Response To The Shelburne-Medicaid Saga
After the posting of the Shelburne-Medicaid story, I received several private emails from dentists that were alarmed by what they read. Below is part of the correspondence between myself and dentist-and legal consultant Barry Levy. He was part of CA state’s criminal case against Drueciel Ford, DDS.
I had put many posts on www.dentaltown.com and the gist of the problem is that when the dental profession doesn’t do what is right, then others step into the void and they normally don’t have the same concerns as the profession has, and unfortunately they have the ability to make the rules that profession must then work with.
To start, the concept that Americans should stay in the US for treatment because there is no recourse should a problem arise, when they get cheaper treatment outside the country is a huge problem. First why are dentists so quick to condemn foreign dentists, but so loathe to condemn non-acceptible treatment from American dentists, and second most dental cases are too small for lawyers to want to take, to let the harmed person be made whole. But a profession should be the same for all, and not dependent on what area code the dentist works in, the type of practice of the number of employees. And to go with that problem one just has to remember the Reader’s Digest article where a patient was checked out by the local dental school and then got so many different diagnosis as to make a person’s head spin.
Second I have begged dentists to realize that a problem for a colleague can have profound implications if we don’t stand up together. Nobody stood up for Dr. Ford, despite the railroading that was being done, and now we see that nobody stood up for Dr. Shelburne. It is hard for me to see how with the blessings that we have in our profession that we aren’t so ready to maintain so blessings.
Third, the rules that are being established are such that the ability to run a practice is becoming more difficult and we are always being told that we should just absorb the costs, but there becomes a time when that is impossible. I like the concept of gloves, and being told that the cost for gloves isn’t something that should be passed on to the patients, but when the post office went to gloves for their workers, and they used far less, the government wanted to pass on those costs to those using the postal system. 4 gloves a day for a postal worker is a cost that must be passed on, but boxes a day for staff is to be absorbed.
Fourth, the fraud rules are becoming such that non-acceptible treatment is being considered a fraud, and could land a dentist in criminal rather than malpractice, and fraud as also been defined as billing for treatment that you didn’t actually perform. So if you bill for work that your associate has done, it has been called fraud in Ca., and tried but lost. But how does that affect a dental practice where the billing costs can’t be contained.
Fifth, is the most insidious concept that making money is wrong and that tactic was used both in California and in Virginia, when looking at the life styles of the dentists involved, and how they were living. This should be striking fear into the heart of the profession and especially so with all the dental seminars about how to increase production.
Sixth is the government’s attempt to win by threatening your staff to turn on you, and spoon feeding them what they want them to say. It happened in Cal. and from the report the amount of time spent by the government interviewing the Dr.’s staff should be troubling to anyone.
Seventh-once you bill using mail or electronic billing a mistake can become a federal crime. And if you look at the dollar amount for a felony, a simple mistake can turn one into a felon. In California over a 5 year span they found something like $600 in errors and that became felony theft. If one wants to defraud the system one would be doing it on all patients and in dentistry the fraud becomes small amounts of money charged to large number of patients. This didn’t happen in either case according to testimony or news reports.
Eight-selective prosecution. I find it abhorrent that the US Government will tell me that billing fraud approaching $25 Million by large groups are too small to interest them, but $8000 by a single practitioner is a huge problem. It doesn’t make sense but the reality is that the government is a bully and would rather attack the single practitioner who doesn’t have legal counsel on retainers than deal with the large groups, doing large harm, but have legal resources. That should trouble all dentists, and especially all dentists that are solo practitioners that don’t have legal counsel on payroll.
And the list goes on and gets worse, but dentists are a little too busy dealing with their practices, their families and their lives to deal with obscure issues that seem not to be relevant or even cross their radar screens, until it is too late. That is why large associations should have the funds put aside to allow others to protect their interests, and when I had discussed the Cal. case the consensus wasn’t to assist, but to watch and see what happens. Well, what happened was that a Cal. dentist was bankrupted and lost her practice to defend herself, and a Virginia dentist may be going to jail.
So I guess it depends, either I was a chicken little stating the sky was falling, or a seer telling what would happen if the profession didn’t wake up. If you weren’t involved with either case then you might think that I am chicken little, but for the two dentists not only did the sky fall down, but their worlds were destroyed.
Barry Levy, DDS
Read the previous post on Dr. Roy Shelburne’s story
