Indiana dentists accused of overtreating patients, overbilling Medicaid

I-Team 8

INDIANAPOLIS (WISH) – UPDATE: May 20, 2015 – Indiana officials have given new information about dentists’ billing practice. See update below.

Kyong Farnsley feared she had cavities in her teeth.

She hadn’t been to the dentist in a while.

So in August 2012 when she walked into Amazing Family Dental in Indianapolis, she says she expected to have an initial exam and a treatment plan set up.

Farnsley says she walked out with half her teeth.

“(The dentist) proceeded to do the exam and told me I had an infection in my mouth and that some of my teeth were infected. He would need to pull them,” Farnsley told I-Team 8. “He said the infection was so bad that if I didn’t have (my teeth) pulled out, I could walk out and have a heart attack and die. I had never heard that before.”

“If he says it’s that severe and I’m going to die, I am going to trust him.”

Fearing for her health, Farnsley said she gave consent for Dr. Shadrach Gonqueh to perform the procedure. A copy of her dental records, obtained by I-Team 8, show 15 of her teeth were extracted.

“If he says it’s that severe and I’m going to die, I am going to trust him. I have two small boys at home. I can’t leave them. I am a single mom at that time; I can’t leave them,” she said.

Afterward, Farnlsey said she was given pain medication but no antibiotics. She left, she says, thinking she would eventually receive dentures. As weeks went by, she sought a second opinion from a new dentist who she says told her the procedure she endured was unnecessary.

Farnsley’s story is not unique. She is currently one of five former patients suing Dr. Gonqueh. Another lawsuit representing three former patients claims Dr. Gonqueh made them “believe that they were in imminent danger and needed to immediately have all their teeth pulled … or risk death by suffering a heart attack,” according to the lawsuit.

An I-Team 8 investigation found allegations of “dental overtreatment” or unnecessary work is not uncommon. In fact, it makes up nearly a third of the 44 active licensing complaints against Indiana dentists, according to Indiana Attorney General Greg Zoeller’s office.

In March, Zoeller’s office filed a licensing complaint against Dr. Gonqueh, accusing him of engaging in fraud by overbilling and receiving more than $27,000 in reimbursements for procedures performed on 158 patients.

“The Board of Dentistry is expected to consider this complaint at its hearing on June 5. At that time, the board will act as jury and judge to determine what, if any, disciplinary action will be taken against the license holder,” Molly Johnson, a spokeswoman for Zoeller’s office, wrote in an email to I-Team 8.DENTIST REACTS

I-Team 8 spoke to Dr. Gonqueh by phone at his Raymond Street office, where he is still practicing. After a reporter identified himself and informed Gonqueh that he was recording the conversation for his news report, Gonqueh declined to answer questions, but did say:

“This story is nothing new,” Gonqueh said. “And I will refer you to my attorney for any further comments. I think you are looking for something where there is nothing.”

Gonqueh’s attorney, Peter Pogue, provided a statement that read:

“Amazing Family Dental, and its dentist, is aware of the recent filings by a few patients and the Attorney General’s Office.  These claims arise out of treatment from several years ago. Amazing Family Dental and its dentist is vigorously defending each of these claims as they proceed through the appropriate legal venue, and Amazing Family Dental and its dentist intend to avail itself of all appropriate legal defenses.  Amazing Family Dental and its dentist maintain that the treatment of each patient is medically appropriate and within the appropriate standard of care, and Amazing Family Dental and its dentist look forward to the opportunity to present the defense to these claims at the appropriate time and in the appropriate forum.  Beyond that, Amazing Family Dental and its dentist do not feel that it is appropriate to comment on pending legal matters.”

(Editor’s note: In the days leading up to this story, I-Team 8 received repeated phone calls from another lawyer, Steve Eslinger of South Bend, who claims to also represent Gonqueh.)

Eslinger’s statement said in part that “expert witnesses” contend that Dr. Gonqueh did nothing wrong.INSPECTOR GENERAL FINDS ‘QUESTIONABLE BILLING’

Last November, the Office of Inspector General from the U.S. Department of Health and Human Services issued a report on pediatric dentistry in Indiana that found “questionable billing practices” among 95 dentists in the state.

Among the other findings were “concerns that certain providers may be billing for services that are not medically necessary or were never provided.”

The report itself does not identify those dentists, but supporting documents obtained by I-Team 8 through a Freedom of Information Act request show that Dr. Gonqueh is among the 95 dentists investigated.

The report’s findings indicate that 94 general dentists and one oral surgeon in Indiana were paid $30.5 million in Medicaid reimbursements for pediatric dental services in 2012. As of April 2, 2015 those dentists and an oral surgeon, whose names are listed in the PDF see below, are under investigation by the Department of Health and Human Services Office of the Inspector General for questionable billing practices.

(ZOOM IN TO READ. REPORT CONTINUES BELOW DOCUMENT)

The report also found those dentists “received extremely high payments per child; provided an extremely large number of services per day; provided an extremely large number of services per child per visit; and provided certain selected services to an extremely high proportion of children.”

It goes on to say, “although our findings do not prove that providers either billed fraudulently or provided medically unnecessary services, providers who bill for extremely large numbers of services warrant further scrutiny.”

UPDATE May 20, 2015: State officials also have been looking into this. A spokeswoman for Indiana Family & Social Services Administration told I-Team 8 that state policies led Indiana dentists to bill Medicaid in ways the federal government questioned, and that state officials believe many dentists the federal government identified did nothing wrong. The Department of Health and Human Services Office of the Inspector General says they also turned over the list above to the Center for Medicaid and Medicare Services for further investigation, although a CMS spokeswoman would not confirm or deny if an investigation is ongoing.HUNDREDS OF COMPLAINTS

Johnson with the Indiana Attorney General’s office said their office’s licensing complaint against Gonqueh was not prompted by the federal inspector general’s report.

“The Attorney General’s Office derives its investigative authority from consumer complaints filed against license holders. The AG’s Office investigates all complaints filed by consumers with the Office against licensed professionals for potential wrongdoing. If a consumer is concerned about the practices of a license holder, he or she can file a complaint by visiting www.IndianaConsumer.com or calling 1-800-382-5516,” Johnson wrote in an email.

Over the past two years, Johnson said the Indiana Attorney General has received 273 dental complaints from consumers. As of May 12, the office has 44 active licensing complaint.

About 30 percent of those, she said, “are in regard to overtreatment or alleged unneeded procedures. As these cases are still open and under investigation, the details of all complaints remain confidential.”LONG ROAD

Three years after her trip to the dentist, Kyong Farnsley’s legal case has yet to see the inside of an Indiana courtroom.

Why?

Both Gonqueh’s attorney, Peter Pogue, and Farnsley’s attorney, Kelley Johnson, acknowledge that under Indiana law, the case must first be heard before the state Department of Insurance, where a panel of dentists will determine if Gonqueh met the standard of care.

“We are not close yet. I expect another year in the medical review panel process before we can actually still bring the case to state court. It’s a long road,” Johnson said.

Wade Fulford with the Indiana Department of Insurance told I-Team 8 that often delays are caused by attorneys wrangling over evidence or the selection process of the dentists who will sit on the panel.

Of the three pending malpractice lawsuits against Gongueh, only one has selected a panel to hear the case, Fulford said.

He said that process can often take months.

Generally, if a panel were to rule in favor of a dentist, Johnson said, it is often very hard for those cases to succeed for the patients in state court because the panel’s decision would be considered expert testimony.

“If that’s the image you have of what it’s like to go to the dentist you are more than likely to avoid going.”

“It absolutely could be used as evidence,” she said.CHILLING EFFECT AND PEER REVIEW

Doug Bush, executive director of the Indiana Dental Association, could not speak to Gonqueh’s case specifically, but said those types of cases should be considered outliers. He mentioned that news coverage of them can also create a chilling effect among prospective patients.

“Those bad actors hurt the entire profession. And it also scares patients. I mean if that’s the image you have of what it’s like to go to the dentist you are more than likely to avoid going to the dentist,” Bush said.

In an effort to help quell that concern, Bush said his members have asked him to talk directly about dental ethics.

The IDA also has a process known as “peer review,” which works to settle disputes between patients and dentists before they enter the courtroom. More information on that can be found by clicking here.

Bush said if patients have concerns about their dental care, they can always seek a second opinion.

“He shouldn’t be a dentist anymore.”

“If the doctor that is giving you this treatment responds negatively to you saying, ‘Let me seek a second opinion,’ then run to another dentist because most dentists are not going to be offended at all,” Bush said.THE WAITING

Kyong Farnsley said her experience cost her friendships and relationships, and she fears she’ll need dental implants to prevent her jawline from diminishing – something she says won’t be covered by insurance.

“It’s really scary,” she said. “Regardless, he shouldn’t be a dentist anymore.”

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