• Dental Medicaid,  Dentistry

    Texas Attorney General Files Suit Over Dental Medicaid Fraud

    A Texas television station has been investigating fraud in the Texas Dental Medicaid Program for over a year. Their investigations have culminated in the Texas Attorney General filing suit against the dentists and corporate entities involved.

    A year-long WFAA investigation into questionable Medicaid dental payments has resulted in the Texas Attorney General filing lawsuits this week.

    Greg Abbott charges that a Dallas dentist and his corporate entities bilked taxpayers out of millions for fraudulent orthodontic work on poor families.

    Dallas dentist Richard Malouf amassed a multi-million dollar mansion, corporate jets and luxury vehicles through his dentistry, News 8 has found.

    He and his former firm, All Smiles, declared bankruptcy following a series of reports detailing how he and other dentists around Texas gamed the welfare system by billing for unnecessary dental work.

    WFAA found that over the past few years, Texas has paid out more in Medicaid orthodontic claims than all other 49 states combined.

    All Smiles billed Medicaid for at least $15 million over two years, which is twice as much as the entire state of Illinois. The Attorney General’s lawsuits, filed in Austin Monday, seek to recoup “two times the amount of the overpayments.”

    WFAA’s findings have spurred outrage among lawmakers and hearings in Austin and Washington D.C.Madelayne Castillo, a former All Smiles employee, and Dallas orthodontist Dr. Christine Ellis filed separate whistleblower lawsuits in April and May alleging fraud by Malouf and his corporations.

    Both lawsuits remained sealed while the Attorney General’s office investigated the claims. On Monday, Abbott’s office joined those lawsuits by refiling them in the state’s name.

    Here is the video report – embedded below:

    Stay tuned as these cases move forward and the feds open fresh investigations into the dental Medicaid industry.

    Certainly, this will NOT be good for the dentistry profession.

    The fallout will be massive, I predict and may very well change how dental Medicaid patients are treated.

  • Dentistry

    Washington Dental Service’s CEO James Dwyer Apologizes for Calling Dentists Not Working Hard Enough

    Washington Dental Service’s (WDS) CEO James Dwyer in an interview in which he said Washington State dentists’ do not work hard enough

    I think James Dwyer will lose his cushy job over this Flap.

    The CEO of the state’s largest dental insurer offered an apology to the more than 4,000 dentists in his dental plan’s network.

    “I can certainly understand my comments have upset some member dentists,” said James Dwyer in a post on Washington Dental Service’s Facebook page.

    The apology was posted the day after a KING 5 Investigators report about rising executive salaries at Washington Dental Service in the face of deep cutbacks that affect nearly every dentist in the state. Washington Dental Services cut the reimbursement fees it pays to dentists by 15 percent last year for all procedures.

    Dwyer, who earns $1.2 million a year, suggested that dentists could make up revenue by working harder. “Number one, they could start working five days a week,” said the CEO.

    The comment touched off an angry reaction from dentists on blogs, Facebook posts, and in emails to KING 5 News.

    It’s a “slap to the face of a recent graduate working over five days/week (including five clinical days) and barely making ends meet,” said one Facebook post.

    The Washington State Dental Association called the Dwyer’s comment “outrageous and disrespectful.” Click here to read their full statement.

    Here is the video in which Dwyer made his comments:


    Here is Dwyer’s apology in full on Facebook:

    Message from Jim Dwyer, CEO: You may have seen the KING TV news report on May 10, 2012 about Washington Dental Service. I can certainly understand that my comments may have upset some member dentists. Please know that the clips of me were taken from a highly edited interview. Working more hours is one of many strategies dentists are employing to cope with a changing market place and the depressed economy. I respect and value our member dentists, and I know they are dedicated to providing quality care for their patients. I apologize for the context of the statement. Jim Dwyer

    But, is his apology enough, particularly in light of his $1.2 million annual salary made on the backs of Washington dentists?

    I would not be surprised if there is a resignation coming shortly for these grossly out of touch comments.

    Here is the original video that started the Flap:

  • Dentistry,  Pinboard Links,  The Morning Flap

    The Morning Flap: May 18, 2012

    These are my links for May 17th through May 18th:

    • Dental Abuse Seen Driven by Private Equity Investments – 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. Isaac’s dentist was dispatched to his school by ReachOut Healthcare America, a dental management services company that’s in the portfolio of Morgan Stanley Private Equity, operates in 22 states and has dealt with 1.5 million patients. Management companies are at the center of a U.S. Senate inquiry, and audits, investigations and civil actions in six states over allegations of unnecessary procedures, low-quality treatment and the unlicensed practice of dentistry.

    • Democrats look to California in bid to retake House– No state figures more prominently in Democratic plans to retake the House than bright blue California.With 25 seats separating them from the speaker’s gavel, Democrats have settled on a blueprint targeting nearly a dozen seats across the Golden State — a yawning figure that highlights the emphasis party officials have placed there.
    • Exit, stage Wright– Yesterday’s breathless campaign hysteria arose out of a not-really-much-of-a-scoop from the broadsheet across town: A rich guy in Omaha wants to spend a lot of money defeating Barack Obama.Stop the presses. Eek.Said rich guy sought the advice of a controversial consultant (who’d very much benefit from getting the rich guy’s commission) on a strategy. The consultant proposed reviving the 2008 controversy over Obama’s relationship with his egregious pastor, Jeremiah Wright.

      You’d have thought, from the mainstream-media tweets yesterday morning, that the mere act of mentioning Obama and Wright in the same breath was nothing less than a hate crime in itself. How dare anyone mention the president in the same breath as the anti-American demagogue who officiated at his wedding, baptized his children and gave him the title of his second book.

      For those of us who enjoy seeing such folk sputter and squirm, the idea of a Wright attack against Obama instantly seemed rather piquant. But it only took a moment’s reflection to see how senseless and even stupid such an approach would be.

    • Hewlett-Packard to Cut About 30,000 Jobs – NYTimes.com – RT @TomBevanRCP: Ouch: HP to cut 30,000 jobs.
    • Ricketts’ aide: Jeremiah Wright plan was DOA– The head of the Super PAC that considered a proposal to attack the president based on his associations with controversial preacher Reverend Wright said Friday that the pitch was a non-starter.“I was immediately troubled by the proposal. It surprised me,” Brian Baker, president of Ending Spending Action Fund funded by billionaire Joe Ricketts, said on MSNBC’s “Morning Joe.” “We run an organization based on fiscal responsibility. They know we asked for a document based on ending spending, fiscal responsibility and jobs in the economy. This is far afield from that.”
    • Mark Zuckerberg will ring NASDAQ opening bell this morning, on Facebook’s IPO day | The Verge – RT @verge: Mark Zuckerberg will ring NASDAQ opening bell this morning, on Facebook’s IPO day
    • Romney Launches First General Election Ad– Mitt Romney’s campaign is out with its first television ad of the general election, describing what a Romney presidency would look like on “day one.”The spot will be launched in four swing-states –Ohio, North Carolina, Iowa and Virginia — with a $1.2 million buy, CNN reports.A generally positive ad, the narrator outlines different Romney initiatives that he would launch from the start of his time in office, which include approving the Keystone XL pipeline and replacing President Obama’s heath care reform legislation.
    • Race issues return with Rev. Jeremiah Wright – Race issues return with Rev. Jeremiah Wright
    • Herman Cain: Jeremiah Wright is ‘fair game’ – Herman Cain: Jeremiah Wright is ‘fair game’
    • Flap’s Blog – FullosseousFlap’s Dental Blog » @Flap Twitter Updates for 2012-05-18 – @Flap Twitter Updates for 2012-05-18
    • Flap’s Blog – FullosseousFlap’s Dental Blog » Michael Ramirez on Fast and Furious – Michael Ramirez on Fast and Furious
    • Flap’s Dentistry Blog: The Daily Extraction: May 17, 2012 – The Daily Extraction: May 17, 2012
    • Explaining Why Minority Births Now Outnumber White Births | Pew Social & Demographic Trends– The changing profile of the nation’s youngest residents also stems from the fact that some groups, especially Hispanics, have higher numbers of children than do non-Hispanic whites. One illustration of this difference is in the “total fertility rate,” or the number of children the average woman is predicted to have in her lifetime, based on current age-specific birth rates. For the U.S. as a whole, according to a Pew Research Center analysis of American Community Survey data, the number is 2.0. (American Community Survey data in this posting come from a Pew Research Center analysis of the 1% sample of the 2010 ACS Integrated Public Use Microdata Series [IPUMS])Among Hispanics, the total fertility rate is 2.4. For non-Hispanic whites and for non-Hispanic Asians, it is 1.8. Non-Hispanic blacks (2.1) have higher fertility than whites but lower fertility than Hispanics.Immigration is an important contributor to higher birth rates among Hispanics, because foreign-born women tend to have more children on average than U.S.-born women. Most growth in the Hispanic population from 2000 to 2010 was due to births, not immigration, a change from the long-time pattern. But most births to Hispanic women are to those born outside the U.S.
    • Flapsblog Posts / Born in Kenya, eh???? – Born in Kenya, eh????
    • Flap’s Blog – FullosseousFlap’s Dental Blog » The Morning Flap: May 17, 2012 – The Morning Flap: May 17, 2012
    • Flap’s Blog – FullosseousFlap’s Dental Blog » Gallup: U.S. Unemployment Decreases Slightly to 8.2% – Gallup: U.S. Unemployment Decreases Slightly to 8.2%
    • Capitol Alert: Latinos will soon be California’s largest ethnic group, Census says – Latinos will soon be California’s largest ethnic group, Census says
    • Latinos will soon be California’s largest ethnic group, Census says– Latinos will become California’s largest ethnic group very soon, a new Census Bureau report indicates.The bureau issued its first post-2000 census estimates of population growth, birth rates, age cohorts, and racial and ethnic characteristics.It pegs California’s Latino population (it uses the term “Hispanic”) at 14.4 million, 38.2 percent of the state’s 37.7 million residents, while the non-Hispanic white population is just under 15 million or 39.7 percent, dropping below the 40 percent mark for the first time.

      For several years, demographers have predicted that the state’s Latino population would surpass whites by 2015, but the new Census Bureau reports indicates that the crossover may occur somewhat sooner.

      Although immigration from Latin America has slowed to almost a stop, other findings indicate, Latinos tend to be younger than the white population and have much-higher birthrate, thus expanding their population while that of whites continues to shrink..

    • USC sued in deaths of 2 students– A wrongful death suit has been filed against USC by the parents of two USC graduate students slain near the campus on April 11.Wanzhi Qu and Xiaohong Fei, father and mother of Ming Qu, and Xiyong Wu and Meinan Yin, parents of Ying Wu, filed the suit Wednesday in Los Angeles Superior Court. They are seeking unspecified damages.Wu and Qu, both 23-year-old electrical engineering students from China, were fatally shot during a downpour about 1 a.m. while sitting in Qu’s recently purchased 2003 BMW, which was double-parked in the 2700 block of Raymond Avenue.

      Wu was found in the passenger seat and Qu on the steps of a nearby house where he collapsed while trying to summon help, Los Angeles police said.

      USC attorney Debra Wong Yang today issued a statement in response to the suit.

    • Flap’s Dentistry Blog: The Morning Drill: May 17, 2012 – The Morning Drill: May 17, 2012
    • Flap’s Blog – FullosseousFlap’s Dental Blog » Day By Day May 17, 2012 – Boom Boom – Day By Day May 17, 2012 – Boom Boom
  • Bill Dorfman,  Dentistry

    Extreme Makeover Dentist Bill Dorfman Secretly Collecting the Teeth of Celebrity Patients

    Dr. Bill Dorfman (Photo: TMZ)

    Kind of extreme, no?

    Dr. Bill Dorfman — a world famous dentist who treats some of the biggest stars on Earth — tells TMZ he keeps a “secret stash” of the teeth he’s plucked from the mouths of his famous patients … in the hopes of eventually selling them on eBay.

    Dorfman — who recently treated Lindsay Lohan and whose website features Jessica Simpson, Usher, Ozzy Osbourne, Anne Hathaway and Eva Longoria — was outside Rock & Brews in El Segundo yesterday when he revealed his secret.

    “I actually save famous people’s teeth when I pull them … but I can’t tell you [their identities] ’cause it’s like patient confidentiality.”

    He continues, “There have been a few really famous people and I thought one day maybe I could sell this on eBay.”

    Dorfman insists he always offers the teeth to his patients first … but they often decline, “So I put it in the back and i just hold on to it.”

    Is it sick, like one dentist said in the piece on TMZ?

    No, probably not. Dentists often keep the extracted teeth of patients and dispose of them, usually in their medical waste containers. There is no harm, keeping them – as is routinely done prior to transport.

    But, I certainly think the revenue should be donated to charity. Didn’t John Lennon’s tooth fetch a pretty penny?

    I am sure Dr. Dorfman will do so, especially after receiving this PR.

    Here is the video report from TMZ:

  • Dentistry,  Medicaid,  Texas

    Texas and the Feds Take Action on Orthodontic Medicaid Fraud

    Texas Dental Medicaid Office

    About damn time.

    A Dallas dentist has agreed to pay the state and federal government $1.2 million to resolve allegations that he submitted false orthodontic claims under Medicaid.

    Dr. Richard Malouf, former majority owner of All Smiles Dental Center, allegedly submitted false Medicaid claims between 2004 and 2007.

    News 8 reported on Malouf’s lavish homes and two multimillion dollar corporate jets. Malouf did not admit any wrongdoing or liability in his settlement.

    He is one of several orthodontists highlighted for multimillion dollar billings under Medicaid.

    Eleven dental operations statewide have had their state funds suspended for credible allegations of fraud in billing the Texas Medicaid Orthodontics program. This follows a 10-month News 8 investigation of medicaid orthodontics in Texas, which found the state spends more on braces for poor children than the rest of the nation combined.

    Watch the video embedded below for more on the story.

    Of course, there will be some money paid back to the State of Texas and the federal government. Some bureaucrats will be scolded or fired. Maybe a dentist or two will have their dental license suspended for a while.

    But, the total lack of oversight in this program is an example of what happens when government involves itself too much into health care. There is vast unaccountable waste, abuse and fraud.

    On the second anniversary of the passage of the Affordable Care Act or ObamaCare, one has to wonder what will happen in the future with the public purse should the United States Supreme Court rule the law is constitutional

  • Dentistry,  Methamphetamine

    Stratfor on Methamphetamine Production in Mexico

    Meth Mouth – the effect of Methamphetamine use

    Stratfor has an excellent piece on the production of methamphetamine in Mexico and Central America, production techniques and precursor chemicals.

    Based on evidence obtained from raided laboratories in the United States and Mexico, it appears there are two primary methods of methamphetamine production in those countries: the phenyl-2-propanone (P2P) method and the reduction method.

    Sometimes referred to as “building up,” P2P is considered the more difficult of the two methods. It requires more chemicals and materials and more sophisticated chemistry. In fact, the chemical process is so technical and complex that it requires several days to complete, necessitating a skillset akin to that of licit chemists. It also entails a purification step that increases the potency of the final product. While P2P produces a more potent final product, the method is subject to the competence of the manufacturers and the quality of the chemicals being used. P2P is the method most employed by Mexican criminal organizations because its two primary requisite precursor chemicals, methylamine and phenyl acetic acid, are loosely regulated in Mexico.

    Reduction is the manufacturing method primarily used in Asia and the United States. This method involves mixing ephedrine or pseudoephedrine with a few easily attainable precursor chemicals. With reduction, a manufacturer can cook a small volume of meth (a few ounces) in as few as eight hours. Indeed, the key difference between the manufacturing methods is that reduction requires less time and less sophistication than P2P, and ultimately it produces an inferior product.

    It should be noted that the manufacturing method has nothing to do with production scale. Either method can be used to cook large or small quantities of the drug. It can be manufactured in a hotel, apartment, home, car trunk or backpack. However, to produce meth on an industrial scale, a manufacturer would need more space. Past seizures have taken place in large warehouses (around 1,600 square meters, or 17,000 square feet), small ranches (6-40 hectares, or 15-100 acres) or even mid-sized homes.

    Cost of production also differentiates the two methods. While meth is more cheaply rendered by reduction, both methods are extremely cost effective. Depending on the price of chemicals used — determined by the quantity of chemicals purchased and the legitimacy of the supplier — the cost of manufacturing 1 kilogram (2.2 pounds) of meth comes to anywhere between $150 and $4,000. The use of methylamine, which is highly regulated, expensive and, as stated, only used in the P2P method, is the key factor in this price range; substituting methylamine with a mixture of methanol and anhydrous ammonia drastically reduces the cost. According to the U.S. Department of Justice’s National Illicit Drug Prices Mid-Year 2009 report, the wholesale market price for meth is $19,720 per kilogram while its street value is $87,717 per kilogram. Needless to say, this is a huge markup.

    But it is not necessarily the overall cost that determines the production method of Mexican criminal organizations, or any meth manufacturer. Rather, it is the availability of precursor chemicals that matters. Mexican manufacturers could save vast sums of money by exclusively using the cheaper reduction method. But the Mexican government’s strict regulation of ephedrine and pseudoephedrine compels criminal organizations to use other methods, such as P2P, that require less-regulated precursor chemicals.

    Read all of the report and then you can watch this video on the effects of methamphetamine on the mouth. The American Dental Association authored the video.

  • Dentistry,  Methamphetamine

    Does Saliva Quality Play an Important Role in Meth Mouth?

    The effects of Methamphetamine on the Teeth – Meth Mouth

    Perhaps, according to a new study. Here is the abstract.

    Methamphetamine abuse and oral health: A pilot study of “meth mouth”

    Michele C. Ravenel, DMD/Carlos F. Salinas, DDS/Nicole M. Marlow, MS/Elizabeth H. Slate, PhD/Zachary P. Evans, PhD/Peter M. Miller, PhD

    Abuse of methamphetamine (meth), a potent central nervous system stimulant, has been associated with significant dental disease. Current descriptions of “meth mouth” are limited in their scope and fail to illuminate the potential pathogenic mechanisms of meth for oral disease. The purpose of this pilot study was to characterize the oral health of subjects with a history of meth abuse as compared to nonabusing control subjects. A total of 28 meth abusers and 16 control subjects were enrolled. Interviews and surveys regarding meth abuse, dental history, oral hygiene, and diet were collected. A comprehensive oral cavity examination including salivary characterization was completed. We observed significantly higher rates of decayed surfaces, missing teeth, tooth wear, plaque, and calculus among meth abusers. No significant difference in salivary flow rates were noted, yet results showed significant trends for lower pH and decreased buffering capacity. These findings suggest that salivary quality may play a more important role in meth mouth than previously considered. Salivary analysis may be useful when managing a dental patient with history of methamphetamine abuse. (Quintessence Int 2012;43:229–237)

    So, what causes Meth Mouth?

    Dr. Bicuspid has an excellent post here.

    The ADA lists the suspected causes as dry mouth, poor oral hygiene, frequent consumption of sugary and carbonated drinks, tooth grinding and clenching, and possibly the acidic nature of MA itself.

    In a study in ISRN Dentistry (June 26, 2011), street samples of MA had pH levels from 3.02 to 7.03, with 72% of samples below the critical pH point of 5.6, i.e. able to cause significant damage to tooth enamel if abused by a route that brings MA into contact with the oral cavity.

    Although this would seem to indicate that injecting MA rather than smoking or snorting it may lead to less enamel damage, this hasn’t been borne out by the research. Researchers at the University of California, Los Angeles (UCLA) reported in the Journal of the American Dental Association that, among abusers of MA, IV users actually had a higher prevalence of oral disease and missing teeth than those who smoked MA, probably due to more advanced addiction and greater self-neglect.

    “Those who use MA may make the transition from noninjecting drug use to injecting drug use, as their dependence on MA becomes more severe,” Vivek Shetty, DDS, DMD, professor of oral and maxillofacial surgery at the UCLA School of Dentistry and lead author on the JADA study (March 2010, Vol. 141:3, pp. 307-318), told DrBicuspid.com.

    “The injected substance has almost 100% bioavailability, and the onset of the drug high is fairly rapid, generally 15 to 30 seconds.”

    It is interesting that IV Meth users have more dental disease than those that smoke the drug. One would think that the constant heat and dehydration of the oral tissues would contribute to more dental destruction. But, perhaps, the more intense rush from IV drug use leads to more self-neglect.

    In any case, salivary analysis of patients may give dentists a better idea of the mechanism of addiction and how to combat it at an early stage.

    Watch below an embedded video below from a dentist colleague, Dr. Mitchell A. Goodis, DDS in Northern California and his interview of the many methamphetamine user patients, whom he has treated.

  • Dentistry,  Medicaid

    Recruiters Solicit Young Patients for Texas Medicaid Dentists Outside Food Stamp Offices

    Texas Dental Medicaid Office

    Welfare dentistry medicaid is big business in Texas. And, while it violates Texas state law, recruiters are actively seeking young patients for Texas dentists at Food Stamp Offices.

    Thousands of kids get free dental care under Medicaid in Texas. Texas taxpayers foot the bill, including putting crowns on the teeth of toddlers who don’t yet have their permanent teeth.

    A News 8 investigation finds that some dentists want that Medicaid business so badly, they hire recruiters to bring in patients.

    At a Texas Health and Human Services Office on Masters Road near Dallas, a man quietly stands in the parking lot, waiting for mothers who’ve just received food stamps to emerge from the waiting room.

    He is a recruiter. He’s handing out cards for Happy Teeth Dental, just two doors down in the same complex.

    At another HHS office across town, two women also wait for new food stamp recipients. They’re handing out cards for Lancaster Dental a few miles away.

    And at another HHS office just up the road, Bear Creek Family Dentistry has a small kiosk set up to recruit new patients.

    Medicaid parents are regularly solicited by dentists offering free stuff — such as iPods, zoo tickets, and electric toothbrushes — if they take their kids to certain dentists.

    It is a little-seen side of Medicaid dentistry, a $1.5 billion business in Texas, where, statistics show, welfare and unregulated free enterprise come together like nowhere else in the United States.

    Watch the video expose which is embedded below:

    All I can say is wow!

    There needs to be some action on the part of the Texas Dental Board to enforce the anti-solicitation law and from the Feds to cut off the spigot of taxpayer money flowing to these dentists.

    I know the United States Senate is investigating dentistry medicaid across the country. But, the abuses are rampant and this is before new federal funds will be doled out under ObamaCare’s Affordable Care Act.

    Hold on to your wallets taxpayers!