This country is slipping into chaos.

Thursday, May 17, 2012

Dental Abuse Seen Driven by Private Equity Investments

Click here for a great article by Bloomberg discussing how private equity firms have moved big time into the Medicaid market.  We've seen horrendous abuses.  Patients suffer, taxpayers are ripped off, and, if the average dentist doesn't wake up, the profession will be ruined (the quaint days of a dentist owning his own shop will be over unless the unlawful corporate practice of medicine is stopped).

Below is an excerpt.
Isaac Gagnon stepped off the school bus sobbing last October and opened his mouth to show his mother where it hurt.  She saw steel crowns on two of the 4-year-old’s back teeth. A dentist’s statement in his backpack showed he had received two pulpotomies, or baby root canals, along with the crowns and 10 X-rays -- all while he was at school. Isaac, who suffers from seizures from a brain injury in infancy, didn’t need the work, according to his mother, Stacey Gagnon.

“I was absolutely horrified,” said Gagnon, of Camp Verde, Arizona. “I never gave them permission to drill into my son’s mouth. They did it for profit.”
Isaac’s case and others like it are under scrutiny by federal lawmakers and state regulators trying to determine whether a popular business model fueled by Wall Street money is soaking taxpayers and having a malign influence on dentistry.
Here is a chart that ran with the story:

Medicaid's Dental Boom

Friday, May 4, 2012

Sen. Grassley blows the whislte on the IRS Whistleblower Program

Sen. Grassley calls out the IRS Whistleblower Program.  See his scathing letter below.  When the program was enacted in 2007, we had high hopes that the program would protect honest taxpayers and go after tax cheats.  But the program has been a miserable failure. 

Tuesday, May 1, 2012

Back to blogging

Thanks for all the emails.  I was wrapped up in a case but will start blogging again starting today.  Over the next few weeks I will focus on Medicaid fraud and violations of the FCPA.