Federal Agents Arrest Two Dentists in Medicaid Fraud

Landmark Dental operated by dentist, Mehran Zamani

Feds arrest two, raid dental firms in $20 million fraud case

Federal agents arrested a dentist and a former dentist, and raided offices in Trumbull and New Britain as they continued to investigate fraud allegedly committed in practices throughout the state that bilked Medicaid out of a reported $20 million.

Arrested were Mehran Zamani, a 47-year-old dentist from Pound Ridge, N.J., who practiced in Trumbull, Stamford and West Haven, and Gary F. Anusavice, a former dentist from North Kingstown, R.I., who oversaw the practices. Both were charged with conspiring to commit Medicaid fraud.

Anusavice, convicted in 1997 for submitting false health care claims in Massachusetts, was permanently barred by the U.S. Department of Health and Human Services from participating in federal and state health care programs. In November 2005, he lost his rights to practice dentistry in Rhode Island and Massachusetts.

Federal authorities claim, however, that Anusavice created several dental firms in Connecticut using other dentists, including Zamani, to operate them.

Zamani was involved in Dental Group of Connecticut in Trumbull, Dental Group of Stamford and Landmark Dental in West Haven. Court papers said Anusavice reviewed patient charts, suggested dental procedures, reviewed billing records and income reports, interviewed and hired dentists and helped manage these offices.

The prosecution claims Anusavice hired Zamani in October 2008 and allowed him to operate the businesses here. Zamani then filed the various applications necessary to obtain Medicaid reimbursements. He failed to disclose Anusavice's involvement in the businesses on any of the applications.

Of course, everyone is due their day in court, but it looks like Club Fed for these dentists and/or former dentists.

Here is a video of a practice operated by Mehran Zamani which was earlier closed:

9 dental offices closed in CT: wtnh.com

Texas Dentists Plead Guilty to Medicaid Fraud

Orthogenesis International Centre

Texas Medicaid dentist Dr. Carlos Armin Morales-Ryan and his wife, orthodontist Dr. Nelia Patricia Garcia-Morales have pleaded guilty to charges involving Texas dental Medicaid.

Local dentist Dr. Carlos Armin Morales-Ryan, 45, and his wife, local orthodontist Dr. Nelia Patricia Garcia-Morales, 42, have pleaded guilty to a criminal information admitting they made false statements on bills to Texas Medicaid, United States Attorney Kenneth Magidson announced today.

Morales-Ryan and Garcia-Morales owned and operated Orthogenesis International Centre, a Laredo dentistry and orthodontics business, and a substantial portion of their business was targeted to rendering services to Medicaid-eligible children. Applicable Texas law and Medicaid regulations required them to be in their offices when services were rendered on Medicaid patients as a prerequisite to receiving payment for the services from Medicaid. Similar consumer protection laws and regulations are applicable to most types of physicians for many of the services they render in Texas, regardless of whether the patient is or is not a Medicaid beneficiary.

Morales-Ryan’s signed plea agreement states that though he and Garcia-Morales were in Hawaii on or about October 12, 2007, he falsely represented to Medicaid that he performed an evaluation and management of a new patient on that date claiming entitlement to payment. However, at the time he made this false representation to Medicaid, he and Garcia-Morales knew the statement was false and that neither of them performed that service on or about that date. Similarly, Garcia-Morales admitted that though she and Morales-Ryan were en route to the U.S. Virgin Islands on March 23, 2007, she falsely represented to Medicaid that she performed an orthodontic retention on that date, claiming entitlement to payment. However, at the time she made this false representation to Medicaid, she and Morales-Ryan knew the statement was false and that neither of them performed an orthodontic retention on or about that date.

Texas Medicaid is a health care program funded in part by the federal government through payroll taxes and in part by the state of Texas.

As a result of their plea agreements, they will be sentenced to five years’ probation and will pay restitution in the amount of $686,545 to the Texas Health and Human Services Commission-Office of Inspector General.

Morales-Ryan currently is not licensed to practice dentistry in Texas due to an unrelated criminal proceeding.

A reminder to all dentists - bill for what you do and no more.

The federal government and the states will catch up with you - eventually.

The Morning Drill: March 13, 2012

Good Morning!

On to today's dentistry and health headlines:

Minn. Medicaid under fire for alleged overpayments

The federal government is investigating whether Minnesota is overpaying the nonprofit healthcare plans that administer its Medicaid programs.

The issue arose after UCare, one of the managed care plans that subcontracts with Medical Assistance (the state Medicaid program), unexpectedly returned to the state $30 million in excess reserves last year when lawmakers were facing huge deficits.

Three other managed care companies -- Blue Plus, Medica, and HealthPartners -- refused to make similar "donations," even though these plans had higher Medicaid operating margins than UCare in 2010, according to Allan Baumgarten, an independent research consultant and author of Minnesota Health Market Review.

In February, Minnesota Department of Human Services (DHS) Commissioner Lucinda Jesson told lawmakers that federal authorities had contacted her last summer about the investigation. But she could not say which federal agency was involved or the scope of their queries.

As part of the Medicaid program, UCare and the other managed care plans subcontract to four dental carriers, including Delta Dental of Minnesota, which administers the bulk of the state's Medicaid dental benefits. In January 2011 Jesson initiated 1% profit caps and competitive bidding for the health plans, but the possible effect this will have on the dental care subcontractors is yet to be determined.

Joe Lally, vice president for strategic planning at Delta Dental of Minnesota, which supports Medicaid dental services through Medica, Blue Plus, and Metropolitan Health Plan, noted that his company is not part of the federal investigation.

"It is not a risk arrangement; it's a self-insured arrangement," he told DrBicuspid.com. "We're simply paid for the services we provide in terms of getting the network together, processing claims, and providing customer service."

In addition to the federal investigation, Sen. Chuck Grassley (R-Iowa) has launched a separate inquiry into Minnesota's management of the Medical Assistance programs -- a $3.7 billion-a-year business for the health plans the state pays to manage care for public patients. Grassley has sent requests for information to the Minnesota DHS and officials in 49 other states.

Lally had heard from lawmakers that the investigation is likely focusing on the profits that the healthcare plans are making from public health programs.

Study: Too much red meat may shorten lifespan

Want to live longer? Trade some of the red meat in your diet for fish, nuts, whole grains, and other healthier protein sources, Harvard researchers say.

That's the conclusion of a new study, published this week in the Archives of Internal Medicine, that found that the risk of dying at an early age -- from heart disease, cancer, or any other cause—rises in step with red-meat consumption.

Eating too much red meat, which is high in saturated fat and cholesterol, has long been seen as unhealthy, especially for the heart. The new study, however, is the first to estimate the effect of swapping out red meat on a person's lifespan.

Using data from two long-running studies of health professionals, researchers tracked the diets of more than 121,000 middle-aged men and women for up to 28 years. Roughly 20% of the participants died during that period.

On average, each additional serving of red meat the participants ate per day was associated with a 13% higher risk of dying during the study. Processed red meat products -- such as hot dogs, bacon, and salami -- appeared to be even more dangerous: Each additional daily serving was associated with a 20% higher risk of dying.

Based on these findings, the researchers estimate that substituting one daily serving of red meat with fish, poultry, nuts, legumes, whole grains, or low-fat dairy products would reduce the risk of dying in this stage of life by 7% to 19%. If everyone in the study had slashed their average red-meat intake to less than half a serving per day, the researchers say, 9% of deaths among men and 8% of deaths among women could have been prevented.

Dentist indicted on drug charges

An Erin dentist has been indicted by a Houston County Grand Jury on charges of illegally prescribing controlled drugs.

Dr. John S. Paffrath, 56, of 71 East Market St., Erin, was charged in a four-count indictment handed down March 5, with unlawful dispensing of prescriptions. He works as a dentist at the Hillcrest Dental Clinic on East Main Street in Erin.

The Tennessee Bureau of Investigation opened a case on Paffrath in June of 2011 after being requested by the 23rd Judicial District Attorney General’s Office to investigate allegations against him, according to a TBI news release.

Between January 2011 and July 2011, Paffrath prescribed controlled drugs such as hydrocodone, oxycodone, xanax and valium to at least four patients without seeing them in his office. He prescribed the medications in quantities inconsistent with therapeutic necessity and for medical complaints outside his area of expertise, the release indicated.

Ex-state senator faces ethics probe over dental payment

Former state Sen. Cheryl Jacques is being accused by the state Ethics Commission of using her state position as an administrative law judge to pressure a dental office to reduce her brother-in-law's dentist bill.

The commission said conflict of interest laws prohibit state employees from using their positions to seek unwarranted privileges.

Jacques, who represented the Attleboro area when she was in the Legislature, is alleged to have threatened to report the dental office to the state Attorney General's Office and get it removed as a provider from the insurance company.

According to the commission:

"Jacques' brother-in-law received dental services from a dental office and received a bill for those services. Sometime in the fall of 2010, Jacques contacted the dental office on her brother-in-law's behalf, and spoke to the office staff and the owner of the office. She identified herself as a judge to the office receptionist, and as Judge Jacques to the owner. "She asserted that the dental office overcharged her brother-in-law for the services, and she demanded that the dental office write off the remaining balance of the bill, which was more than $1,000.

"Jacques claimed that the dental office had misled her brother-in-law because the dental office was not an in-network insurance provider under the brother-in-law's insurance plan. When the dental office owner offered to write off a few hundred dollars of the bill, Jacques insisted that the owner write off the entire remaining balance.

"When the owner refused, Jacques threatened to contact the insurance company to have the dental office removed as a plan provider, and also to report the dental office to the Consumer Protection Division of the Attorney General's Office."

The commission said it would schedule a hearing on the case within 90 days.

Enjoy your morning!

New Jersey Dentist Paresh Patel Accused of Medicaid Fraud in False Dental Records Submitted After a Fire

Paresh Patel, D.M.D.

I have been seeing a goodly number of cases of dentist Medicaid fraud lately. Here we have another.

A dentist for three children who were killed in a house fire here last month has been charged with fraud after the police say he gave them dental records that revealed a Medicaid scheme.

The Middlesex County prosecutor, Bruce J. Kaplan, said the dentist, Paresh Patel, owner of Healthy Smiles Dental Associates in Metuchen, was charged after he provided records that showed certain dental work had never been performed on the children, even though he had billed Medicaid for the work.

Dr. Patel has been practicing for 20 years and plans to enter a not-guilty plea during a court appearance, his lawyer, Lawrence Y. Bitterman, said.

Here is more on the story:

Police say a dentist who treated three of the children killed in a deadly house fire faces fraud charges for allegedly giving them bogus dental records.

Parish Patel faces falsifying dental records and obstruction charges for allegedly turning over fake dental records for three of the kids who died in the Feb. 23 blaze. He is also accused of insurance fraud for allegedly submitting at least five claims totaling more than $1,000.

Patel, 46, was charged after investigators tried to identify the children. Investigators say records Patel provided reflected certain dental work that had never been done. Investigators say the bogus records delayed the identification of the children.

Christopher Jefferson, 5, Tyler Davis, 7, and Alize Jefferson, 12, were the three children killed. Their grandmother Ann Jefferson, 62, and 2-year-old Elijah Taylor also died in the blaze.

Dentists - bill for what you do and don't for what you don't do.

It is as simple as that....

More Americans Seeking Dental Treatment at Hospital Emergency Rooms

(USA Today) While government-managed health care programs such as Medicaid pay for emergency room visits for adult enrollees seeking temporary relief from toothaches, tooth abscesses and other dental emergencies, coverage of outpatient dentist office treatment for those problems varies greatly from state to state, according to a 2011 federal Medicaid report. Federally mandated preventive and other dental care usually ends when Medicaid recipients enter early adulthood. That leaves states to determine whether they will provide dental benefits to adult Medicaid patients and if so, what type and how much. Ten states — Alabama, Arizona, California, Colorado, Delaware, Missouri, Texas, Utah, Virginia and Washington — offer no Medicaid dental benefits to adults, the report shows.

This has been a problem for some years now.

More Americans are turning to the emergency room for routine dental problems - a choice that often costs 10 times more than preventive care and offers far fewer treatment options than a dentist's office, according to an analysis of government data and dental research.

Most of those emergency visits involve trouble such as toothaches that could have been avoided with regular checkups but went untreated, in many cases because of a shortage of dentists, particularly those willing to treat Medicaid patients, the analysis said.

The number of ER visits nationwide for dental problems increased 16 percent from 2006 to 2009, and the report released Tuesday by the Pew Center on the States suggests the trend is continuing.

In Florida, for example, there were more than 115,000 ER dental visits in 2010, resulting in more than $88 million in charges. That included more than 40,000 Medicaid patients, a 40 percent increase from 2008.

Many ER dental visits involve the same patients seeking additional care. In Minnesota, nearly 20 percent of all dental-related ER visits are return trips, the analysis said.

That's because emergency rooms generally are not staffed by dentists. They can offer pain relief and medicine for infected gums but not much more for dental patients. And many patients are unable to find or afford follow-up treatment, so they end up back in the emergency room.

"Emergency rooms are really the canary in the coal mine. If people are showing up in the ER for dental care, then we've got big holes in the delivery of care," said Shelly Gehshan, director of Pew's children's dental campaign. "It's just like pouring money down a hole.

"It's the wrong service, in the wrong setting, at the wrong time," she said.

The center in Washington, D.C., is a division of the nonprofit Pew Charitable Trusts.

The fact is there needs to be a frank discussion as to who will pay for American's dental care.

There is no doubt that providing emergency treatment at a hospital for a bad tooth or a gum infection is not cost efficient. However, with many states facing insolvency and the federal government running massive deficits, how can the Medicaid system be changed to facilitate better care practices.

The Pew Charitable Trusts want to license mid-level dental practitioners to provide routine care. I hate to tell them but the costs to providing care to these folks will not be that marginally different than that provided by a licensed dentist. A new type of practitioner will not be the answer either short or long term.

Perhaps, the states could build and staff their own emergency dental centers?

But, as I said, many states face extreme budget challenges and who will decide if care is an emergency or not? Where will these centers be located, who will run them and what will eligibility for patients be?

There are many questions and no easy answers to this problem.

Then, there is the issue of personal responsibility for one's own dental condition.

Church Street Health Management Files for Bankruptcy

Another one of the corporate dental enterprises that supplies health management services for dentists has filed for bankruptcy.

Church Street Health Management LLC and four affiliates, providers of management services to 67 dental centers, filed for bankruptcy as part of a plan to sell the businesses.

The companies had assets valued at $895.3 million and debt of $303.4 million, according to Chapter 11 documents filed yesterday in U.S. Bankruptcy Court in Nashville, Tennessee, where Church Street is based.

A sale in bankruptcy is the “best option to maximize the value of the assets for stakeholders and to safeguard the welfare of the patients,” Martin McGahan, Church Street’s chief restructuring officer, said in court papers.

Affiliates Small Smiles Holding Co., Forba NY LLC, EEHC Inc. and Forba Services Inc. also sought court protection from creditors. Small Smiles is the parent of a group of companies that provide management services to dental centers serving low- income families in 22 states.

The 20 largest unsecured creditors are owed about $21.1 million, according to court documents. National Association of Medicaid Fraud Control Units is the largest, owed about $10.7 million for a settlement. Twelve state Medicaid Fraud Control units are collectively owed about $6.2 million.

And, good grief, look who are the largest creditors?

Medicaid Fraud Control Units which are the American taxpayers.

I know there are state and federal investigations being pursued against these health management companies that actually are sham dentistry practice owners - the sooner there is some sort of regulation the better - for the sake of the patients and Americans who are picking up the tab.

The Morning Drill: February 13, 2012

Good Monday morning!

On to today's dentistry and health headlines:

Dentist admits filing false Medicaid reports

Prominent Wilmington dentist Marieve Rodriguez admitted to 10 misdemeanor counts of filing false Medicaid reports today in exchange for state prosecutors dropping 19 felony counts of health care fraud.

In addition Rodriguez, who operates Gentle Care Family Dentistry on Gilpin Avenue, will pay a $100,000 fine, repay $72,000 to the state’s Medicaid program and $50,000 to cover the costs of prosecution.

She also agreed to have her license to practice medicine suspended for a year and to not participate in the state’s Medicaid program -- should she get her license back -- for at least five years.

By admitting to the 10 misdemeanor charges, Rodriguez faces up to 10 years in prison, but prosecutor Kathleen Vavala is only recommending one year of home confinement as part of the deal.

Judge John A. Parkins Jr. set sentencing for June 20.

Ill. man bilks Medicaid of $2M for erectile pumps

An Illinois man was sentenced Friday by a federal judge in Rhode Island to more than three years in prison for shipping unwanted penis enlargers to diabetes patients as part of a larger fraud scheme that prosecutors say bilked $2.2 million from Medicare over four years.

Gary Winner, 50, of Wheeling, Ill., must also forfeit more than $2.2 million that prosecutors say Medicare lost because of the plot.

U.S. District Court Judge William E. Smith also ordered Winner to pay a $12,500 fine and serve three years of supervised release following his prison sentence.

Lawyers for Winner had sought a maximum sentence of 1 ½ years. The guidelines for determining Winner’s punishment recommended he get a prison term between just under six years and a little more than seven years. Winner’s attorneys argued that punishment was too harsh, according to court papers.

Winner’s attorneys also asked that his emotional problems and difficult childhood, including physical and psychological abuse at his father’s hands, be taken into consideration, court papers show.

Prosecutors sought a prison term at the low end of the range that Winner was facing. He pleaded guilty in November to two counts of health care fraud, the introduction of an adulterated and misbranded medical device into interstate commerce and money laundering. He faced up to 33 years in prison.

California sets trends in health regulation

Beyond skateboards, Silicon Valley and hippies, California has a trendsetting streak of a different kind.

The state has been first to pass major public health initiatives that have spread throughout the country. California was first to require smog checks for clean air, pass anti-tobacco initiatives and bike helmets laws.

While these laws were met with skepticism and ridicule, they've often become standard practice in other states. The Golden State was first to ban smoking in workplaces, bars and restaurants in 1998. Now similar rules exist throughout the country.

Some advocates tout the state as a forward-thinking vanguard in which its health and safety laws are routinely emulated by other states.

"There have been progressive legislations in tobacco, environment and obesity prevention," said Mark Horton, a lecturer at the University of California Berkeley School of Public Health. "In some respect, the rest of the country looks to California as a laboratory for moving forward with those various types of initiatives."

But some critics liken the Golden State to a nanny state. California has 151,002 health and safety laws.

Alzheimer's Families Clamor for Drug

In the wake of research suggesting a skin-cancer drug may have benefits in treating Alzheimer's disease, physicians and advocacy groups are getting a flurry of calls from patients seeking to use the drug off-label.

The clamor underscores how urgently patients want solutions to the rising tide of Alzheimer's. But experts caution that more research is needed to determine whether the drug, bexarotene, is effective in humans at all, not to mention what the dosage should be.

The study, published Thursday in the journal Science, was conducted in mice, and the road to an effective Alzheimer's treatment is littered with failures that looked promising early on in animals.

"The Alzheimer's community is very desperate for anything that shows any sign of hope or promise," said Eric Hall, chief executive of the Alzheimer's Foundation of America, a New York-based advocacy organization that started to field calls from consumers as soon as the paper was published.

While Mr. Hall said he was "cautiously optimistic" about the drug, which appears to clear a sticky substance called amyloid from the brains of Alzheimer's mice, "I don't think people should be taking this in their own hands or running to it," he said.

Sam Gandy, a neurology professor at Mount Sinai School of Medicine and associate director of its Alzheimer's Disease Research Center, said he wasn't surprised to get inquiries from patients about bexarotene, as they also often ask for off-label use of another treatment on the market, intravenous immunoglobulin, which costs about $50,000 a year and is given in time-consuming infusions.

Enjoy your morning!

Update With Video: Dentist Who Used Paper Clips in Root Canals Receives a Year in Jail

Mass. AG: Dentist used paper clips in root canals: MyFoxBOSTON.com

This is just in: the paper clip during root canal treatment using dentist has been sentenced to a year in jail.

A mother is blasting the one-year jail sentence given to a former Massachusetts dentist who used paper clips instead of stainless steel posts in her son's root canal.

Brenda Almeida says she is very upset about the sentence imposed Monday on Dr. Michael Clair, who pleaded guilty earlier this month to a list of charges, including assault and battery and Medicaid fraud.

Almeida says her teenage son's tooth turned black and had to be removed after Clair performed the root canal.

Judge Richard Moses said he considered Clair's acceptance of responsibility and "certain mental health issues" Clair is dealing with in imposing the one-year sentence.

Prosecutors sought a sentence of five to seven years.

The 53-year-old Clair, who had a dental practice in Fall River, now lives in Crofton, Md.

We certainly hope this dentist receives the mental health treatment that he desperately needs while in jail.

Obviously, he will never practice dentistry again.

Update:

Here is former dentist Michael Clair being sentenced:

Dentist Who Used Paper Clips in Root Canals Receives a Year in Jail

Mass. AG: Dentist used paper clips in root canals: MyFoxBOSTON.com

This is just in: the paper clip during root canal treatment using dentist has been sentenced to a year in jail.

A mother is blasting the one-year jail sentence given to a former Massachusetts dentist who used paper clips instead of stainless steel posts in her son's root canal.

Brenda Almeida says she is very upset about the sentence imposed Monday on Dr. Michael Clair, who pleaded guilty earlier this month to a list of charges, including assault and battery and Medicaid fraud.

Almeida says her teenage son's tooth turned black and had to be removed after Clair performed the root canal.

Judge Richard Moses said he considered Clair's acceptance of responsibility and "certain mental health issues" Clair is dealing with in imposing the one-year sentence.

Prosecutors sought a sentence of five to seven years.

The 53-year-old Clair, who had a dental practice in Fall River, now lives in Crofton, Md.

We certainly hope this dentist receives the mental health treatment that he desperately needs while in jail.

Obviously, he will never practice dentistry again.

The Morning Drill: January 12, 2012

Good Morning!

On to today's dentistry and health headlines:

New toothpaste substitutes cocoa extract for fluoride

A New Orleans start-up has developed a toothpaste that uses a naturally occurring compound found in cocoa instead of fluoride to help strengthen teeth.

Theodent relies on Rennou, a proprietary blend of a cocoa extract and other minerals that work together to strengthen teeth. The extract is a white crystalline powder with a chemical makeup similar to caffeine, according to Arman Sadeghpour, PhD, Theodent president and CEO.

"Theodent is more effective at strengthening enamel than fluoride," he said in an interview with DrBicuspid.com. "More and more people are shying away from fluoride due to concerns about toxicity."

Theodent Classic ($9.99) hit store shelves at Whole Foods Markets last week. Theodent 300, an extra-strength and luxury version ($99.99) for supersensitive teeth, will be marketed to select cosmetic dentists and medical professionals, according to the company.

Indianapolis dentist faces Medicaid fraud charges

An Indianapolis dentist faces Medicaid fraud charges for allegedly billing the state for unnecessary dental work.

Arnel J. Gallanosa was charged Wednesday with 10 counts of Medicaid fraud, five counts of theft and three counts of conspiracy to commit Medicaid fraud. He declined to comment on the allegations.

A court affidavit alleges Gallanosa offered patients money for accepting free dental work, then billed Indiana's Medicaid program.

In one instance, Gallanosa allegedly paid a man who recruited three dental patients from an Indianapolis mental health facility. Prosecutors say the same day he removed 33 teeth from the three patients.

Marijuana Smoke Not as Damaging to Lungs as Cigarette Smoke, Study Suggests

Using marijuana carries legal risks, but the consequences of occasionally lighting up do not include long-term loss of lung function, according to a new study in the Jan. 11, 2012, issue of the Journal of the American Medical Association.

Marijuana is the most commonly used illicit drug in the United States, according to the National Survey on Drug Use and Health. In 2009, 16.7 million Americans ages 12 and older reported using marijuana at least once in the month prior to being surveyed. In addition, since 1996, 16 states and Washington, D.C., have legalized the medical use of marijuana to help manage the symptoms of many diseases, including cancer, AIDS and glaucoma.

"With marijuana use increasing and large numbers of people who have been and continue to be exposed, knowing whether it causes lasting damage to lung function is important for public-health messaging and medical use of marijuana," says the study's senior author, University of Alabama at Birmingham associate professor Stefan Kertesz, M.D.

Kertesz, of the UAB Division of Preventive Medicine and the Center for Surgical, Medical and Acute Care Research and Transitions at the Veterans Affairs Medical Center in Birmingham, says it's long been known that marijuana smoke has many irritant chemicals found in tobacco smoke and can cause lung irritation, wheezing and cough immediately after use; however, the research on long-term effects on lung function have inconsistencies.

Orange Juice Prices Are Climbing Because of a Contamination Fear

Orange juice concentrate futures are shooting up right now, thanks to news that traces of a fungicide banned in the United States was detected in juice from a brand the FDA didn't name. The Journal reports, "January-delivery orange juice on ICE Futures U.S. surged 9.3 percent to $2.12 per pound, the highest price since November 1977," which if we recall correctly from Trading Places, means someone should check on the Duke brothers. The chemical at the center of the orange juice price spike, called carbendazim, is used in Brazil, which exports to the United States, and while the amount found in the juice is miniscule at 35 parts per billion, news that the FDA would increase its testing sparked a market rally that has pushed up the price of orange juice concentrate to its highest level in more than 34 years.

Enjoy your morning!

The Morning Drill: December 13, 2011

Good Morning!

Medicaid fraud and the indictment of dentists/professional dental corporations for abusing the system have been increasing in the news lately. Today's first headline is just one example.

The Feds are taking an increasingly active role in prosecuting these cases. My advice to dentists is to tread lightly in these government programs. Should you not dot your I's and cross your T's, you could be confronted with a federal investigation into your financial affairs.

But, as far as those dentists who abuse the system and enrich themselves with our taxpayer money - hope you enjoy cuddling with your prison cell mate.

On to today's headlines:

Mass. dentist accused of $250K in Medicare fraud

SmileCenter, a dental office in Plymouth, MA, received at least $253,519 in unallowable reimbursements from MassHealth, the state's Medicaid program, according to the state auditor's office.

Most of the billing was for orthodontic services performed by a dentist who did not possess the required accreditation, State Auditor Suzanne Bump stated in a press release.

According to MassHealth regulations, dentists who practice orthodontics must complete a minimum of two years of training in a specialized program administered by the ADA.

SmileCenter's sole dentist, Christopher Freyermuth, DDS, who is also its sole proprietor, did not complete such a program, but still billed and received $201,509 from MassHealth for orthodontic services.

As a result of the investigation, MassHealth will terminate SmileCenter's specialty as an orthodontic practice, transfer its members for treatment to other dentists, and seek restitution, according to the state auditor.

The review of the $1.2 million SmileCenter received from MassHealth for dental services between 2007 and 2010 cited a pervasive pattern of excessive treatments, duplicative payments, and payments for services that were possibly never performed, officials said.

Dental X-rays predict fracture risk

A new study reveals that it is now possible to use dental X-rays to predict who is at risk of fractures.

Researchers at the University of Gothenburg's Sahlgrenska Academy reported in the journal Nature Reviews Endocrinology that it is possible to use dental X-rays to investigate the bone structure in the lower jaw, and so predict who is at greater risk of fractures in the future.

Lauren Lissner, a researcher at the Institute of Medicine at the Sahlgrenska Academy, said: 'We've seen that sparse bone structure in the lower jaw in mid-life is directly linked to the risk of fractures in other parts of the body, later in life.'

The study draws on data from the Prospective Population Study of Women in Gothenburg started in 1968.

Given that this has now been running for over 40 years, the material is 'globally unique'.

Teen dies after wisdom teeth surgery

Law enforcement is investigating after a 14-year-old boy died after having his wisdom teeth removed.

Ben Ellis underwent surgery Wednesday morning, and was found dead Thursday morning.

The Gilmer County Sheriff's Office and the Georgia Bureau of Investigation are looking into the cause of death.

Ben's family told the Sheriff's Office that he seemed fine on Wednesday after the surgery.

"He had dental surgery at approximately 10:30 Wednesday morning. Through the rest of the day he seemed to be doing fine. He went to bed. Through the day he had taken one penicillin tablet and one Oxycodone, that we're aware of. They (his parents) checked on him around 1 .a.m., and again, he was doing fine. Then at 6 a.m., when they went to get him up, they found him deceased," Lt. Frank Coleman said.

Ben was a freshman at Gilmer County High School and the youngest of four Ellis children to attend the school.

The school's bulletin board was covered with messages of condolence on Friday after students were notified of his death.

Hope for Hemophiliacs: Gene Therapy Stops the Bleeding

Hemophilia is a rare blood-clotting disease famously known for afflicting the royal families throughout Europe. One type, Hemophilia B, also called Christmas disease after Stephen Christmas, the first patient described with it, is caused by a defect in the eponymous gene on the X chromosome that leads to less than 1 percent of normal expression of Factor IX (FIX), an important blood clotting factor. Hence patients, who are usually male because they only have one X chromosome, require regular intravenous transfusions of Factor IX to prevent internal bleeding, or hemorrhage. These injections cost an individual patient about $300,000 a year, which may add up to around $20 million over a lifetime.

That may soon change due to a “landmark” study published this weekend in the New England Journal of Medicine. An international research team led by scientists at the University College London successfully used gene therapy (adeno-associated viral vectors) to replace the defective or missing copy of the FIX gene in a small cohort of patients, prompting the New York Times to write that Hemophilia B may be “the first well-known disease to appear treatable by gene therapy, a technique with a 20-year record of almost unbroken failure.” The viral vector used by the team inserted the replacement gene into the liver cells of the hemophiliac patients, carefully avoiding the chromosomes to reduce the risk of inducing cancerous mutations, and induced physiologically relevant expression of the coagulation factor up to 22 months post-therapy.

Enjoy your morning!

The Morning Drill: December 7, 2011

Santa Monica, California

Good Morning.

Getting a later start this morning here in California, so on to day's dentistry and health headlines:

La. Medicaid reimburses physicians for fluoride varnish

Effective December 1, the Louisiana Medicaid program is now reimbursing physicians for applying fluoride varnish twice each year to the teeth of Medicaid recipients between the ages of 6 months and 5 years.

Previously, Medicaid only covered this service when performed by a dental provider, according to the state Department of Health and Hospitals.

With the implementation of the updated fluoridation varnish policy, physicians, nurse practitioners, physician assistants, registered nurses, and licensed practical nurses will now be reimbursed for applying fluoride varnish.

Medicaid money runs out, and braces stay on

When you don't have much money, and receive medical and dental care at state expense, it's rare to complain.

Texas received only 712 complaints from Medicaid patients in the last year. But sometimes the quality of care becomes so questionable, patients speak up.

The case of a Garland girl points to some weaknesses in Medicaid Orthodontics, a program that's paid out hundreds of millions of dollars to Texas dentists in the last three years.
     
You can actually watch Anntornett Taylor grow up through her dental records, in the still photos taken of her when she visited her orthodontist.

Medicaid paid for her first set of braces when she was 12 years old. Now she is 21. She has had braces for nine years. And they are still on.
   
"It would be extremely unusual for a patient to be in braces for nine years," said Dr. Larry Tadlock, Associate Clinical Professor at Baylor College of Dentistry.

Prospect of new tax to cover expense of universal dental care

A DRAMATIC expansion in access to dental services, estimated to cost $9 billion over four years, has been proposed in a confidential report by a committee appointed by the government.

The report recommends that the Gillard government begin developing the first stages of a universal dental scheme next year with a view to scaling the scheme up in later years, taking account of the strains on the government's promise to deliver a surplus in the May budget.

The interim report, delivered recently to the government by the National Advisory Council on Dental Health, has called for priority to be given to ensuring dental treatment for young people and those on low incomes.
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It also raises the prospect that a new tax to fund a full-scale public dental scheme may be necessary, stating that ''other financing options may be required''.

The council, chaired by a former senior health official, Mary Murnane, is believed to have proposed a range of options including a mix of the existing state government and school dental schemes, the teen dental scheme and the present Medicare chronic disease dental scheme.

Three Ways an Athlete Can Prevent Dental Injuries During Sports

Broken teeth and various dental injuries can be common during sports, especially for an athlete that participates in contact sports. There are a lot of different ways that dental injuries can occur to an athlete, including if he or she gets hit in the mouth with a ball or hard object. Dental injuries can be very painful, cause a lot of internal problems, and can be very costly to fix.

Here are three ways that an athlete can prevent dental injuries during sports, which can help keep him or her safe and healthy.

• Always Wear a Mouthguard
• Use Helmets or a Faceguard
• Always Remove Retainers Prior To Playing Sports

Enjoy your morning/afternoon!

California Dental Association Sues the California Department of Healthcare Services Over Medicaid Payments to Dentists

The California Dental Association has joined others including the California Medical Association (CMA), the California Pharmacists Association (CPhA), and the National Association of Chain Drug Stores in a federal lawsuit.

A coalition of medical professionals filed a lawsuit Monday against state and federal Medicaid administrators over the approval of broad cuts to the program known as Medi-Cal in California.

Trade associations for medical professionals say the approved 10 percent cuts to reimbursement rates for Medi-Cal didn't go through appropriate legal channels, according to a lawsuit filed in U.S. District Court.

The cuts approved last month by the federal Centers for Medicare and Medicaid Services include a 10 percent reduction to payments for outpatient services for doctors, clinics, optometrists, dental services, medical equipment and pharmacies.

The cuts would save the state's general fund $623 million.

Doctors and medical professionals say continued cuts will hurt the state's already ailing Medi-Cal system, and it is already difficult for recipients to find doctors who still participate in the federal program.

The state of California ended adult Medicaid services except for pregnant women and some emergencies in 2009. However, the Medicaid system called Deni-Cal in California does provide children's services. California has one of America's lowest compensation rates for dentists and other health providers.

Dentists and physicians know that the California Medicaid system is on the verge of collapse since NOBODY is going to accept another 10 per cent cut in the fees they now charge. Providers will simply refuse to care for the poor, blind and disabled who qualify for Medicaid.

The CDA believes this latest attack on the already inadequate Medi-Cal network of dental care will result in further hindrance of dentists' ability to provide appropriate care.

"The state's elimination of adult dental services in 2009 was devastating to low-income Californians," said Dan Davidson, DMD, president of the CDA. "More cuts to children's services are unconscionable."

The information that CMS relied on to approve the state's cuts do not measure whether and how patients' access to care would be impacted or otherwise take into consideration, as required by law, the costs to provide the care, according to the CDA. In fact, a recent poll and independent studies show that access to care is already unequal, making the recent cuts illegal by federal standards.

Because California Medi-Cal rates are already extremely low, many providers cannot afford to participate. Kaiser State Health Facts lists California as the lowest reimbursed state in the nation. The co-payments and arbitrary limits on services will create additional barriers for sick, vulnerable patients seeking care and, ultimately, they will be forced to delay care or use emergency rooms for basic health services, according to the CDA.

CMA, CPhA, and CDA successfully sued in the past to enjoin prior Medi-Cal cuts and expect to demonstrate once again that federal law, which ensures that Medi-Cal patients have equal access to healthcare, was not followed.

If anything, there will be continued uncertainty in treating the poor. Previously, the state has asked clinics and providers who were paid while an appeal of a previous cut was made, to reimburse the state when the appeal was denied. This was many months later. Of course, these providers and clinics did not have the money to pay the state back.

So, here we go again.

How can a dentist be expected to provide services and then find out in six months that the money they thought they were receiving is now actually 10 per cent less and you owe California a check for the difference. Who in their right mind would participate in such a system?

Updated: The Cease and Desist Letter From the Smile Center of San Antonio and Dr. Stephen Simpton

Photo courtesy of WOAI-TV, San Antonio

Today, after receiving my neat new crown (thank you, Dr. Dovidio), I went over to my old mailbox at The UPS Store (where my wife has a mailbox) and received an old certified letter (from two weeks ago) from a Texas law firm. It was a cease and desist letter over a link I posted here some time ago.

I won't bore you with the details of the letter, nor scan it, but it essentially said stop publishing nasty stuff about our client Dr. Stephen Simpton. Unfortunately, sir, Mr. Jon Michael Smith, Attorney at Law in Austin Texas, a free press does not quite work this way - as I am sure you really know.

I have moved the post over to Flapsblog.com since the video is breaking the template here at Blogger. Here is the link.

The Morning Drill: November 14, 2011

Good morning!

A collection of dentistry and health related links/comments for your day.

Supreme Court will hear health care case this term

The Supreme Court said Monday it will hear arguments next March over President Barack Obama's health care overhaul, accepting a case that could rival the historic Bush v. Gore ruling in shaking the political landscape.

The decision to hear arguments in the spring allows plenty of time for a decision in late June, just over four months before Election Day. This sets up an election-year showdown over the White House's main domestic policy achievement.

The justices announced they will hear more than five hours of arguments from lawyers on the constitutionality of a provision at the heart of the law, the requirement that individuals buy health insurance starting in 2014 or pay a penalty, and other related questions about the act.

The White House said "we are pleased that the court has agreed to hear this case."

"We know the Affordable Care Act is constitutional and are confident the Supreme Court will agree," communications director Dan Pfeiffer said in a statement.

Republicans have called the Patient Protection and Affordable Care Act unconstitutional since before Obama signed it into law in March 2010. But federal appeals courts have been split on their assessment.

The high court's 5-4 decision in the Bush v. Gore case nearly 11 years ago effectively sealed George W. Bush's 2000 presidential election victory.

Professional Dental Cleanings May Reduce Risk of Heart Attack, Stroke

Professional tooth scaling was associated with fewer heart attacks and strokes in a study (Abstract 17704) from Taiwan presented at the American Heart Association's Scientific Sessions 2011.

Among more than 100,000 people, those who had their teeth scraped and cleaned (tooth scaling) by a dentist or dental hygienist had a 24 percent lower risk of heart attack and 13 percent lower risk of stroke compared to those who had never had a dental cleaning. The participants were followed for an average of seven years.

Scientists considered tooth scaling frequent if it occurred at least twice or more in two years; occasional tooth scaling was once or less in two years.

The study included more than 51,000 adults who had received at least one full or partial tooth scaling and a similar number of people matched with gender and health conditions who had no tooth scaling. None of the participants had a history of heart attack or stroke at the beginning of the study.

The study didn't adjust for heart attack and stroke risk factors -- such as weight, smoking and race -- that weren't included in the Taiwan National Health insurance data base, the source of the information used in the analysis.

"Protection from heart disease and stroke was more pronounced in participants who got tooth scaling at least once a year," said Emily (Zu-Yin) Chen, M.D., cardiology fellow at the Veterans General Hospital in Taipei, Taiwan.

Professional tooth scaling appears to reduce inflammation-causing bacterial growth that can lead to heart disease or stroke, she said.

Texas Medicaid problems may apply nationwide

Claims procedures discovered in a News 8 investigation of the Texas Medicaid Dental program may apply to the whole country, because of the payment process employed by a major government contractor.

In a series of investigative reports over the last several months, News 8 discovered hundreds of millions of dollars in Medicaid billing for orthodontics. Now it appears the problems, which have triggered a federal audit, may be linked as much to the way the claims are approved, as they are to the individual dentists involved.

It turns out that the claims examiners are paid by quantity, and not necessarily quality, under a program called Activity Based Compensation, or ABC. The more claims they process, the more money they make, creating a strong incentive not to take too much time with each one.

"Your tax dollars aren't working," said a former claims specialist, one of several News 8 has interviewed. "You're paying for [dental] services that shouldn't be paid for."

Texas paid out $184 million in Medicaid dental claims last year, as much as the rest of the nation combined.

New California Medicaid cuts may affect kids' dental services

In 2009, some 3 million adults in California lost their Medicaid dental benefits as the state struggled to close a severe budget gap.

Now many of the state's poorest children are facing potential cutbacks in Medicaid dental services as well.

On October 27, the U.S. Centers for Medicare and Medicaid Services (CMS) approved a state proposal to reduce Medi-Cal provider reimbursements by 10% in the 2012 fiscal year, retroactive to June 1, 2011.

The rate reductions were authorized by California Assembly Bill 97, which was signed by Gov. Jerry Brown in June and required federal approval of all Medi-Cal budget reductions prior to implementation.

The cuts, which will save the state $623 million, would impact outpatient services for physicians, dentists, clinics, optometrists, medical equipment, laboratories, and pharmacies. California spends $14 billion annually on the Medi-Cal program.

Medi-Cal currently provides dental benefits to 6.9 million people through a contract with Delta Dental of California. In 2009, the state eliminated most adult Denti-Cal services except for pregnant women and some emergency situations.

While children's services are exempt from the Medi-Cal cuts, the exemption applies to medical services, not dental, according to the California Dental Association (CDA).

"After the loss of the adult dental program, we are now talking about cuts almost exclusively on the care provided to children," said Daniel G. Davidson, DMD, the president-elect of the CDA. "Access to care should be the main goal here, and because these cuts are counter to that goal, CDA is analyzing its options to determine the most appropriate next steps to take to reverse it."

Under the federal Medicaid Act, the state is required to demonstrate that Medicaid patients and privately insured patients have equal access to healthcare and that access will remain intact if the cuts are implemented. In a statement issued October 27, CMS said that, based on "extensive data" submitted by the state, it believes access to care won't be jeopardized for Californians as a result of the cuts.

But many healthcare groups remain unconvinced, and the California Medical Association (CMA) is threatening to file a lawsuit to stop the cuts from being implemented.

"The primary concern on our part is access to dental services for children because adult dental was virtually eliminated two years ago," said Joel Diringer, JD, MPH, the interim executive director of the Center for Oral Health. "And we are talking primarily about private dentists because the FQHCs [federally qualified health centers] won't be affected by the cuts. Private providers and community clinics are the ones that will be affected by this."

As of 2007, Denti-Cal served some 8 million people in California, although only 25% of beneficiaries reported a dental visit in 2007, according to the California Health Care Foundation (CHCF). In fact, the service is significantly underutilized, Diringer noted -- even with the elimination of most adult Denti-Cal services in 2009.

"Only about one-third of children on Denti-Cal have a dental visit annually," he said.

Enjoy your morning!

California Physicians to Go to Court to Block Medicaid Pay Cuts

The latest flap is over the latest 10 per cent cut of physician's fees by the State of California.

The California Medical Association (CMA) will go to court again to block the latest cut to already stingy Medicaid reimbursement rates in that state, a CMA leader said today.

The association contends that the 10% reduction in provider reimbursement will drive more physicians out of the program and make it harder for the poor to receive medical care, violating federal requirements that govern the Medicaid program.

"When regulators don't follow their own rules, legal action is our only recourse," CMA Vice Speaker Ted Mazer, MD, told Medscape Medical News. "They've just destroyed the program."

No California physician in his right business mind would accept Medi-Cal (California's Medicaid), especially with all of the governmental regulations.

Here we have another consequence of ObamaCare and the Medi-Cal cuts actually undermine it. I mean, how can you have affordable medical care when there are no providers of such care?

The CMA has repeatedly argued that by approving the reduction in Medi-Cal rates, the Obama administration is undermining its own Affordable Care Act, which will add 3 million individuals to the state program beginning in 2014 as a result of expanded Medicaid eligibility.

"On one hand, [the administration] is trying to create the infrastructure for healthcare reform where they put at least a third of the newly insured into Medicaid, and at the same time the administration is gutting the Medicaid program in California," said Dr. Mazer. "CMS has set a precedent — balance your budget on the backs of the poor. I'm sure other states will follow suit."

Carol Havens, MD, the president of the California chapter of the American Academy of Family Physicians, agrees with Dr. Mazer about the effects of the rate cut on healthcare reform.

"Having insurance means nothing if you don't have access to care," Dr. Havens told Medscape Medical News. "I see a world of hurt in this decision.

California Reduces State Dental Medicaid Benefits and Patients Suffer

This is me working on a patient at the Simi Valley Free Clinic last year

California patients who cannot afford treatment have been suffering for some time now.

Little surprises Nagaraj Murthy, a dentist in Compton for the past 32 years.

He has seen patients who have suffered toothaches for years. Others who haven't been to the dentist in a decade. Some who can't chew hard food.

But in the two years since California sharply reduced dental benefits for roughly 3 million Medi-Cal recipients, he and other dentists say the situation has become dire for patients who are waiting until their infections land them in an emergency room or their rotted teeth have to be immediately pulled.

"They aren't coming until the mouth is completely swelled up or the pain cannot be tolerated," Murthy said.

Dental care is the oft-ignored cousin of medical care, experts say. Because dental coverage is an optional benefit under the federal Medicaid program for the nation's poor, several states don't offer it. Others, like California, have slashed the benefit in recent years, meaning millions nationwide are going without treatment and facing heightened risks of serious and costly health problems like respiratory infections and heart disease.

One-third of Americans reported skipping dental checkups and care because of the cost, according to a Kaiser Family Foundation poll released in April. And a report by the national Institute of Medicine in July said "persistent, systemic" barriers, including lack of insurance and a shortage of dentists, are increasingly limiting people's access to dental care and exacerbating socioeconomic disparities in public health. The report urged states to include dental coverage for adults with Medicaid and recommended better training so primary care doctors can spot oral diseases.

"Oral health isn't just the responsibility of dentists," said Frederick P. Rivara, a Seattle pediatrician who chaired the committee that wrote the report. "There is a real need to have other healthcare providers involved."

Pending reforms of the healthcare system aren't expected to help. Some provisions are designed to increase public education, dental training and dental care by providers such as hygienists and dental health aides. But many of the those improvements aren't funded. And despite the push to provide health coverage to the uninsured, experts say adults who cannot afford private dental plans will still be on their own.

Since California cut back dental coverage, Murthy said he has lost about half of his adult patients because they don't have money to pay for services. He doesn't charge them for preliminary exams but said he can't afford to provide free treatment.

Read all of the piece.

And, there are dentists, such as myself, who could help some of these indigent patients out, be willing to accept lower pay, if there was an appropriate situation to provide care - like a facility and infrastructure.

But, there is none and with California's budget shortfall, there will be NO help from the state anytime soon.

The Morning Drill: September 7, 2011

A collection of dentistry and health related links/comments for your day.

Living With a Smoker Increases Absenteeism in School Children, U.S. Study Confirms

Children who live in households where they are exposed to tobacco smoke miss more days of school than do children living in smoke-free homes, a new nationwide study confirms. The report from investigators at Massachusetts General Hospital (MGH) -- which finds these children have higher rates of respiratory illnesses that can be caused by second-hand smoke and details the probable economic costs of their increased school absence -- has been released in the online edition of Pediatrics.

"Among children ages 6 to 11 who live with smokers, one quarter to one third of school absences are due to household smoking," says Douglas Levy, PhD, of the Mongan Institute for Health Policy at MGH, the paper's lead author. "On a national basis these absences result in $227 million in lost wages and time for caregivers or their employers."

The authors note that one-third of U.S. children live with at least one smoker, and more than half of those aged 3 to 11 have detectable levels of a blood marker for tobacco exposure. Second-hand smoking has been shown to increase incidence of ear infections and several respiratory conditions, and school absenteeism is an accessible measure of serious illness in children. Earlier studies of the relationship between lost school days and household smoking have focused on local populations and did not evaluate the severity of the problem's impact. The MGH team analyzed data from the 2005 National Health Interview Study, an annual in-person survey of representative households nationwide.

Weight Loss Without the Hunger: Eat a Lighter Lunch, Scientists Say

Losing weight without a grumbling stomach or expensive liquid diet can be as simple as eating a lighter lunch, finds a new Cornell University study to be published in the October issue of the journal Appetite.

Participants who ate portion-controlled lunches did not compensate by eating more calories later in the day, leading researchers to believe the human body does not possess the mechanisms necessary to notice a small drop in energy intake.

"Making small reductions in energy intake to compensate for the increasing number of calories available in our food environment may help prevent further weight gain, and one way of doing this could be to consume portion-controlled lunches a few times a week," said doctoral student Carly Pacanowski, who co-authored the study with David Levitsky, Cornell professor of nutritional sciences and of psychology.

N.C. Medicaid cuts take hold in October

New cuts to health services for the poor take hold in October, with the elimination of eye exams and glasses for adults on Medicaid.

Medicaid recipients are receiving notices about reductions, eliminations or other changes to an array of health services in the next few months. The $354 million Medicaid cut in the state budget includes limits and other changes to services totaling $16.5 million.

In addition to getting rid of routine adult eye care and glasses, the state plans to limit payments for deep cleaning dental treatments for people who have gum disease to once every two years from once a year. Outpatient physical therapy, occupational therapy and speech therapy for adults will be limited to three visits a year.

Insurer's cuts leave dentists nursing $60 million toothache

Caring for your teeth costs more in Washington than just about anywhere else in the country, according to the state's largest dental insurer, which recently slashed payments to dentists for the first time in more than 50 years.

Washington Dental Service (WDS), a nonprofit that insures about 1.5 million patients in Washington, says the $60 million it expects to save in cuts to dentists has allowed it to offer a more affordable plan to small businesses.

Angry and dismayed dentists, hit with cuts of up to 15 percent or more, warn that the drastic reductions will hurt patients, who have grown accustomed to dentists who take time to focus on prevention and options, instead of just waiting until something hurts or breaks.

About 95 percent of the dentists in the state accept payments from WDS, but in the wake of the June 15 cuts, some have dropped the insurer, and many say they're still considering doing so.

Dentists, most of whom own their own clinics, say they have no control over rising overhead costs and warn they likely will have to make drastic changes in their practices.

"Never in my 23 years in practice has there been a bigger threat to the way I take care of my patients," said Dr. Chris Pickel, a Northgate-area dentist and immediate past president of the Seattle-King County Dental Society.

"This is a big tipping point right now," Pickel said. "It forces dental practices to go to a volume-based system, where you see more patients per day," limiting time for proactive, preventive care.

Enjoy your morning!

Video: Federal Investigators Auditing Texas Dental Medicaid Over Orthodontic Treatment for Tens of Thousands

Orthodontic treatment with Medicaid? And, for that many patients?

For the past six months, News 8 investigations have revealed hundreds of millions of dollars of questionable Medicaid spending on braces for children in Texas.

Now federal investigators are auditing the Texas Health and Human Services Commission, which controls those funds. Taking the lead in the audit is the Office of Inspector General of the U.S. Department of Health and Human Services.

In a letter to the state, the inspector general says it will examine the "authorization process for orthodontic treatment" under Texas Medicaid. "The objective of our audit," the letter continues, "is to review the State's controls to ensure that only medically necessary orthodontic cases are paid." The time period covered by the audit is September 1, 2008 through May 28, 2011.

A News 8 investigation revealed that during that period, Texas taxpayers spent $424 million on orthodontic treatment for children under Medicaid. Taxpayers spent $100 million in 2008, $140 million in 2009, and $184 million in 2010, state records show.

Last year, Texas spent as much as the other 49 states combined.

Somebody is going to be in trouble here.

Medicaid funds should be used for the poor and disadvantaged and in California all adult dental Medicaid has been eliminated because of budgetary issues. Yet, Texas is using this for cosmetic orthodontic treatment?

Millwee said he's been working with the TMHP program for a decade. He said his office noticed an increase in Medicaid orthodontic claims in 2007 after a lawsuit ruled that Texas children needed improved access to health care under Medicaid.

He said Texas children do not receive cosmetic braces on their teeth under Medicaid. Many dental professionals argue that they do, because orthodontics is essentially a cosmetic procedure.

Texas spent $184 million on Medicaid orthodontics last year; that's nine times as much as California, which spent $19.5 million.

One state's program is not another's, Millwee said.

Indeed, it isn't.

But, American taxpayers expect fair use of their tax dollars and not a crony system of abuse and excuses.

Medicaid Study: Dentists Hesitate to Treat Children on Medicaid?

Dentists are hesitant to see children on Medicaid for an emergency dental appointment?

Shocking?

Dentists were less willing to see kids who needed an emergency appointment if they were covered by Medicaid than if they had private insurance in a new study based in Cook County, Illinois.

Even dental practices that were enrolled in the state's Medicaid and Children's Health Insurance Program were more willing to treat a kid with private insurance than one enrolled in the state's plan for low-income families according to the findings, which are published in Pediatrics.

"I believe it comes down to financial incentives and administrative burden," Nancy Maserejian, a researcher at New England Research Institutes in Watertown, Massachusetts told Reuters Health in an email.

"The amount of money dental practices get paid to do the same procedure is a lot less when Medicaid is reimbursing them," added Maserejian, who has studied access to dental care but was not involved in the current study.

It's very possible that for people on Medicaid, access to dentists varies widely on a state-by-state basis, researchers say, since each state has its own system of paying dentists for different procedures and its own reimbursement rates.

Well, Medicaid or called Denti-Cal in California is different in each state. Some states pay dentists better than others and some have less burdensome rules. In California if you are over the age of 21, most routine dental services are no longer paid.

But, what do you expect?

America continues to be a capitalist country and money paid for dental services rendered is the "invisible hand."

In economics, the invisible hand, also known as invisible hand of the market, is the term economists use to describe the self-regulating nature of the marketplace. This is a metaphor first coined by the economist Adam Smith in The Theory of Moral Sentiments, and used a total of three times in his writings. For Smith, the invisible hand was created by the conjunction of the forces of self-interest, competition, and supply and demand, which he noted as being capable of allocating resources in society

So, why is dentistry any different?

Most dental offices are small private businesses and if there is self-interest of the market to see these patients, then they do it. If not, then the patients will have to wait.

In this case, many of the offices that were contacted were not even enrolled in the Illinois Medicaid program, so the prospect of them being paid at all, may have been much lower. Again, the invisible hand at play. Dental offices are not constructed to operate at a financial loss.

Amy Martin, who has studied access to dental care at the University of South Carolina's Arnold School of Public Health, said that although access to care is a problem in many places, these results may not generalize to other parts of the country.

Cook County -- which includes the city of Chicago -- is an especially wealthy area with lots of residents covered by insurance, she said, meaning that dentists can get by just fine only treating patients with private insurance.

"There's little market motivation in Cook County to accept new patients who have Medicaid, while that might not be the case in a poor, rural county that depends on Medicaid patients to stay in business, Martin, who was not involved with the new research, told Reuters Health.

I think the hidden agenda with this piece was to demonize the big, bad rich dentists in not seeing poor patients on Medicaid. Please, don't get me started on that B.S..