Health-related clinics, including dental practices, have been a primary target of state and federal governments regarding criminal and civil enforcement actions. From allegations of prescription drug distribution to medical billing fraud, it’s common to see headlines about dental clinics under investigation for failed government compliance.
Dental practices aren’t immune from government scrutiny. Working with an experienced attorney to form a government compliance plan can help protect you and your dental practice from government enforcement actions. We work with dental practices across the country at Mahan Dental Law to help them create government compliance protocols to avoid costly and damaging government investigations. Contact Mahan Dental Law today to schedule an initial consultation and learn more about our services.
The Government Has Cracked Down on Dental Fraud
Hospitals, pathology labs, general practices, and durable medical equipment companies have all been targeted by state and federal investigators for non-compliance with laws and regulations. You may not think dental practices are frequently targeted, but they are just as susceptible to government enforcement.
Medicare benefits don’t cover routine dental care, and dental care is excluded from any state-based Medicaid programs. As a result, dentists don’t commonly rely on Medicare and Medicaid funds. However, that doesn’t mean dental providers are protected from being investigated by government agencies. Dental practices need to be on alert to government compliance issues.
Compliance with Medicaid
A 2021 case in Tennessee demonstrates how dental practice owners can receive scrutiny for non-compliance even though Medicaid doesn’t cover routine dental cases. In this case, a judge ruled that the federal Anti-Kickback Statute can apply to a dental practice via the Tennessee Medicaid False Claims Act. Even though TennCare stated it doesn’t cover routine dental care, the court denied a motion to dismiss a claim from the State of Tennessee that dental services paid for by long-term care residents using Medicaid benefits violated the Anti-Kickback Statute.
One of the best ways to avoid claims for fraudulent billing is to have accurate and up-to-date building practices. The more detailed your employees and staff members are when updating a patient’s record, the more accurate your billing. Auditing your billing practices can help you identify any issues. A billing software design for medical practices can also help you keep up-to-date records. If you aren’t sure where to start, the attorneys at Mahan Dental Law can advise you on best practices and work with you to implement them. If you are under investigation, it’s easier to prove your innocence with accurate records.
Investigations Involving Opioid Distribution
Federal and state agencies have also been cracking down on fraudulent prescriptions for opioids. The Department of Justice recently announced a task force designed to investigate and charge medical professionals for unlawfully prescribing opioids. The Department of Justice and local partners brought criminal charges against 14 defendants across the United States for unlawful distribution of opioids.
One case involved a Kentucky dentist who has been charged with unlawfully prescribing morphine. The dentist allegedly wrote three opioid prescriptions and gave them to a 24-year-old patient over a five-day period in August 2020. The patient died from an overdose within those five days. Another charge involved a clinic director who allegedly unlawfully obtained opioid pain pills for personal use.
As the owner or manager of a dental practice, you may not think anyone in your practice would write fraudulent prescriptions. Unfortunately, these types of cases can happen anywhere. The attorneys at Mahan Dental Law can evaluate your dental practice and look for any gaps in your safety protocols. We can also help you develop best practices that could help you detect fraudulent prescription usage so you can report it quickly. Finally, we can help you search for a dentist to join your team. Running background checks and looking for any previous warning signs related to fraudulent prescriptions is crucial.
Creating a Culture of Compliance
The actions of a small minority of dentists and dental support organizations have increased government scrutiny of all dental practices. Developing a culture of government compliance is crucial in light of the heightened scrutiny of dental practices and other medical offices. The first step in creating an effective compliance program is implementing procedures and policies that focus on the quality of care and adherence to local and federal laws and regulations.
Ideally, dental practices should have a chief compliance officer who has the authority to Implement policies at the dental practice effectively. The compliance officer should be able to maintain his or her independence and make judgment calls about a lack of compliance.
Smaller dental practices may not have the resources to hire a compliance officer. In that case, it’s essential that the owner, manager, or another trusted staff member trains staff on the procedures and policies of the dental practice. It’s also important to continually review the training and compliance programs to ensure they are effective.
Responding to and Correcting Compliance Issues
Dental practice owners should respond to any compliance issues promptly and thoroughly. Compliance programs should focus on accurate billing and patient quality of care. If you aren’t sure where to start, we recommend contacting Mahan Dental Law attorneys. We will review your policies and procedures and identify areas for improvement. It will also help you implement a plan to develop a culture of compliance.
Discuss Your Case with a Dental Practice Attorney Today
Owners of dental practices have a lot on their minds, from issues related to billing and payments to human resources challenges. If you were the owner of a dental practice, you might not have taken the time to set up a government compliance strategy. The attorneys at Mahan Dental Law can help you review every aspect of your dental practice and look for potential red flags.
We can help you work to limit your exposure to government investigations for non-compliance. If you are already under investigation, we can advocate for your rights. Contact Mahan Dental Law to schedule an initial consultation and discuss your case with an experienced dental practice attorney.