_________________________________________________________________ Dental Ethics: A Brief Review
A dentist may, in the course of his or her career, be called upon to provide expert testimony in the disposition of a judicial or administrative action. When a dentist has a poor result or out- come with his or her own patient, this may be difficult. When a patient presents for treatment with a poor result from another dentist, it is even more difficult. Dentists must have the abil- ity to work with colleagues to achieve results that improve or maintain the patient’s oral and general health. When a second opinion is sought, the patient’s second dentist must take care to provide criticism that is justifiable. Avoidance of disparaging remarks to the patient about the first dentist’s work cannot be overstated. The second dentist must balance this with his or her obligation to the profession when determining “whether the bad work is symptomatic of a potentially harmful pattern on the part of the first dentist and what sort of response is then appropriate” [3]. DENTAL MALPRACTICE Although this course addresses dental ethics and not dental law, dental professionals should be aware of what constitutes dental malpractice. In general, dental malpractice has occurred when a dental provider, through improper treatment and/or diagnosis, causes significant injury, loss, or death to the patient. When malpractice issues arise, the consumer may report his or her complaint to a dental society, attorney, or licensing board. Although licensing boards strive to maintain high standards in the dental profession, it is not possible to conduct regular reviews of each licensed professional. Therefore, most boards rely on written complaints received from the consumer. Upon receipt of a complaint, licensing boards are usually required to open an investigation, the scope of which depends on the allegations [5]. HEALTH INSURANCE Legal cases in dental care do not always involve malpractice that results in the injury and/or death of a patient. There have been several cases of dental Medicare/Medicaid fraud in the news. Although most insurance errors are the result of simple mistakes, cases of deliberate fraud ultimately undermine the dental profession and cost consumers millions of dollars in higher healthcare costs and health insurance premiums. There are several federal and state laws to deter and punish those who defraud (or seek to defraud) Medicare and Medicaid, including the False Claims Act, the Anti-Kickback Statute, and the Criminal Health Care Fraud Statute [11]. Those who commit healthcare fraud are subject to a penalty of 10 years imprisonment and a substantial fine. If serious bodily injury has occurred, the violator may be sentenced to 20 years, and if death has occurred, the sentence may be life imprisonment [11].
In 2010, a New York Attorney General indicted four individu- als and three corporations on charges of stealing upwards of $5.7 million from the Medicaid system out of dental clinics in Brooklyn, Queens, and the Bronx [20]. The defendants owned the clinics (but were not dentists themselves, and therefore are prohibited from owning a dental clinic) and employed many dentists who were instructed to encourage patients, often homeless and lured by recruiters with McDonald’s gift cards, CD players, and cash, to agree to high-value and quick- turnaround procedures (e.g., complete tooth extraction and denture fitting in the same office visit). The employed dentists were required to pay two-thirds of the Medicaid billings to the three corporations involved in the suit. In 2013, a dentist practicing in Connecticut (who was pre- viously barred from practicing in every other state in New England) was sentenced to eight years in prison and ordered to pay $10 million in fines and restitution for operating a number of assembly line-style clinics that performed unneces- sary dental procedures targeting poor patients and collecting more than $20 million in fraudulent claims from Medicaid [7]. The clinics hired recruiters to canvas neighborhoods and paid bonuses to those who brought in patients. In some cases, transportation was arranged for patients to the clinics, which were located in low-income neighborhoods. Most of the unnec- essary procedures involved drilling into perfectly healthy teeth but included other questionable treatments. The plaintiff had relocated to Connecticut following the announcement of a program to increase Medicaid payments in an effort to induce more dentists to treat low-income patients. The dentist hid his involvement in the Connecticut clinics by using false names and false corporations and by falsifying documents. In 2019, a dentist based in Los Angeles, California, was sen- tenced to 40 months in prison for his role in a $3.8 million healthcare fraud scheme in which he billed numerous dental insurance carriers for crowns and fillings that were never pro- vided to patients [10]. In the past decade, there has also been a focus on dental pro- fessionals who inappropriately prescribe and/or bill insurance carriers for unnecessary medications—particularly opioid anal- gesics [6]. In 2017, a dentist in Pennsylvania was charged with hundreds of counts of charges of distribution of hydrocodone and oxycodone (Schedule II and III controlled substances) outside the usual course of professional practice; using or maintaining a drug-involved premises; healthcare fraud; and omitting material information from required reports, records, and other documents [6].
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