Friday, June 01, 2012

The Morning Drill: June 1, 2012

Good Friday morning!

On to today's dentistry and health headlines:

FTC opposes NC dental management legislation

The Federal Trade Commission (FTC) has issued a letter to the North Carolina General Assembly stating its opposition to pending legislation that would give the state dental board more control over contracts between dentists and out-of-state dental management chains.

HB 698 and SB 655, known as the Dental Management Bill, would give the North Carolina State Board of Dental Examiners more authority to investigate and enforce regulations regarding dental chains. North Carolina has 4,600 dentists, and more than 50 dental practices in the state use management companies, according to the dental board and the North Carolina Dental Society (NCDS).

But opponents contend the state's rules are already the most restrictive in the U.S.

Supporters and opponents of the proposed legislation have poured hundreds of thousands of dollars into media campaigns and political contributions to sway lawmakers. The Alliance for Access to Dental Care, which opposes the bill, has raised more than $1 million, made $86,000 in campaign contributions last year, and has spent $370,000 on a media campaign, according to disclosure reports. Meanwhile, the NCDS gave about $57,000 to lawmakers in 2011 and hired political consultants for TV ads and mailings supporting the bill.

Now the FTC is recommending that lawmakers reject both HB 698 and SB 655.

Thompson inquired about N.C. dental bill

A Bloomberg Businessweek story provides some detail on the involvement of former governor Tommy Thompson, now a candidate for the U.S. Senate, regarding a bill being heard in the North Carolina legislature that would toughen regulations affecting dental-management companies.

According to the story, the North Carolina bill would place new rules on dental management companies. Those companies have been funded in large part by private equity firms. According to Bloomberg Businessweek, private equity firms have "bought or put money into at least 25 dental-management companies in the last decade."

As to Thompson's involvement, the story says Thompson, who has significant holdings in health-care companies as well as private-equity firms, tried to get in contact with Thom Tillis, the speaker of the North Carolina House of Representatives. But the two didn't connect, according to the story.

Thompson spokesman Brian Nemoir said Thompson called Tillis to learn more about the bill.

"He has not formed a position on the legislation and he has no financial stake it in," Nemoir said in an email.

Suit: Dentist responsible for $24M in false claims

Less than a week after federal agents arrested a dentist who has an office in Stamford as part of a Medicaid fraud investigation, Attorney General George Jepsen has brought a civil action against him and 27 other individuals, dental practices and corporations.

Jepsen, in his action against Mehran Zamani of Stamford and Pound Ridge, N.Y., alleges an illegal scheme that resulted in more than $24 million in fraudulent Medicaid clams over two years in violation of the Connecticut False Claims Act and Connecticut Unfair Trade Practices Act.

Also named in the state's complaint are Gary Anusavice of North Kingston, R.I.; Paul Anusavice of North Grafton, Mass.; John Gallagher of Manchester, Mass.; David Wu of Cheshire; and Alphonso Mack of Bloomfield. The complaint seeks restitution, treble damages and civil penalties, as well as a permanent injunction against the unlawful acts and practices alleged in the complaint.

Gary Anusavice and Zamani were arrested last week on federal criminal charges for their alleged involvement in the same billing scheme. Zamani operates Mehran Zamani DDS PC.

"This is the first case the state has initiated under the Connecticut False Claims Act," Jepsen said in prepared comments. "It gives the state the rightful ability to seek compensation for taxpayers from those who seek to abuse the system with false claims for reimbursements they are not eligible to receive."

Delta Dental to cut payments to NJ, Conn. dentists

New Jersey and Connecticut are the latest states to be hit with reductions in reimbursements by Delta Dental within the last year.

Delta Dental announced it will to cut payments to New Jersey and Connecticut dentists by 4% to 5% in 2013. Delta cut reimbursement rates for Idaho and Washington dentists last year.

The cuts will take effect January 1, 2013, for dentists in Delta Dental's Premier fee-for-service network and will be based on ZIP codes, according to letters sent to New Jersey and Connecticut dentists.

The cuts will enable Delta Dental to remain competitive against large insurance companies such as Horizon Blue Cross Blue Shield of New Jersey, Anthem Blue Cross Blue Shield of Connecticut, Cigna, Metropolitan Life, and Aetna, according to spokeswoman Diane Belle. Lower reimbursements will result in overall reductions in claim payments, which the company says it will pass on to its insureds, Belle said.

"We're hoping to pass on the savings to our group in the form of lower rates," Belle told "Our employers are facing a lot of challenges, and employee benefits are places where they're looking to cut. We know that people are more likely to visit the dentist if they have dental insurance, and we want them to keep the insurance so we have to make it attractive for them to keep it."

The changes will affect 5,846 New Jersey dentists and 2,175 Connecticut dentists. Delta Dental's Premier Network is the largest network in the U.S.

Legislators say changes in dental care for LA County's poor children must be made

Southern California legislators are demanding changes to Los Angeles County's managed care dental program for poor children after reports revealed that fewer than one in four saw a dentist last year.

"Obviously, I'm concerned," said state Sen. Ed Hernandez, D-West Covina, who chairs the Senate health committee. "The most needy population needs to absolutely have access to health care."

Of the roughly 900,000 children with Medi-Cal in Los Angeles County, about 154,000 receive their dental care from a managed care plan. State data show that they are among the least successful in California at obtaining dental care.

In fiscal year 2010-2011, 23 percent of them saw a dentist, compared with about 31 percent in Sacramento - the only other county with Medi-Cal dental managed care - and about half of all Medi-Cal kids statewide.

A story by the CHCF Center for Health Reporting that recently appeared in the Daily Bulletin and its sister newspapers gave examples of children on the managed care plan who lived in pain while waiting months to get their teeth fixed.

Unlike Sacramento County, where dental managed care is mandatory, Los Angeles County's Medi-Cal program allows parents to sign their kids up for a dental managed care plan, or opt for the "fee-for-service" approach used in the rest of the state.

Under managed care, the state contracts directly with private dental plans, paying them a monthly fee - currently about $11.50 - for each child, whether or not the child actually sees a dentist.

The plans pay clinics and dentists a lesser amount per month, often between $4 to $6, to provide the care. Fee-for-service, on the other hand, allows dentists to bill Medi-Cal for services, which results in a substantially higher reimbursement.

Enjoy your morning and weekend!

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