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Dental Management Expert Witness

Provides Opinion & Testimony In:

Dental Management, Dental Malpractice, Peer Review, Dental Managed Care, Knox Keene Act, Quality Assurance, Insurance Fraud, Practice Management, Standard of Care, Practice Valuations, Diagnosis, Treatment Planning, Informed Consent, Traumatic Injuries Mouth, General Dentistry,

Expert No. 3629

Executive Profile

Healthcare Executive with 22 years of experience in dental practice management, 15 years in dental plan leadership positions and 10 years as an industry consultant with special skills in the following areas:

  • Strategic Planning & Business Development
  • QA Policy Development / Implementation
  • Professional, Government & Community Relations
  • Claims Operations & Utilization Management
  • Fiscal and P&L Management   
  • Dental Practice Management
  • Regulatory Compliance
  • Provider Network Development
  • Negotiations and Contracting
  • Professional Education & Communication
  • Public Health Issues

Professional Experience
   
Dental Solutions
Los Angeles, CA
2001 – Present
   
Dental Solutions is an independent consulting practice that services the needs of dental plans, dental practices, regulators and dental service vendors
   
Provide consulting solutions to client organizations including OraPharma, Inc, Wilshire Park Dental Group, Frontier Dental Management, Interdent, Inc., Aetna Dental Plan of California, Golden West Dental & Vision, Jaimini Health, Inc., Coalition of Orange County Community Clinics, Previser Corporation and Institute for Healthcare Advancement.  Affiliations with other consulting organizations include Jay Grant & Associates, a regulatory counseling firm.

Community Health Centers
Irvine, CA
2003 – Present
Dental Consultant
   
The County Community Clinics is a non-profit organization that’s mission is to provide access to safety net medical and dental services as well to diverse populations within the county that are uninsured.
   
Provide dental consulting services in the areas of strategic planning, quality assurance, quality improvement, professional education and peer review. Develop, in concert with community organizations, a system of care to coordinate service delivery for the culturally diverse populations that the organization serves. Perform annual quality and scope of services and billing audits to verify compliance with County guidelines. Advise Dental Provider Forum with regard to ongoing dental industry issues. Conduct quarterly continuing dental education programs.
   
Financial – California Benefits Dental Plan
Irvine, CA
2008 – Present
Dental Director
   
California Benefits Dental Plan is a dental HMO subsidiary of Financial, Employee Benefits Group.
   
Responsible for policy management and oversight of the Plan’s Quality Assurance Program. Act as Chairman, Quality Management and Public Policy Committee. Functional management of access and availability, grievances and appeals, utilization management and quality management functions. Support Sun Life dental PPO product as State of Virginia Dental Director and participant in national compliance focus group.
   
Wilshire Park Dental Group
Los Angeles, CA
2004 – 2011
Executive Director, Corporate Secretary
   
Wilshire Park Dental Group is a privately held multi-specialty dental group with multiple locations in southern California that has annual revenue exceeding $4 million. The Los Angeles location is a 18 chair dental facility that provides general dentistry, orthodontics, pediatric dentistry, periodontal, implant and oral surgery, and prosthodontic services. Clinicians are owners and all maintain part-time teaching positions at local dental schools.
   
In capacity as Executive Director, wholly responsible for the operations and practice management of the group’s practices including but not limited to marketing, production, collections, billing, human resources management, facility management, practice expansion, budget development and expense management.
   
Pacificare Health Systems, Inc.
Santa Ana, CA
1994 – 2001
PacifiCare is an industry leader in the delivery of healthcare and ancillary products for employer groups and consumers in eight western states with annual revenue of $11 billion.
   
Vice President, Chief Dental Officer
Pacificare Dental
(1994 – 2001)
   
Responsibilities included management of Quality Improvement, Regulatory Compliance and Appeals & Grievance departments. Plan delegate to government entities and industry association liaison. Served on the Board of Directors of the company’s Political Action Committee. Successfully developed and managed the largest DHMO network in California 

  • Contributed to management team that achieved profit growth exceeding 15% in each of the last three (3) years.
  • Led successful development of new Quality Improvement Program to meet or exceed requirements of California Department of Managed Health Care.
  • Improved grievance and appeals process to consistently resolve 99% of all grievance and/or appeals within 30 days.
  • Successfully completed contracting with multiple provider networks so as to achieve PPO network coverage for six states.
  • Created and implemented Provider Advisory Councils to gain continual feedback for the Plan and to validate provider satisfaction with company programs.   
  • Led company efforts to acquire government contracts including Geographic Managed Care (GMC) and the Heath Insurance Purchasing Cooperative (HIPC), now known as PacAdvantage.
  • Successfully integrated provider networks and dental programs necessitated by company acquisition of FHP, while achieving greater than 90% provider retention.
  • Developed and implemented an incentive program for providers based on patient satisfaction and other measures.

Prudential Health Care Plan
Woodland Hills, CA
1991 – 1993
   
Dental Director, Western Region
Simi Valley, CA
   
Responsibilities included directing all company Quality Assurance activities including Peer Review and the successful preparation for the company’s first routine QA Audit by the California Department of Corporations.   

  • Established and implemented claims review policies and procedures and realized a savings of $5 million on less than $90 in annual claims volume.
  • Led staff that successfully recruited and maintained a dental provider network covering ten western states with greater than 95% provider retention rate.   

Safeguard Health Enterprises, Inc
Aliso Viejo, CA
1989 – 1991
Director of Professional Education, Community Dental Centers
   
Responsibilities included directing the education and training programs for over 70 dentists in 22 locations, coordination of the Quality Assurance Program and development of company standards and protocols.  

  • Developed and implemented system-wide practice management program including scheduling, treatment planning and other guidelines.
  • Successfully planned and coordinated construction of the company’s first all dental specialty center and achieved profitability within the first 9 months of operation.

Previous Positions

General Dentist, All about Teeth, Dental Director
Delaware Valley Dental, Dental Director
Modern Dental Concepts, Dentist / Owner

Professional Associations & Affiliations

Certified Quality Assurance Consultant – CADP – 2001 – 2011
Associate Fellow, World Clinical Laser Institute – 2008 – 2011
California Association of Dental Plans – President, 2001 – 2003; Treasurer, 2000 – 2001
National Association of Dental Plans – Board Member, September 2000 to November 2001
American Dental Association, California Dental Association, Los Angeles Dental Society – 1991 to
Present
Institute for Healthcare Advancement – Advisory Committee, 1994 to 2003

Lectures And Publications

Available Upon Request

Education and Certification

Licensed in: Pennsylvania, New Jersey and California

Boards Passed: National, Northeast Region and California

Doctor of Dental Surgery – Temple University, Philadelphia, PA

B.A., Biology – Temple University, Philadelphia, PA

Groups

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